PHOBIASPHOBIASAs Part of Anxiety DisordersAs Part of Anxiety Disorders

A phobia is an overwhelming and unreasonable fear of an object or situation that poses little real danger. Unlike the brief anxiety most people feel when they give a speech or take a test, a phobia is long-lasting, causes intense physical and psychological distress, and can affect your ability to function normally at work or in social settings.

Several types of phobias exist. Some people fear large, open spaces. Others are unable to tolerate certain social situations. And still others have a specific phobia, such as a fear of snakes, elevators or flying.

Not all phobias need treatment, but if a phobia affects your daily life, a number of therapies are available that can help you overcome your fears — often permanently.

Phobias are divided into three main categories:

• Specific phobias. These include a fear of enclosed spaces (claustrophobia); animals, particularly spiders, snakes or mice; heights (acrophobia); flying (pterygophobia); water (hydrophobia); storms; dentists; injections; tunnels; bridges; and not being able to get off public transportation quickly enough. There are many other specific phobias.

• Social phobia. More than just shyness, social phobia involves a combination of excessive self-consciousness, a fear of public scrutiny or humiliation in common social situations, and a fear of negative evaluation by others.

• Fear of open spaces (agoraphobia). Most people who have agoraphobia develop it after having one or more panic attacks. Agoraphobia is a fear of a place, such as a mall, an elevator or a room full of people, with no easy means of escape if a panic attack should occur.

No matter what type of phobia you have, it's likely to produce the following reactions:

• A feeling of uncontrollable anxiety when you're exposed to the source of your fear — sitting on an airplane, for instance, or walking into a large party

• The feeling that you must do everything possible to avoid what you fear

• The inability to function normally because of your anxiety

• Often, the knowledge that your fears are unreasonable or exaggerated but feeling powerless to control them

• Physical as well as psychological reactions, including sweating, rapid heartbeat, difficulty breathing, a feeling of panic and intense anxiety

• In some cases, anxiety just thinking about what you fear

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When to see a Doctor?

An unreasonable fear can be an annoyance — having to take the stairs instead of an elevator, for instance — but it isn't considered a phobia unless it seriously disrupts your life. If anxiety affects your ability to function at work or socially, consider seeking medical or psychological treatment. Most people can be helped with the right therapy.

Causes• Much is still unknown about the actual

cause of phobias. Studies seem to show a strong correlation between your own phobias and the phobias of your parents, however. Children may learn phobias by observing a family member's phobic reaction to an object or a situation — for example, a fear of snakes or spiders.

• Brain chemicals, genetics and traumatic experiences also appear to influence the development of phobias.

ComplicationsHaving a phobia may cause other problems, including:

• Social isolation. If you have a phobia, you may find that you avoid social situations and public places. Financial, professional and interpersonal problems often result from social phobia and agoraphobia.

• Depression. The avoidance of many activities that other people find enjoyable in their personal and professional lives may lead you to become depressed.

• Substance abuse. Some people with phobias turn to alcohol or other drugs to deal with stress. This unwise and unhealthy choice can lead to abuse of alcohol or other drugs.

Tests and Diagnosis

There are no laboratory tests for phobias. Instead, the diagnosis is based on a thorough clinical interview and rigorous diagnostic guidelines. Your doctor will ask questions about your symptoms and take a medical, psychiatric and social history.

To be diagnosed with a phobia, you must meet certain criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

Specific PhobiasThe diagnostic criteria for specific phobias include: • A persistent and intense fear triggered by an object

or situation, such as snakes, spiders or storms.• An immediate anxiety response when you confront

the source of your fear.• Knowing that your fear is irrational or exaggerated

but feeling powerless to control it. This doesn't apply to children, who often don't have the maturity to recognize that their fear is unreasonable.

• Avoiding what you fear at all costs, or enduring it with extreme distress.

• No other explainable reason for your symptoms, including medical conditions and other anxiety disorders.

• In children and teens, symptoms lasting at least six months.

Social PhobiaThe diagnostic criteria for social phobia include:

• A persistent and intense fear of humiliating or embarrassing yourself in one or more social situations — usually with unfamiliar people or when you're under close scrutiny.

• Exposure to the situations you fear creates intense anxiety, which may take the form of a panic attack.

• Knowing that your fear is unreasonable or exaggerated but feeling powerless to control it.

• Avoiding the social or performance situations that you fear or enduring them with extreme distress.

• The phobia and its complications severely affect your life, including your job, social activities and relationships.

• No other explainable reason for your symptoms, including health problems, medication or other psychological disorder.

In children, additional diagnostic criteria for social phobia include:

• Fear and social anxiety with other children, not just with adults.

• Anxiety expressed by crying, tantrums, freezing or shrinking from social situations with unfamiliar people.

• Often, an inability to realize that their fears are unreasonable.

• Phobia lasting at least six months.

AgoraphobiaThe criteria for a diagnosis of agoraphobia include:

• An irrational fear of being alone in a place or situation where you would be unable to find help or to escape easily if you were to have a panic attack. People with agoraphobia might fear being in a large crowd, standing in line, or traveling on a bus, train or automobile. In the most severe cases, they may never leave the house.

• The avoidance of anxiety-provoking situations whenever possible. Having to face these situations causes extreme distress.

• No other explainable reason for your symptoms, such as a medical condition, medication or other psychological disorder.

Treatments and Drugs

Your doctor or a mental health provider may suggest medications or behavior therapy or both to treat phobias. Most adults don't get better on their own and may require some type of treatment. The goal of phobia treatment is to reduce your anxiety and fear and to help you better manage your reactions to the object or situation that causes them.

Medications • Beta blockers. These medications work by blocking

the stimulating effects of adrenaline on your body, such as increased heart rate, elevated blood pressure, pounding heart, and shaking voice and limbs. Beta blockers can be very effective for people who have severe stage fright.

• Antidepressants. The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs). These medications act on the chemical serotonin, a neurotransmitter in your brain that's believed to influence mood. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). If SSRIs aren't effective or cause intolerable side effects, your doctor may prescribe another type of antidepressant, such as a monoamine oxidase inhibitor (MAOI).

Sedatives. Medications called benzodiazepines help you relax by reducing the amount of anxiety that you feel. They include lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax) and chlordiazepoxide (Librium). Sedatives need to be used with caution because they can be addictive, and should be avoided if you have a history of alcohol or drug dependence.

Behavior Therapy

Desensitization or exposure therapy focuses on changing your response to the object or situation that you fear. Gradual, repeated exposure to the cause of your phobia may help you learn to conquer your anxiety. For example, if you're afraid of flying, your therapy may progress from simply thinking about flying to looking at pictures of airplanes, to going to an airport, to sitting in an airplane, and finally to taking a flight.

Cognitive behavioral therapy is a more comprehensive form of therapy. It involves working with a therapist to learn ways to view and cope with the feared object or situation differently. You learn alternative beliefs about your fears and the impact they have on your life. There's special emphasis on learning to develop a sense of mastery and control of your thoughts and feelings.

Treatment Choices

Specific phobias usually are treated with behavioral therapy. Social phobias may be treated with antidepressants or beta blockers, along with behavior therapy. Agoraphobia, especially when it's accompanied by a panic disorder, is usually treated with SSRIs and behavior therapy.

Coping and Support

Childhood fears, such as fear of the dark, of monsters or of being left alone, are common, and most children outgrow them. But if your child has a persistent, excessive fear that's limiting his or her ability to function in daily life, talk to your doctor.

To help your child cope with fears: • Talk openly about fears. Don't trivialize the problem or

belittle your child for being afraid. Instead, let your child know that you're there to listen, and to help.

• Don't reinforce phobias. Instead, take advantage of opportunities to help children overcome their fears. If your child is afraid of the neighbor's friendly dog, for example, don't go out of your way to avoid the animal. Instead, help your child cope when confronted with the dog. For example, you might offer to be your child's home base, waiting and offering support while your child steps a little closer to the dog and then returns to you for safety. Over time, encourage your child to keep closing the distance.

• Pursue positive approaches. Help your child learn to breathe deeply and repeat positive statements such as "I can do this" when facing something scary. Your child also may benefit from rating the fear on a scale of 1 to 10. Recognizing that the fear rates only a 5 on the scale, for example, may help your child see the feeling as being less overwhelming.

Prevention

If you have unreasonable fears, consider getting psychological help. By dealing with your own fears, you won't pass them on to your children.