Fears and phobias

When does fear as a normal coping mechanism turn into a disorder that manifests itself in an irrational way? Dr Chris investigates the phobia phenomenon.

Fear is a normal human emotion in response to a threatening situation. Most people who are peering over the edge of a cliff, or who are confronted by a snarling dog will feel afraid. This is a protective mechanism, which makes us alert in dangerous situations, and prepares us to deal with the danger.

In some people, these fears extend to similar, though not actively threatening situations. Some people are afraid of all dogs, or are afraid of heights, even in situations where there is no real danger. Many people are afraid of flying or, more accurately, are afraid of crashing while in a plane! These are best described as exaggerated fears or minor phobias. And then there are major phobias.

What are phobias?
A phobia is a fear of particular situations or things that are not dangerous, and which most people wouldn't regard as threatening. The feelings of anxiety, fear and distress experienced by the phobic person, if exposed to their trigger, are extreme, and completely out of proportion to the situation. Those with phobias don't usually suffer anxiety symptoms at other times, but even the thought of being exposed to their dreaded trigger can induce distressing symptoms.

What are the symptoms?
The symptoms of phobic anxiety are the same as for other anxiety states, but are unusually intense. Symptoms include intense fear, palpitations, sweating, dry mouth, shortness of breath, chest pain, dizziness, faintness and diarrhoea.

Which are the most common phobias?
Agoraphobia (fear of public places or open spaces), claustrophobia (fear of confined spaces), arachnophobia (fear of spiders), phobic fear of heights, phobic fear of flying, and social phobia are amongst the most common types. People with social phobia suffer symptoms in normal social situations, and this can be particularly disabling.

What causes phobias?
The exact cause isn't known. Theories include frightening experiences in early childhood, learned behaviour from a family member who suffers from the same phobia, or subconscious symbolism (eg, a fear of snakes as a result of repressed sexuality).

How can phobias be helped?
Self-help groups can be a good way of contacting people with similar problems. They offer an opportunity for those with phobias to talk about their problems in a supportive environment. Many are often embarrassed to talk about their phobia to others, as the triggers are typically things that most other people don't worry about.

Psychotherapy can greatly help, particularly a specific discipline called cognitive behaviour therapy (CBT). This can help those affected to learn to modify their anxiety responses.

Another form of psychotherapy that may be used is 'graduated exposure' or 'desensitisation'. The person is very gradually introduced to increasingly strong stimuli connected with their trigger. For example, a person with arachnophobia might initially be asked to imagine a spider, then be asked to look at a drawing, then hold a drawing, then look at a photograph, hold a photograph, look at a spider in a glass tank, look at a spider in a wire cage, look at a spider that someone else is holding, and possibly, eventually, touch one. The progression may take many months to achieve. At each stage, the person is encouraged to talk about the symptoms that they feel, keep a diary, and use specific techniques to control their anxiety.

Both of these psychotherapy techniques should only be undertaken by specifically qualified practitioners.

What about medications?
Certain types of anti-depressant medication (SSRIs) can be used as an additional treatment for phobia sufferers, particularly for those suffering from social phobia. They are not curative by themselves, but can be a helpful addition to psychotherapy. Tranquillisers are not often used to treat phobias. Although they are very effective at relieving anxiety symptoms, they can be addictive after only four weeks' regular use. They are therefore only occasionally used, for short periods of time, if there is a crisis.

Further information
National Phobics Society
339 Stretford Rd
Manchester M15 4ZY
Tel 0870 7700456

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