Back to list

A phobia is an anxiety disorder in which the affected person experiences an excessive or irrational fear of a specific situation, object or activity that disrupts their ability to function in normal daily activities. Fear occurs when the situation, object, or activity is anticipated or encountered and sometimes triggers a panic attack. Adults with phobias usually realize that their fear is irrational or excessive; however, having this insight is not typical in children with phobias.

The phobia produces symptoms of anxiety that can range from mild to severe. People with mild symptoms usually do not seek treatment because their phobia does not interfere with their ability to function in normal daily activities. Those who experience severe symptoms may become unable to function in their daily routine, such as being afraid to leave their home.

There are three types of phobia:

• Agoraphobia (fear of public places, in which a person feels trapped or fears having a panic attack in public)
• Social phobia (fear of social situations or public performance in which a person may be embarrassed by symptoms of anxiety or a panic attack)
• Specific phobias (fear of specific objects, situations, or activities that may cause a person harm, loss of emotional or physical control [e.g., screaming or fainting])

Incidence and Prevalence
Phobias are common psychiatric disorders. Nearly 11% of the U.S. population, about 25,000,000 people, may suffer from a phobia during their lifetime. Agoraphobia is diagnosed in 60% of the people who seek treatment for phobias, over half of whom are women. Social phobia affects men and women equally and occurs in about 2% of the U.S. population. Specific phobias are common in childhood and typically are outgrown by adulthood.

Risk Factors

Most individuals with agoraphobia have a history of panic disorder. There is also some evidence that agoraphobia may run in families. Also, a child who suffers separation anxiety (anxiety for being away from home and immediate family) may be predisposed to developing agoraphobia.

There appears to be a link between alcoholism and social phobia. The stress associated with social phobia is thought to create an increased risk for alcohol abuse (e.g., drinking to "calm the nerves"). Similarly, the depression caused by the low self-esteem and social isolation that results from social phobia may predispose a person to alcohol abuse and dependence. Conversely, people with alcoholism tend to withdraw and become inhibited and may develop fear of being embarrassed or humiliated in social situations.

A person who has a particularly frightening or threatening experience with an animal or in certain situations may put a person at risk for developing a specific phobia. Witnessing a traumatic event in which others experience harm or extreme fear is another risk factor for specific phobia. Receiving repeated information or warnings about potentially dangerous situations or animals is also a risk factor.

Causes:

The primary cause of agoraphobia is panic attack associated with panic disorder. Approximately 40% of people with panic disorder develop agoraphobia.

The cause of social phobia is unknown. There is a possibility that altered function of serotonin (a neurotransmitter involved in many behaviors) may be a factor.

A frightening or threatening experience with an animal or in a particular situation can cause a specific phobia. For instance, someone who has been bitten by a vicious dog may generalize their fear to include all dogs, regardless of the animals' dispositions.

Fear can be learned from others as well. For instance, the child of a parent who responds with intense fear and anxiety whenever they encounter a harmless garden snake learns to respond to snakes with the same fear and anxiety.

Symptoms

Panic attack is common in people with agoraphobia, social phobia, and specific phobia. Symptoms experienced during a panic attack include the following:

• Abdominal distress (diarrhea, nausea, constipation)
• Chest pain or discomfort
• Chills or hot flashes
• Fear of dying
• Fear of losing control or going crazy
• Feeling faint, dizzy, lightheaded, unsteady
• Feeling of choking
• Feeling of unreality or of being detached from oneself
• Numbness or tingling sensations
• Palpitations, pounding heart, racing heartbeat
• Shortness of breath, feeling smothered
• Sweating
• Trembling or shaking

Some people with agoraphobia become fearful of having a panic attack in any public place or situation and eventually fear and avoid leaving their home. Some are capable of leaving home only with someone they trust. Others become completely housebound. Those who are housebound can suffer severe anxiety or nervousness even inside their home.

People who suffer social phobia may experience severe anxiety or dread or a panic attack when they endure a social or performance situation.

When a person with specific phobia encounters the feared object or situation they may experience severe anxiety or dread or a panic attack.

Another common symptom experienced by people with phobias is anticipatory anxiety. Anticipatory anxiety can cause people to avoid situations in which they might have a panic attack or to avoid the objects that trigger a response of intense fear and anxiety.

Treatment:

Treatment of phobias involves behavior therapy, medication, and counseling.

Agoraphobia
Treatment of agoraphobia involves

• patient education,
• behavior therapy (exposure with response prevention), and
• medication.

Patients need to understand their condition and receive reassurance that they are not "going crazy" and that their condition can be managed. Because they may have received some explanation that their symptoms are caused by a medical disease, they need to be educated about agoraphobia.

Exposure with response prevention is a very effective behavior therapy for people with agoraphobia. In this treatment, the patient (1) is exposed to a situation that causes anxiety or panic and then (2) learns to "ride out" the distress until the anxiety or attack passes. The duration of exposure gradually increases with each session. This treatment works best if the patient is not taking tranquilizers because tranquilizers can prevent the experience of anxiety.

Antidepressant medications (except buproprion, WellbutrinŽ) have been shown to reduce the occurrence of panic attacks. Some studies have shown paroxetine (PaxilŽ) to be quite effective.

Benzodiazepines are effective in treating anticipatory anxiety as well as symptoms of panic attacks.

Social Phobia
Treatment of social phobia involves

• behavior therapy (exposure with response prevention),
• social skills training, and
• medication.

Most people benefit from combining medication with supportive counseling or group therapy. Also, avoiding alcohol and drugs is of particular importance for people with social phobia, because social withdrawal and isolation typically accompany substance abuse.

Exposure with response prevention is an effective treatment for social phobia. It is particularly useful in a group therapy setting, which can provide a social or performance situation for the patient.

In social skills training, first, the sills lacking are identified. The patient is then taught appropriate skills. They practice skills in a group therapy setting and then practice them in social situations they encounter in their daily activities.

Medications used to treat social phobia include:

• Paroxetine and other SSRIs
• Beta-blockers
• Monoamine oxidase inhibitors (MAOIs)
• Benzodiazepines

Paroxetine (PaxilŽ), an SSRI antidepressant, has been shown to be particularly beneficial to adults with social phobia. This class of drugs is also used to treat generalized anxiety disorder and panic disorder. These drugs work by altering levels of serotonin (a neurotransmitter that affects many behavioral states), which helps reduce anxiety.

Beta-blockers prevent norepinephrine from binding to nerve receptors in many areas of the body. They slow the heart rate and are effective in reducing physical symptoms such as nervous tension, sweating, panic, high blood pressure and shakiness. Although the FDA (food and drug administration) has not approved beta-blockers for the treatment of social phobia, psychiatrists may prescribe them. They are effective in reducing symptoms performers experience with "stage fright."

Some small studies have shown monoamine oxidase inhibitors (MAOIs) to be helpful in treating social phobia. They are used to treat other psychiatric disorders, including major depressive disorder (see MAOI).

Benzodiazepines may also help control social phobia. They are used frequently to treat many anxiety disorders, including generalized anxiety disorder.

Specific Phobias
Treatment of specific phobias involves

• exposure and response prevention,
• progressive desensitization, and
• medication.

There is a wealth of evidence that suggests that exposure and response prevention is the most effective treatment for specific phobias. This form of treatment is used to treat other anxiety disorders, including obsessive-compulsive disorder.

Progressive desensitization is not as effective as exposure and response prevention, but is used in people with specific phobias who have great difficulty facing the object or situation that causes their fear. This treatment involves learning relaxation and visualization techniques. The patient is exposed to the source of fear gradually. For instance, a person with fear of heights looks down from a second-story window of a skyscraper. Once the person begins to experience anxiety, they are removed from the situation. They then learn to visualize being in the situation without experiencing anxiety. Once they are able to look out that window without experiencing anxiety, they move up to the third-story window, and so on.

Benzodiazepines have been known to reduce anticipatory anxiety in people with specific phobia. For example, people who are afraid of flying may find that these drugs help control their fear and make flying possible.

SSRIs, like ParoxetineŽ, can be effective in controlling specific phobias. These drugs may be particularly helpful in people whose phobia interferes with their ability to function in normal daily activities, like riding the train to work or speaking in front of groups.

Back to list