Phobias

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A phobia (from the Template:Lang-el,phóbos, meaning "fear" or "morbid fear") is an irrational, intense and persistent fear of certain situations, activities, things, animals, or people. The main symptom of this disorder is the excessive and unreasonable desire to avoid the feared stimulus. When the fear is beyond one's control, and if the fear is interfering with daily life, then a diagnosis under one of the anxiety disorders can be made.[1]

This is caused by what are called neutral, unconditioned, and conditioned stimuli, which trigger either conditioned or unconditioned responses. An example would be a person who was attacked by a dog (the unconditioned stimulus) would respond with an unconditioned response. When this happens, the unconditioned stimulus of them being attacked by the dog would become conditioned, and to this now conditioned stimulus, they would develop a conditioned response. If the occurrence had enough of an impact on this certain person then they would develop a fear of that dog, or in some cases, an irrational fear of all dogs.

Phobias are a common form of anxiety disorders. An American study by the National Institute of Mental Health (NIMH) found that between 8.7% and 18.1% of Americans suffer from phobias.[2] Broken down by age and gender, the study 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.

Phobias are not generally diagnosed if they are not particularly distressing to the patient and if they are not frequently encountered. If a phobia is defined as "impairing to the individual", then it will be treated after being measured in context by the degree of severity. A large percent of the American population is afraid of public speaking, which could range from mild uncomfortability, to an intense anxiety that inhibits all social involvement.

Phobias are generally caused by an event recorded by the amygdala and hippocampus and labeled as deadly or dangerous; thus whenever a specific situation is approached again the body reacts as if the event were happening repeatedly afterward. Treatment comes in some way or another as a replacing of the memory and reaction to the previous event perceived as deadly with something more realistic and based more rationally. In reality most phobias are irrational, in that the subconscious association causes far more fear than is warranted based on the actual danger of the stimulus; a person with a phobia of water may admit that their physiological arousal is irrational and over-reactive, but this alone does not cure the phobia.

Some phobias are generated from the observation of a parent's or sibling's reaction. The observer then can take in the information and generate a fear of whatever they experienced.


Causes

Phobias are known as an emotional response learned because of difficult life experiences. Generally phobias occur when fear produced by a threatening situation is transmitted to other similar situations, while the original fear is often repressed or forgotten. The excessive, unreasoning fear of water, for example, may be based on a childhood experience of almost drowning. The individual attempts to avoid that situation in the future, a response that, while reducing anxiety in the short term, reinforces the association of the situation with the onset of anxiety.


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 may trigger secretion of hormones that affect fear and aggression. When the fear or aggression response is initiated, the amygdala may trigger the release of hormones into the body to put the human body into an "alert" state, in which they are ready to move, run, fight, etc.[3] This defensive "alert" state and response is generally referred to in psychology as the fight-or-flight response.

Clinical phobias

Psychologists and psychiatrists classify most phobias into three categories[4][5] and, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), such phobias are considered to be sub-types of anxiety disorder. The three categories are:

  • Social phobia- fears involving other people or social situations such as performance anxiety or fears of embarrassment by scrutiny of others, such as eating in public. Overcoming social phobia is often very difficult without the help of therapy or support groups. Social phobia may be further subdivided into
  • Specific phobias - fear of a single specific panic trigger such as spiders, snakes, dogs, water, heights, flying, catching a specific illness, etc. Many people have these fears but to a lesser degree than those who suffer from specific phobias. People with the phobias specifically avoid the entity they fear.
  • Agoraphobia - a generalized fear of leaving home or a small familiar 'safe' area, and of possible panic attacks that might follow. 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.

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 they are powerless to override their initial panic reaction.

Treatments

Various methods are claimed to treat phobias. Their proposed benefits may vary from person to person.

Some therapists use virtual reality or imagery exercise to desensitize patients to the feared entity. These are parts of systematic desensitization therapy.

Cognitive behavioral therapy (CBT) can be beneficial. Cognitive behavioral 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.[7][8] In one clinical trial, 90% of patients were observed with no longer having a phobic reaction after successful CBT treatment.[8][9][10][11]

Eye Movement Desensitization and Reprocessing (EMDR) has been demonstrated in peer-reviewed clinical trials to be 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.[12]

Hypnotherapy coupled with Neuro-linguistic programming can also be used to help remove the associations that trigger a phobic reaction.[13] However, lack of research and scientific testing compromises its status as an effective treatment.

Antidepressant medications such SSRIs, MAOIs may be helpful in some cases of phobia. Benzodiazepines may be useful in acute treatment of severe symptoms but the risk benefit ratio is against their long-term use in phobic disorders.[14]

Emotional Freedom Technique, a psychotherapeutic alternative medicine tool, also considered to be pseudoscience by the mainstream medicine, is allegedly useful.

These treatment options are not mutually exclusive. Often a therapist will suggest multiple treatments.

Non-psychological conditions

The word "phobia" may also signify conditions other than fear. For example, although the term hydrophobia means a fear of water, it may also mean inability to drink water due to an illness, or may be used to describe a chemical compound which repels water. It was also once used as a synonym for rabies, as an aversion to water is one of its symptoms. Likewise, the term photophobia may be used to define a physical complaint (i.e. aversion to light due to inflamed eyes or excessively dilated pupils) and does not necessarily indicate a fear of light.

Non-clinical uses of the term

It is possible for an individual to develop a phobia over virtually anything. The name of a phobia generally contains a Greek word for what the patient fears plus the suffix -phobia. Creating these terms is something of a word game. Few of these terms are found in medical literature. However, this does not necessarily make it a non-psychological condition.

Terms for prejudice or discrimination

A number of terms with the suffix -phobia are used non-clinically but have gained public acceptance, though they are often considered buzzwords. Such terms are primarily understood as negative attitudes towards certain categories of people or other things, used in an analogy with the medical usage of the term. Usually these kinds of "phobias" are described as fear, dislike, disapproval, prejudice, hatred, discrimination, or hostility towards the object of the "phobia". Often this attitude is based on prejudices and is a particular case of most xenophobia. These non-clinical phobias are typically used as labels cast on someone by another person or some other group.

Below are some examples:

  • Chemophobia – prejudice against artificial substances in favour of "natural" substances.
  • Ephebiphobia – fear or dislike of youth or adolescents.
  • Homophobia – fear or dislike of homosexuals or homosexuality.
  • Xenophobia – fear or dislike of strangers or the unknown, sometimes used to describe nationalistic political beliefs and movements. It is also used in fictional work to describe the fear or dislike of space aliens.


References

  1. ↑ Edmund J. Bourne, The Anxiety & Phobia Workbook, 4th ed, New Harbinger Publications, 2005, ISBN 1-57224-413-5.
  2. ↑ Kessler et al., Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication, June 2005, Archive of General Psychiatry, Volume 20
  3. ↑ Winerman, Lea. "Figuring Out Phobia", American Psychology Association: Monitor on Psychology, August 2007.
  4. ↑ AllPsych Journal | Phobias: Causes and Treatments
  5. ↑ NIMH - The Numbers Count: Mental Disorders in America
  6. ↑ Crozier, W. Ray; Alden, Lynn E. International Handbook of Social Anxiety: Concepts, Research, and Interventions Relating to the Self and Shyness, p. 12. New York John Wiley & Sons, Ltd. (UK), 2001. ISBN 0-471-49129-2.
  7. ↑ Hall, Lynne L. Fighting Phobias, the Things That Go Bump in the Mind, FDA Consumer Magazine, Volume 31 No. 2, March 1997.
  8. ↑ 8.0 8.1 Wolpe, Joseph (1958). Psychotherapy by reciprocal inhibition.. Stanford University Press. http://www.springerlink.com/index/8452N0KP134NK203.pdf. 
  9. ↑ E. B., Foa; Blau, J. S., Prout, M., & Latimer, P. (1977). "Is horror a necessary component of flooding (implosion)?". Behaviour Research and Therapy (15): 397–402. 
  10. ↑ Craske, Michelle; Martin M. Antony, David H. Barlow (2006). Mastering your fears and phobias,. US: Oxford University Press. ISBN 978-0195189179. http://books.google.com/?id=ndcxMZ7NEcsC&dq=Foa;+Blau,+J.+S.,+Prout,+M.,+%26+Latimer,+P.+(1977).+%22Is+horror+a+necessary+component+of+flooding+(implosion)%3F%22. 
  11. ↑ Eysenck, Hans (1977). You and Neurosis. 
  12. ↑ De Jongh A; Ten Broeke E; Renssen M R. (1999) Treatment of specific phobias with Eye Movement Desensitization and Reprocessing (EMDR): protocol, empirical status, and conceptual issues. Journal of anxiety disorders 1999;13(1-2):69-85.
  13. ↑ "Hypnotist removes phobias with hypnotherapy and NLP" http://www.comedywood.com/video/maury-phobias1.wmv
  14. ↑ Stein, Dan J (16 February Fears are common in children and adolescents. However, for some youth, these fears persist and develop into specific phobias. A specific phobia is an intense, enduring fear of an identifiable object or situation that may lead to panic symptoms, distress, and avoidance (e.g., fears of dogs, snakes, storms, heights, costumed characters, the dark, and similar objects or situations). Moreover, phobias can affect a youngster's quality of life by interfering with school, family, friends, and free-time. It is estimated that 5% to 10% of youth will develop a phobia before reaching the age of 16. 2004). Clinical Manual of Anxiety Disorders (1st ed.). USA: American Psychiatric Press Inc. p. 53. ISBN 978-1585620760. http://books.google.com/?id=44reFIgFDBMC. 

External links

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