Louise Morales-Brown is a social researcher within the civil service, collecting evidence of social issues to inform and evaluate policy decisions. She has an undergraduate degree in applied psychology and criminology from the University of Brighton, in the U.K. She is currently undertaking her Ph.D. part-time at Lancaster University, where she is researching into patient experiences of diabetes distress.
Social phobia, or social anxiety: This is a profound fear of public humiliation and being singled out or judged by others in a social situation. The idea of large social gatherings is terrifying for someone with social anxiety. It is not the same as shyness.
Agoraphobia: This is a fear of situations from which it would be difficult to escape if a person were to experience extreme panic, such being in a lift or being outside of the home. It is commonly misunderstood as a fear of open spaces but could also apply to being confined in a small space, such as an elevator, or being on public transport. People with agoraphobia have an increased risk of panic disorder.
Specific phobias are known as simple phobias as they can be linked to an identifiable cause that may not frequently occur in the everyday life of an individual, such as snakes. These are therefore not likely to affect day-to-day living in a significant way.
Social anxiety and agoraphobia are known as complex phobias, as their triggers are less easily recognized. People with complex phobias can also find it harder to avoid triggers, such as leaving the house or being in a large crowd.
A phobia becomes diagnosable when a person begins organizing their lives around avoiding the cause of their fear. It is more severe than a normal fear reaction. People with a phobia have an overpowering need to avoid anything that triggers their anxiety.
A feeling of anxiety can be produced simply by thinking about the object of the phobia. In younger children, parents may observe that they cry, become very clingy, or attempt to hide behind the legs of a parent or an object. They may also throw tantrums to show their distress.
For example, those who experience agoraphobia may also have a number of other phobias that are connected. These can include monophobia, or a fear of being left alone, and claustrophobia, a fear of feeling trapped in closed spaces.
These are far from the only specific phobias. People can develop a phobia of almost anything. Also, as society changes, the list of potential phobias changes. For instance, nomophobia is the fear of being without a cell phone or computer.
These usually develop before the age of 4 to 8 years. In some cases, it may be the result of a traumatic early experience. One example would be claustrophobia developing over time after a younger child has an unpleasant experience in a confined space.
Phobias that start during childhood can also be caused by witnessing the phobia of a family member. A child whose mother has arachnophobia, for example, is much more likely to develop the same phobia.
More research is needed to confirm exactly why a person develops agoraphobia or social anxiety. Researchers currently believe complex phobias are caused by a combination of life experiences, brain chemistry, and genetics.
If the phobia does not cause severe problems, most people find that simply avoiding the source of their fear helps them stay in control. Many people with specific phobias will not seek treatment as these fears are often manageable.
The doctor, psychiatrist, or psychologist may recommend behavioral therapy, medications, or a combination of both. Therapy is aimed at reducing fear and anxiety symptoms and helping people manage their reactions to the object of their phobia.
If the SSRI does not work, the doctor may prescribe a monoamine oxidase inhibitor (MAOI) for social phobia. Individuals on an MAOI may have to avoid certain types of food. Side effects may initially include dizziness, an upset stomach, restlessness, headaches, and insomnia.
Taking a tricyclic antidepressant (TCA), such as clomipramine, or Anafranil, has also been found to help phobia symptoms. Initial side effects can include sleepiness, blurred vision, constipation, urination difficulties, irregular heartbeat, dry mouth, and tremors.
Benzodiazepines are an example of a tranquilizer that might be prescribed for a phobia. These may help reduce anxiety symptoms. People with a history of alcohol dependence should not be given sedatives.
This can help people with a phobia alter their response to the source of fear. They are gradually exposed to the cause of their phobia over a series of escalating steps. For example, a person with aerophobia, or a fear of flying on a plane, may take the following steps under guidance:
The doctor, therapist, or counselor helps the person with a phobia learn different ways of understanding and reacting to the source of their phobia. This can make coping easier. Most importantly, CBT can teach a person experiencing phobia to control their own feelings and thoughts.
If you have a phobia, the one thing you should never be afraid of is seeking help. The Anxiety and Depression Association of America (ADAA) offer a useful resource for locating a therapist. They also offer a range of talks on how to overcome specific phobias.
A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation.[7][8][9][1] Phobias typically result in a rapid onset of fear and are usually present for more than six months.[1] Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed.[1] If the object or situation cannot be avoided, they experience significant distress.[1] Other symptoms can include fainting, which may occur in blood or injury phobia,[1] and panic attacks, often found in agoraphobia and emetophobia.[6] Around 75% of those with phobias have multiple phobias.[1]
Phobias can be divided into specific phobias, social anxiety disorder, and agoraphobia.[1][2] Specific phobias are further divided to include certain animals, natural environment, blood or injury, and particular situations.[1] The most common are fear of spiders, fear of snakes, and fear of heights.[10] Specific phobias may be caused by a negative experience with the object or situation in early childhood.[1] Social phobia is when a person fears a situation due to worries about others judging them.[1] Agoraphobia is a fear of a situation due to perceived difficulty or inability to escape.[1]
It is recommended that specific phobias be treated with exposure therapy, in which the person is introduced to the situation or object in question until the fear resolves.[2] Medications are not helpful for specific phobias.[2] Social phobia and agoraphobia may be treated with counseling, medications, or a combination of both.[4][5] Medications used include antidepressants, benzodiazepines, or beta-blockers.[4]
Fear is an emotional response to a current perceived danger. This differs from anxiety which is a response in preparation of a future threat. Fear and anxiety often can overlap but this distinction can help identify subtle differences between disorders, as well as differentiate between a response that would be expected given a person's developmental stage and culture.[1]
The International Classification of Diseases (11th version: ICD-11) is a globally used diagnostic tool for epidemiology, health management and clinical purposes maintained by the World Health Organization (WHO). The ICD classifies phobic disorders under the category of mental, behavioural or neurodevelopmental disorders. The ICD-10 differentiates between Phobic anxiety disorders, such as Agoraphobia, and Other anxiety disorders, such as Generalized anxiety disorder. The ICD-11 merges both groups together as Anxiety or fear-related disorders.[11]
Most phobias are classified into 3 categories. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), such phobias are considered subtypes of anxiety disorder. The categories are:
Phobias vary in severity among individuals. Some individuals can avoid the subject and experience relatively mild anxiety over that fear. Others experience full-fledged panic attacks with all the associated impairing symptoms. Most individuals understand that their fear is irrational but cannot override their panic response. These individuals often report dizziness, loss of bladder or bowel control, tachypnea, feelings of pain, and shortness of breath.[13]
Phobias may develop for a variety of reasons. Childhood experiences, past traumatic experiences, brain chemistry, genetics, or learned behavior, can all be reasons why phobias develop. There are even phobias that may run in families and be passed down from one generation to another.[14]
There are multiple theories about how phobias develop and likely occur due to a combination of environmental and genetic factors. The degree to whether environment or genetic influences have a more significant role varies by condition, with social anxiety disorder and agoraphobia having around a 50% heritability rate.[15]
Rachman proposed three pathways for the development of phobias: direct or classical conditioning (exposure to phobic stimulus), vicarious acquisition (seeing others experience phobic stimulus), and informational/instructional acquisition (learning about phobic stimulus from others).[16][17]
Much of the progress in understanding the acquisition of fear responses in phobias can be attributed to classical conditioning (Pavlovian model).[18] 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, the room is a conditioned stimulus (CS). When paired with an aversive unconditioned stimulus (UCS) (the shock), it creates a conditioned response (CR) (fear for the room) (CS+UCS=CR).[18] For example, 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 can originate from an aversive or traumatizing event in the person's life, such as almost falling from a great height. The original fear of nearly falling is associated with being high, leading to a fear of heights. In other words, the CS (heights) associated with the aversive UCS (almost falling) leads to the CR (fear).The conditioned response (CR), however, can also be removed or extinguished. It is quite fascinating that we can reverse the effects of the conditioned stimulus (CS) and unconditioned stimulus (UCS). Repeatedly presenting the conditioned stimulus alone, that is without the unconditioned stimulus (UCS), can extinguish the conditioned response (CR). [19]
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