Phobias: Things that Go Bump in the Mind
Phobias: Things that Go Bump in the Mind
Nana Dawson-AndohMy heart began to quicken and my palms started to sweat as I watched the ground get further and further away as I rode up the escalator into the main streets of Washington, D.C. I had this sudden feeling of vertigo and had to close my eyes to preserve my balance. I was certain that the if I let go of my tight grip on the railing, I would fall to my death. My only option was to turn away and run as fast as I could towards the safety of sunlight and solid ground.
This over-reaction in such a simple situation was a result of my acrophobia, or fear of heights. I am not alone in this; according to some surveys, approximately 10% to 11% of the U.S. adult population suffer from a phobia in any given year. 1 Phobias are the most common psychiatric illness in women and the second most common in men over age 25. 2 They are emotional and physical responses to intense, unrealistic fears of certain objects or situations. Symptoms include feelings of panic, dread, horror, or terror; recognition that the fear goes beyond normal boundaries and the actual threat of danger; automatic reactions such as rapid heartbeat, shortness of breath, trembling, and an overwhelming desire to flee the situation. 3 People with phobias often take extreme measures to avoid the feared object or situation, which often interfere with their daily lives.
There are three distinguishable types of phobias: specific phobia, social phobias and agoraphobia. Specific phobias are the most common and are persistent fears of specific objects or situations such as snakes or heights. Social phobias are more complex and involve severe, persistent, and irrational fears of social or performance situations where people may feel embarrassed. 1 The last category, agoraphobia, is the most debilitating of the phobias, and is the fear of being alone in public places where escape is difficult or impossible. Phobias are classified according to the cause of reaction and avoidance. The explanations for phobias are varied and range from being remnants of human evolutionary past to scarring childhood events. The treatments for the various phobias are just as diverse, and include exposure therapy and drugs.
Arachibutyrophobia (the fear of peanut butter sticking to the roof of the mouth), Bolshephobia (the fear of Bolsheviks), Caligynephobia (the fear of beautiful women), Francophobia (the fear of France), and Walloonphobia (the fear of the Walloons) are just some of the multitude of reported phobias. Although the above listed specific phobias are along the more unusual, there seems to be an observable trend in the objects or situations that people fear the most. Phobias of insects or animals, natural environments like heights, blood or injury and dangerous situations are the most common. 4 Specific phobias exhibit themselves at any age, but are commonly first seen in childhood or adolescence. They are the easiest to hide because a sufferer need only to avoid whatever particular circumstance produces the emotional and physical affects.
Social phobia is not as common as specific phobias, but can be much more distressing and disruptive. It is sometimes explained away as mere shyness. But shy people do not necessarily experience extreme anxiety in social situations or avoid any circumstances that make them feel in any way self-conscious to the extreme degree of social phobics. 5 People afflicted with this type of phobia often view small mistakes as more exaggerated than they really are; find blushing to be painfully embarrassing; feel as if all eyes are on them; fear speaking in public, dating, or talking with persons in authority; fear using public restrooms or eating out; and fear talking on the phone or writing in front of others. 2 Social phobia can develop in late childhood, and can also result in depression.
The least prevalent, but most incapacitating form of phobia is agoraphobia. It is only seen in about 2% to 4% of the U.S. adult population and in twice as many women as men. 1 Agoraphobia is sometimes accompanied with panic attacks, which are unexpected and profound attacks of anxiety that have symptoms of dizziness, palpitations and diarrhea. These panic attacks often occur without warning and sufferers begin to associate public situations where they happened with the attacks and avoid them. Eventually, they begin to shun all public places and are confined to their homes.
There are various theories that attempt to explain the possible sources of phobias from both a psychological and biological perspective. Sigmund Freud postulated that phobias were the result of the inordinate utilization of repression and displacement defense mechanisms. 1 Modern psychoanalysts consider real or feared childhood separation from a parent or guardian as the underlying basis for agoraphobia. This explains why death or other types of loss can trigger agoraphobia and also why they fiercely avoid situations that may symbolize or mean separation from a loved one. 6
Behaviorist theorists believe that phobias are learned behaviors. They hypothesize that individuals learn to fear certain objects, situations or events or events through indirect or direct experience. They then develop conditioned fear responses to the stimulus and begin to avoid the object or situation, causing the phobia to become even more firmly entrenched. This theory helps to explain how simple childhood events like being chased by a dog can develop into a full-blown cynophobia. It also sheds light on how agoraphobics who may have initially experienced a panic attack in a crowded area, soon begin to associate that feeling with all crowds. They may then avoid all crowds, not allowing themselves to test the correctness of presumption, therefore strengthening their phobia.
Some researchers have attributed this to a predilection or preparedness inherited from ancient ancestors. Early humans possessed an excellent fear and flight response that helped protect them from hazards such as snakebites, falls from large heights, and being trapped in close spaces. Those who possessed the ability to sense and evade danger were most likely to reproduce and ensure the survival of the human species. This predisposition has been passed down genetically through the ages and has manifested itself in modern day phobias. Other researchers put heavy emphasis on the role of culture in development of phobias and argue that childhood experiences establish early on the belief that certain objects or situations that can be fearful.
The most effective therapies for specific phobias to date are exposure treatments such as flooding, desensitization and modeling. These work to break the reinforcing pattern of avoidance that the patient has cultivated by forcing them to face the object or situation head on. In this way, phobics learn that what they fear the most is really not that scary. Exposure treatments have also had considerable success in helping those suffering from agoraphobia, and have a lower relapse rate when combined with support groups.
Cognitive-behavioral therapy has been shown to be the best treatment for social phobics, and instructs them to replace negative thoughts with positive coping statements. Group therapy has also been successful in providing social phobics with a supportive circle of people who can empathize with their experience and serve as a significant first rebellion against the very nature of the disease.4 Drugs used to treat social phobia include anti-anxiety drugs, beta-blockers, monoamine oxidase (MAO) inhibitors, antidepressants and serotonin specific reuptake inhibitors (SSRIs) like Prozac and Zoloft. The FDA recently approved the SSRI, Paxil, as the first drug formally endorsed as treatment for social-anxiety disorder.4
Exposure treatments have also had considerable success in helping those suffering from agoraphobia, and have a lower relapse rate when combined with support groups or individual therapy. Cognitive-behavioral therapies and anti-depressant drugs do help agoraphobics, but recovery can be prolonged because the behavior becomes so deep-rooted.
An interesting aspect of phobias, is that suffers are intellectually aware of the irrational nature of their fears. But the phobias produce such a strong emotional reaction, coupled with physiological response, that phobics may feel as if they will die if they can not escape the feared situation or object. The question then arises of the relationship between the emotional and physiological systems of the body. Does the rapidly beating heart cause the fear, or do the sweaty palms cause the urge to run away? What is the true cause of the fear?
Another puzzling problem is if phobias were a result of evolutionary survival skills, why are people afraid of geniophobia (the fear of chins) or dentophobia (the fear of dentists)? Also as we become more technologically advanced, and the world seemingly more sterile, should we not fear less the natural world and more the technologically world? Who knows what new things people will be afraid of? But there will hopefully be new and improved treatments to combat the latest monsters under the bed.
WWW Sources1)Comer, R. Abnormal Psychology. New York: W.H. Freeman and Co. 1998
4) Time Magazine, April 2, 2001, Vol. 157, no. 13 , Very good article on the nature of phobias
09/30/2005, from a Reader on the Web
Nana Dawson-Andoh's article was terrific! I had done a google search specifically about overcoming phobias, as I had undergone some traumatic experiences and am in the process of having EMDR for these. even cooler, I was her HA once at BMC and it's neat to see some of her biology work here. A pleasure to find Mawrters on the cutting edge.