Phobias

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Phobias

• A phobia is an irrational fear which takes over
  the persons life.

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There are 3 types of phobias

• Agoraphobia the vast majority of agoraphobics
  are women. The disorder usually starts in early
  adulthood.
• Social phobias this is when you are afraid of
  being embarrassed/humiliated in public. It can
  take the form of fear of public speaking or being
  in a place in which many people are together,
  such as a restaurant. Some people may find it
  difficult to interact with an authority figure.
  Most social phobics are women and it is usually
  first seen in adolescence.
• Specific phobias for example, fear of spiders
  or a fear of a situation, such as a small
  enclosed space. There are not any differences
  between the number of women and men who get these
  phobias. These phobias usually develop at a
  young age. However, phobias of cancer and death
  usually occur in middle age.

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Anxiety Disorder

• A phobia (from Greek f?ß??, phobos, "fear"), is
  an irrational, intense, persistent fear of
  certain situations, objects, activities, or
  persons. The main symptom of this disorder is the
  excessive, unreasonable desire to avoid the
  feared subject. When the fear is beyond one's
  control, or if the fear is interfering with daily
  life, then a diagnosis under one of the anxiety
  disorders can be made.

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Phobias, age and gender

• Broken down by age and gender, it was found that
  phobias were the most common mental illness among
  women in all age groups and the second most
  common illness among men older than 25.

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Causes

• It is generally accepted that phobias arise from
  a combination of external events and internal
  predispositions.
• In a famous experiment, Martin Seligman used
  classical conditioning to establish phobias of
  snakes and flowers.
• The results of the experiment showed that it took
  far fewer shocks to create an adverse response to
  a picture of a snake than to a picture of a
  flower, leading to the conclusion that certain
  objects may have a genetic predisposition to
  being associated with fear.

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Causes

• Many specific phobias can be traced back to a
  specific triggering event, usually a traumatic
  experience at an early age.
• Social phobias and agoraphobia have more complex
  causes that are not entirely known at this time.
• It is believed that heredity, genetics, and brain
  chemistry combine with life-experiences to play a
  major role in the development of anxiety
  disorders and phobias.

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The anatomical side of phobias

• Phobias are more often than not linked to the
  amygdala, an area of the brain located behind the
  pituitary gland in the limbic system.
• The amygdala secretes hormones that control fear
  and aggression, and aids in the interpretation of
  this emotion in the facial expressions of others.

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The amygdala

• Studies have shown a difference between the
  response cycles of those facing an object of a
  phobia and those facing a dangerous object that
  does not trigger phobia-like responses.
• In one case, patients with arachnophobia were
  shown pictures of a spider (the object of fear)
  and a snake (a control picture, intended to
  induce the normal response).
• When flashed up, the arachnophobe responded with
  brief fear to the snake.

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The amygdala

• However, when shown the spider, the
  arachnophobe's amygdala reacted, and then did not
  stop secreting 'alarm' hormones, even after they
  had rationalized the situation they were in.
• For this reason, a phobia is generally classified
  as a panic disorder by most psychologists, since
  it involves an unnatural or illogical functioning
  of the brain.

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Clinical phobias

• Most psychologists and psychiatrists classify
  most phobias into three categories
• Social phobia, also known as social anxiety
  disorder - fears involving other people or social
  situations such as performance anxiety or fears
  of embarrassment by scrutiny of others, such as
  eating in public. Social phobia may be further
  subdivided into
• generalized social phobia, and
• specific social phobia, which is cases of anxiety
  triggered only in specific situations. The
  symptoms may extend to psychosomatic
  manifestation of physical problems. For example,
  sufferers of paruresis find it difficult or
  impossible to urinate in reduced levels of
  privacy. That goes beyond mere preference. If the
  condition triggers, the person physically cannot
  empty their bladder.

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Specific phobias

• Specific phobias or fear of a single specific
  panic trigger such as spiders, dogs, elevators,
  water, flying, catching a specific illness, etc.
• Agoraphobia - a generalized fear of leaving home
  or a small familiar 'safe' area, and of possible
  panic attacks that might follow. Agoraphobia is
  the only phobia regularly treated as a medical
  condition.
• According to the Diagnostic and Statistical
  Manual of Mental Disorders, Fourth Edition
  (DSM-IV), social phobia, specific phobia, and
  agoraphobia are sub-groups of anxiety disorder.
• Many of the specific phobias, such as fear of
  dogs, heights, spiders and so forth, are
  extensions of fears that a lot of people have.
  People with these phobias specifically avoid the
  entity they fear.

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The severity of phobias

• Phobias vary in severity among individuals.
• Some individuals can simply avoid the subject of
  their fear and suffer only relatively mild
  anxiety over that fear.
• Others suffer fully-fledged panic attacks with
  all the associated disabling symptoms.
• Most individuals understand that they are
  suffering from an irrational fear, but are
  powerless to override their initial panic
  reaction.

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Treatments

• Some therapists use virtual reality or imagery
  exercise to desensitize patients to the feared
  entity. These are parts of systematic
  desensitization therapy.
• Cognitive behavioural therapy (CBT) can be
  beneficial. Cognitive behavioural therapy lets
  the patient understand the cycle of negative
  thought patterns, and ways to change these
  thought patterns. CBT may be conducted in a group
  setting. Gradual desensitisation treatment and
  CBT are often successful, provided the patient is
  willing to endure some discomfort and to make a
  continuous effort over a long period of time.
• Anti-anxiety or anti-depression medications can
  be of assistance in many cases. Benzodiazepines
  could be prescribed for short-term use.
• These treatment options are not mutually
  exclusive. Often a therapist will suggest
  multiple treatments.

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More on treatment methods

• Systematic desensitisation techniques
• By presenting milder forms of the stimulus and
  allowing the patient to accustom themselves to it
  gradually, it is then possible to make the
  stimulus more and more like the original
  neurosis-producing stimulus.
• Eventually the patient becomes de-sensitized to
  this stimulus, the reaction is lost and the
  neurosis cured.
• For example, if someone is suffering from
  agorophobia (fear of going out of the house),
  they can be first taken out for a few minutes
  every day and gradually the time spent out each
  day is increased until the sufferer feels
  confident enough to spend time outside the house
  on their own.
• This is a technique for de-sensitizing the
  sufferer concerning the original neurotic
  reaction ie, fear of open spaces and public
  places.

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Implosion therapy

• The therapist exposes the client to mental images
  of the feared object in the safety of the
  therapeutic setting.
• This is achieved by the therapist getting the
  client to imagine the most terrifying form of
  contact with the feared object.
• The therapist uses verbal descriptions of the
  feared stimulus.
• After repeated trials, the stimulus eventually
  loses its anxiety producing power and the anxiety
  extinguishes (or implodes) because no harm comes
  to the individual in the safe setting of the
  therapists room.

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Flooding therapy

• The client is forced to confront the situation
  that gives rise to the fear response.
• For example, a person who has a fear of heights
  might be taken to a tall building and physically
  prevented from leaving.
• By preventing avoidance of or escape from the
  feared object or situation, the fear response is
  eventually extinguished.
• Emmelkamp and Wessels, 1975, found that implosion
  therapy and flooding are effective with certain
  types of phobias, but for some people, both
  therapies lead to increased anxiety. Hence, both
  therapies should be used with considerable
  caution.

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Gender and phobias

• Gender. With the exception of obsessive-compulsive
  disorder (OCD) and possibly social anxiety,
  women have twice the risk for most anxiety
  disorders as men.
• A number of factors may increase the reported
  risk in women, including hormonal factors,
  cultural pressures to meet everyone else's needs
  except their own, and fewer self-restrictions on
  reporting anxiety to physicians.

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Age and phobias

• Age. In general, phobias, OCD and separation
  anxiety show up early in childhood, while social
  phobia and panic disorder are often diagnosed
  during the teen years.
• Studies suggest that 3 to 5 of children and
  adolescents have some anxiety disorder.
• Indeed, this may be an underestimation,
  particularly since symptoms in children may
  differ from those in adults. One study indicated
  that if such children could be identified as
  early as two years of age they possibly could be
  treated to avoid later anxiety disorders.

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Personality and phobias

• Personality Factors. Children's personalities may
  indicate higher or lower risk for future anxiety
  disorders.
• For example, research suggests that extremely shy
  children and those likely to be the target of
  bullies are at higher risk for developing anxiety
  disorders later in life.
• Children who cannot tolerate uncertainty tend to
  be worriers, a major predictor of generalized
  anxiety.
• In fact, such traits may be biologically based
  and due to a hypersensitive amygdala--the "fear
  centre" in the brain.

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Family history and phobias

• Family History and Dynamics. Anxiety disorders
  run in families.
• Genetic factors play a role in some cases, but
  family dynamics and psychological influences are
  also often at work.
• For example, in a 2002 study, toddlers tended to
  avoid rubber snakes or spiders if their mothers
  indicated a negative response to these objects by
  their facial expressions.
• Girls had a stronger response than did boys.
• Studies are reporting the anxiety in new mother
  can affect their infants.
• One study reported a higher rate of crying and an
  impaired ability to adapt to new situations in
  infants of mothers who had been stressed and
  anxious during pregnancy.
• In another, infants of mothers with panic
  disorder had higher levels of stress hormones and
  more sleep disturbances than other children.