Phobias are persistent, irrational fears of certain objects or situations. People who have phobias are often so overwhelmed by their anxiety that they avoid the feared objects or situations. Most people experience these fears with mild to moderate intensity, and the fear passes. Phobias occur in several forms. A specific phobia is a fear of a particular object or situation. Social phobia is a fear of being painfully embarrassed in a social setting. And agoraphobia, which often accompanies panic disorder, is a fear of being in any situation that might provoke a panic attack, or from which escape might be difficult if one occurred at all. Traumatic events often trigger the development of specific phobias, which are slightly more prevalent in women than men. Research shows that social phobia may have a hereditary component to it and occurs in women and men in equal proportions. However, men may seek treatment for social phobia more frequently than women.
People with phobias, particularly social phobia, may also have problems with substance abuse. Many people with social or a specific phobia become so anxious that they experience panic attacks, which are intense and unexpected bursts of terror accompanied by physical symptoms.
As more situational panic attacks occur, people with phobias may take extreme measures to avoid situations where they fear another attack might happen or where help would not be immediately available. This avoidance, similar to that in many panic disorder patients, may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. Appropriate diagnosis and treatment of other disorders are important to the successful treatment of phobias.
The fear of being alone or in a public place that has no escape hatch (such as a public bus), is the most disabling because victims can become housebound. The illness can begin any time from late childhood through early adulthood and, left untreated, worsens with time.
“I’m scared to death of flying, and I never do it anymore. It’s an awful feeling when that airplane door closes and I feel trapped. My heart pounds, and I sweat bullets. If somebody starts talking to me, I get very stiff and preoccupied”.
“When the airplane starts to ascend, it just reinforces that feeling that I can’t get out. I picture myself losing control, freaking out, climbing the walls, but ofcourse I never do. I’m not afraid of crashing or hitting turbulence. It’s just that feeling of being trapped”. “Whenever I’ve thought about changing jobs, I’ve had to think, “Would I be under pressure to fly?” These days, I only go to places where I can drive or take a train. My friends always point out that I couldn’t get off a train traveling at high speeds either, so why don’t trains bother me? I just tell them it isn’t a rational fear”.
Many people experience specific phobias, intense, irrational fears of certain things or situations – dogs, closed–in places, heights, escalators, tunnels, highway driving, water, flying and injuries involving blood are a few of the more common ones.
Phobias aren’t just extreme fear, they are irrational fears. You may be able to ski the world’s tallest mountains with ease but panic going above the 10th floor of an office building. Adults with phobias realize their fears are irrational, but often facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety.
Specific phobias strike more than 1 in 10 people. No one knows just what causes them, though they seem to run in families and are a little more prevalent in women. Phobias usually first appear in adolescence or adulthood. They start suddenly and tend to be more persistent than childhood phobias, only about 20 per cent of adult phobias vanish on their own.
When children have specific phobias – for example, a fear of animals – those fears usually disappear over time, though some may continue into adulthood. No one knows why they stay on in some people and disappear in others.
If the object of the fear is easy to avoid, people with phobias may not feel the need to seek treatment. Sometimes, though, they may make important career or personal decisions to avoid a phobic situation. When phobias interfere with a person’s life, treatment can help. Successful treatment usually involves a kind of cognitive–behavioral therapy called ‘Desensitization or exposure therapy’, in which patients are gradually exposed to what frightens them until the fear begins to fade. Three–fourths of patients benefit significantly from this type of treatment. Relaxation and breathing exercises also help reduce anxiety symptoms.
There is currently no proven drug treatment for specific phobias, but sometimes certain medications may be prescribed to help reduce anxiety symptoms before someone faces a phobic situation.
“I couldn’t go on dates or to parties. For a while, I couldn’t even go to class. While at college, I even had to come home for a semester”.
“My fear would happen in any social situation. I would be anxious before I even left the house, and it would escalate as I got closer to class, a party, or whatever. I would feel sick to my stomach – it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else”.
“When I would walk into a room full of people, I’d turn red and it would feel like everybody’s eyes were on me. I was too embarrassed to stand off in a corner by myself, but I couldn’t think of anything to say to anybody. I felt so clumsy, I couldn’t wait to get out”.
Social phobia is an intense fear of becoming humiliated in social situations, specifically of embarrassing yourself in front of other people. It often runs in families and may be accompanied by depression or alcoholism. Social phobia often begins around early adolescence or even younger.
If you suffer from social phobia, you tend to think other people are very competent in public and you are not. Small mistakes you make, may seem to you much more exaggerated than they really are.
Blushing itself may seem painfully embarrassing, and you feel as though all eyes are focused on you. You may be afraid of being with people other than those closest to you.
Or your fear may be more specific, such as feeling anxious about giving a speech, talking to a boss or other authority figure, or dating. The most common social phobia is a fear of public speaking.
Sometimes, social phobia involves a general fear of social situations such as parties. More rarely, it may involve a fear of using a public restroom, eating out, talking on the phone, or writing in the presence of other people, such as when signing a check.
Although this disorder is often thought of as shyness, the two are not the same. Shy people can be very uneasy around others, but they don’t experience the extreme anxiety in anticipating a social situation, and they don’t necessarily avoid circumstances that make them feel self–conscious.
In contrast, people with social phobia aren’t necessarily shy. They can be completely at ease with people most of the time, but particular situations, such as walking down an aisle in public or making a speech, can give them intense anxiety. Social phobia disrupts normal life, interfering with career or social relationships. For example, a worker can turn down a job promotion because he can’t give public presentations. The dread of a social event can begin weeks in advance, and symptoms can be quite debilitating.
People with social phobia are aware their feelings are irrational. Still, they experience a great deal of dread before facing the feared situation, and they may go out of their way to avoid it.
Even if they manage to confront what they fear, they usually feel very anxious beforehand and are intensely uncomfortable throughout. Afterwards, the unpleasant feelings may linger, as they worry about how they may have been judged or what others may have thought or observed about them.
About 80 per cent of people who suffer from social phobia find relief from their symptoms when treated with cognitive–behavioral therapy or medications or a combination of the two. Therapy may involve learning to view social events differently, being exposed to a seemingly threatening social situations in such a way that it becomes easier to face, and learning anxiety–reducing techniques, social skills and relaxation techniques.
The medications that have proven effective include selective serotonin reuptake inhibitors, MAO inhibitors and high–potency benzodiazepines. People with a specific form of social phobia called ‘Performance phobia’ have been helped by drugs called beta–blockers. For example, musicians or others with this anxiety may be prescribed a beta–blocker for use on the day of a performance.