Phobia

This article is about the clinical psychology. For other uses, see Phobia (disambiguation).

Phobia
Specialty	Psychiatry, clinical psychology
Symptoms	Fear of an object or situation
Complications	Suicide
Usual onset	Rapid
Duration	More than six months
Types	Specific phobias, social phobia, agoraphobia
Causes	Unknown, some genetic effects
Treatment	Exposure therapy, counselling, medication
Medication	Antidepressants, benzodiazepines, beta-blockers
Frequency	Specific phobias: ~5% Social phobia: ~5% Agoraphobia: ~2%

A phobia is a type of anxiety disorder defined by a persistent and excessive fear of an object or situation. The phobia typically results in a rapid onset of fear and is present for more than six months. The affected person goes to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the feared object or situation cannot be avoided, the affected person experiences significant distress. With blood or injury phobia, fainting may occur. Agoraphobia is often associated with panic attacks. Usually a person has phobias to a number of objects or situations.

Phobias can be divided into specific phobias, social phobia, and agoraphobia. Types of specific phobias include those to certain animals, natural environment situations, blood or injury, and specific situations. The most common are fear of spiders, fear of snakes, and fear of heights. Occasionally they are triggered by a negative experience with the object or situation. Social phobia is when the situation is feared as the person is worried about others judging them. Agoraphobia is when fear of a situation occurs because it is felt that escape would not be possible.

Classification

Most phobias are classified into three categories and such phobias are considered sub-types of anxiety disorder. The categories are:

1. Specific phobias: Fear of particular objects or social situations that immediately results in anxiety and can sometimes lead to panic attacks. Specific phobia may be further subdivided into four categories: animal type, natural environment type, situational type, blood-injection-injury type.

2. Agoraphobia: a generalized fear of leaving home or a small familiar 'safe' area, and of possible panic attacks that might follow. It may also be caused by various specific phobias such as fear of open spaces, social embarrassment (social agoraphobia), fear of contamination (fear of germs, possibly complicated by obsessive-compulsive disorder) or PTSD (post traumatic stress disorder) related to a trauma that occurred out of doors.

3. Social phobia, also known as social anxiety disorder, is when the situation is feared as the person is worried about others judging them.

Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer relatively mild anxiety over that fear. Others suffer full-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 panic reaction. These individuals often report dizziness, loss of bladder or bowel control, tachypnea, feelings of pain, and shortness of breath.

Specific phobias

A specific phobia is a marked and persistent fear of an object or situation. Specific phobias may also include fear of losing control, panicking, and fainting from an encounter with the phobia. Specific phobias are defined in relation to objects or situations whereas social phobias emphasize social fear and the evaluations that might accompany them.

Specific phobias can be broken down into five subtypes: animal, natural environment, blood-injection-injury, situation and others. In children, blood-injection-injury phobia and phobias involving animals, natural environment (darkness) usually develop between the ages of 7 and 9, and these are reflective of normal development. Additionally, specific phobias are most prevalent in children between ages 10 and 13.

Social phobia

See also: Social anxiety disorder

Unlike specific phobias, social phobias include fear of public situations and scrutiny, which leads to embarrassment or humiliation in the diagnostic criteria.

Causes

Environmental

Rachman proposed three pathways to acquiring fear conditioning: classical conditioning, vicarious acquisition and informational/instructional acquisition.

Much of the progress in understanding the acquisition of fear responses in phobias can be attributed to classical conditioning (Pavlovian model). When an aversive stimulus and a neutral one are paired together, for instance when an electric shock is given in a specific room, the subject can start to fear not only the shock but the room as well. In behavioral terms, this is described as a conditioned stimulus (CS) (the room) that is paired with an aversive unconditioned stimulus (UCS) (the shock), which leads to a conditioned response (CR) (fear for the room) (CS+UCS=CR). For instance, in case of the fear of heights (acrophobia), the CS is heights such as a balcony on the top floors of a high rise building. The UCS originates from an aversive or traumatizing event in the person's life, such as almost falling down from a great height. The original fear of almost falling down is associated with being in a high place, leading to a fear of heights. In other words, the CS (heights) associated with the aversive UCS (almost falling down) leads to the CR (fear). This direct conditioning model, though very influential in the theory of fear acquisition, is not the only way to acquire a phobia.

Vicarious fear acquisition is learning to fear something, not by a subject's own experience of fear, but by watching others reacting fearfully (observational learning). For instance, when a child sees a parent reacting fearfully to an animal, the child can become afraid of the animal as well. Through observational learning, humans can to learn to fear potentially dangerous objects—a reaction also observed in other primates. In a study focusing on non-human primates, results showed that the primates learned to fear snakes at a fast rate after observing parents’ fearful reactions. An increase of fearful behaviours was observed as the non-human primates continued to observe their parents’ fearful reaction. Even though observational learning has been proven effective in creating reactions of fear and phobias, it has also been shown that by physically experiencing an event, chances increase of fearful and phobic behaviours. In some cases, physically experiencing an event may increase the fear and phobia more so than observing a fearful reaction of another human or non-human primate.

Informational/instructional fear acquisition is learning to fear something by getting information. For instance, fearing electrical wire after having heard that touching it causes an electric shock.

A conditioned fear response to an object or situation is not always a phobia. To meet the criteria for a phobia there must also be symptoms of impairment and avoidance. Impairment is defined as being unable to complete routine tasks whether occupational, academic or social. In acrophobia, an impairment of occupation could result from not taking a job solely because of its location at the top floor of a building, or socially not participating in a social event at a theme park. The avoidance aspect is defined as behaviour that results in the omission of an aversive event that would otherwise occur, with the goal of preventing anxiety.

Diagnosis

It is recommended that the terms distress and impairment take into account the context of the person's environment during diagnosis. The DSM-IV-TR states that if a feared stimulus, whether it be an object or a social situation, is absent entirely in an environment, a diagnosis cannot be made. An example of this situation would be an individual who has a fear of mice but lives in an area devoid of mice. Even though the concept of mice causes marked distress and impairment within the individual, because the individual does not usually encounter mice, no actual distress or impairment is ever experienced. It is recommended that proximity to, and ability to escape from, the stimulus also be considered. As the phobic person approaches a feared stimulus, anxiety levels increase, and the degree to which the person perceives they might escape from the stimulus affects the intensity of fear in instances such as riding an elevator (e.g. anxiety increases at the midway point between floors and decreases when the floor is reached and the doors open).

Treatments

There are various methods used to treat phobias. These methods include systematic desensitization, progressive relaxation, modeling, medication and hypnotherapy.

It is recommended that specific phobias be treated with exposure therapy where the person is introduced to the situation or object in question until the fear resolves. Medications are not useful in this type of phobia. Social phobia and agoraphobia are often treated with some combination of counselling and medication. Medications used include antidepressants, benzodiazepines, or beta-blockers.

Therapy

Cognitive behavioral therapy (CBT) can be beneficial by allowing the person to challenge dysfunctional thoughts or beliefs by being mindful of their own feelings, with the aim that the person will realize that his or her fear is irrational. CBT may be conducted in a group setting. Gradual desensitization treatment and CBT are often successful, provided the person is willing to endure some discomfort. In one clinical trial, 90% of people were observed to no longer have a phobic reaction after successful CBT treatment.

CBT is also an effective treatment for phobias in children and adolescents and has been adapted for use with this age. One example of a CBT program targeted towards children is the Coping Cat. This treatment program can be used with children between the ages of 7 and 13 to treat social phobia. This program works to decrease negative thinking, increase problem-solving and provide a functional coping outlook in the child. Another CBT program was developed by Ann Marie Albano to treat social phobia in adolescents. This program has five stages: Psychoeducation, Skill Building, Problem Solving, Exposure and Generalization and Maintenance. Psychoeducation focuses on identifying and understanding the symptoms. Skill Building focuses on learning cognitive restructuring, social skills and problem-solving skills. Problem Solving focuses on identifying problems and using a proactive approach to solving them. Exposure involves exposing the adolescent to social situations in a hierarchical approach. Finally, Generalization and Maintenance involves practising the skills learned.

Peer-reviewed clinical trials have demonstrated that eye movement desensitization and reprocessing (EMDR) is effective in treating some phobias. Mainly used to treat post-traumatic stress disorder, EMDR has been demonstrated as effective in easing phobia symptoms following a specific trauma, such as a fear of dogs following a dog bite.

Another method used to treat people with extreme phobias is prolonged exposure, in which the person is exposed to the object of their fear over a long period of time. This technique is only tested^{[clarification needed]} when a person has overcome avoidance of, or escape from, the feared object or situation. People with slight distress from their phobias usually do not need prolonged exposure to their fear.

Systematic desensitization

A method used in the treatment of a phobia is systematic desensitization, a process in which the people seeking help slowly become accustomed to their phobia, and ultimately overcome it. Traditional systematic desensitization involves a person being exposed to the object they are afraid of overtime, so that the fear and discomfort do not become overwhelming. This controlled exposure to the anxiety-provoking stimulus is key to the effectiveness of exposure therapy in the treatment of specific phobias. It has been shown that humor is an excellent alternative when traditional systematic desensitization is ineffective. Humor systematic desensitization involves a series of treatment activities that consist of activities that elicit humor with the feared object. Previously learned progressive muscle relaxation procedures can be used as the activities become more difficult in a person's own hierarchy level. Progressive muscle relaxation helps people relax their muscles before and during exposure to the feared object or phenomenon.

Participant modeling, in which the therapist models how the person should respond to fears, has been proven effective for children and adolescents. This encourages people to practice the behaviour and reinforces their efforts. In a manner similar to systematic desensitization, people with phobias are gradually introduced to their feared objects. The main difference between participant modelling and systematic desensitization involves observations and modelling; participant modelling encompasses a therapist modelling and observing positive behaviours over the course of gradual exposure to the feared object.

Medications

Medications can help regulate apprehension and fear of a particular fearful object or situation.

Hypnotherapy

Hypnotherapy can be used alone and in conjunction with systematic desensitization to treat phobias. Through hypnotherapy, the underlying cause of the phobia may be uncovered. The phobia may be caused by a past event that the person does not remember, a phenomenon known as repression. The mind represses traumatic memories from the conscious mind until the person is ready to deal with them. Hypnotherapy may also eliminate the conditioned responses that occur during different situations. People are first placed into a hypnotic trance, an extremely relaxed state in which the unconscious can be retrieved. This state makes people more open to suggestion, which helps bring about desired change. Consciously addressing old memories helps individuals understand the event and see it in a less threatening light.

Epidemiology

Phobias are a common form of anxiety disorder, and distributions are heterogeneous by age and gender. Between 8.7 percent and 18.1 percent of people suffer from phobias, making it the most common mental illness among women in all age groups and the second most common illness among men older than 25. Between 4 percent and 10 percent of all children experience specific phobias during their lives, and social phobias occur in one percent to three percent of children and adolescents.

One study found that females have a higher number of cases per year than males (26.5 percent for females and 12.4 percent for males). Among adults, 21.2 percent of women and 10.9 percent of men have a single specific phobia, while multiple phobias occur in 5.4 percent of females and 1.5 percent of males. Women are nearly four times as likely as men to have a fear of animals (12.1 percent in women and 3.3 percent in men) — a higher dimorphic than with all specific or generalized phobias or social phobias. Social phobias are more common in girls than in boys, while situational phobia occurs in 17.4 percent of women and 8.5 percent of men.

Society and culture

Terminology

Main article: List of phobias

The word phobia comes from the Greek: φόβος (phóbos), meaning "aversion", "fear" or "morbid fear". The regular system for naming specific phobias to use prefix based on a Greek word for the object of the fear, plus the suffix -phobia. However, there are many phobias irregularly named with Latin prefixes, such as apiphobia instead of melissaphobia (fear of bees) or aviphobia instead of ornithophobia (fear of birds). Creating these terms is something of a word game. Such fears are psychological rather than physiological in origin and few of these terms are found in medical literature. In ancient Greek mythology Phobos was the twin brother of Deimos (terror).

The word phobia may also refer to conditions other than true phobias. For example, the term hydrophobia is an old name for rabies, since an aversion to water is one of that disease's symptoms. A specific phobia to water is called aquaphobia instead. A hydrophobe is a chemical compound that repels water. Similarly, the term photophobia usually refers to a physical complaint (aversion to light due to inflamed eyes or excessively dilated pupils), rather than an irrational fear of light.

Non-medical use

A number of terms with the suffix -phobia are used non-clinically to imply irrational fear or hatred. Examples include:

• Xenophobia – Fear or dislike of strangers or the unknown, sometimes used to describe nationalistic political beliefs and movements.
• Homophobia – Negative attitudes and feelings toward homosexuality or people who are identified or perceived as being lesbian, gay, bisexual or transgender.

Usually these kinds of "phobias" are described as fear, dislike, disapproval, prejudice, hatred, discrimination or hostility towards the object of the "phobia".

External links

• Phobia at Wikipedia, the free Terran encyclopedia that anyone can edit.