Phobias – A Guide

A phobia is an anxiety disorder. It is an extreme or irrational fear of an animal, object, place, or situation.

Introduction
Symptoms of phobias
Causes of phobias
Diagnosing phobias
Treating phobias
Self-help advice for phobias

Introduction

Phobias are more than simple fears. They develop when a person begins to organise their life around avoiding the things they are afraid of.

If you have a phobia, you will have an overwhelming need to avoid all contact with the source of your anxiety. Coming into contact, or even the thought of coming into contact, with the cause of your phobia will make you anxious and may cause you to panic.

If the cause of your phobia is an object or animal, such as snakes, and you do not come into contact with it regularly, it is unlikely to affect your day-to-day life. However, if you have a more complex phobia, such as agoraphobia (the fear of open spaces and public places), you may find it very difficult to lead a normal life.

Types of phobia

There are many different phobias, which can be divided into two main categories:

• simple phobias, and
• complex phobias.

Simple phobias

Simple phobias are fears about specific objects, animals, situations or activities. Some common examples include:

• dogs,
• spiders,
• snakes,
• enclosed spaces,
• dentists, and
• flying.

Phobias affect different people in different ways. Some people only react with mild anxiety when confronted with the object of their fear, while others experience severe anxiety or have a severe panic attack.

Complex phobias

Complex phobias tend to be more disabling than simple phobias because they are often associated with a deep-rooted fear or anxiety about a particular circumstance or situation. Two common examples of complex phobias are:

• agoraphobia, and
• social phobia.

Agoraphobia is a fear of open spaces or public places and can involve anxieties about leaving the home, going into shops or travelling on public transport. It can also involve a fear of being unable to escape immediately to a place of safety, usually the home.

Social phobia is a fear of social situations, such as weddings, or performing in social situations, such as public speaking. People with a social phobia have a fear of embarrassing themselves or of being humiliated in public.

How common are phobias?

Phobias are the most common type of anxiety disorder. In the UK, an estimated 10 million people have phobias. Phobias can affect anyone, regardless of age, sex and social background.

Simple phobias, such as a fear of going to the dentist, usually start during early childhood, often between the ages of four and eight. Simple phobias often disappear on their own as the child gets older and usually do not cause problems in adulthood.

Complex phobias usually start later in life. Social phobias often begin during puberty and agoraphobia in the late teens to early twenties. Sometimes, complex phobias continue for many years.

Outlook

Almost all phobias can be successfully treated and cured. Treating simple phobias involves gradually becoming exposed to the animal, object, place or situation that causes fear. This process is known as desensitisation or self-exposure therapy (see Treatment and Self-help, above).

Treating complex phobias often takes longer and involves talking therapies, such as counselling, psychotherapy and cognitive behavioural therapy (CBT).

Medication is not usually used to treat phobias. However, it is sometimes prescribed to help people cope with the effects of anxiety.

Symptoms of phobias

A common factor of phobias is a need to avoid contact with the thing that causes fear and anxiety. How far someone with a phobia will go to avoid contact varies considerably from person to person.

For example, someone with a fear of spiders (arachnophobia) may not want to touch a spider, whereas someone else with the same fear may not even want to look at a picture of one.

All phobias, particularly complex phobias such as agoraphobia (a fear of open spaces and public places), can limit your daily activities and may cause severe anxiety and depression.

Physical symptoms

Panic attacks are common among people with phobias. They can be very frightening and distressing. The symptoms often occur suddenly and without warning.

As well as overwhelming feelings of anxiety, a panic attack can cause physical symptoms including:

• sweating,
• trembling,
• hot flushes,
• chills,
• shortness of breath,
• difficulty breathing,
• a choking sensation,
• rapid heartbeat (tachycardia),
• chest pain or a feeling of tightness in the chest,
• a sensation of butterflies in the stomach,
• nausea,
• headaches and dizziness,
• feeling faint,
• numbness or pins and needles,
• dry mouth,
• a need to go to the toilet,
• ringing in your ears, and
• feeling confused or disorientated.

Psychological symptoms

In severe cases, you may also experience psychological symptoms such as:

• fear of losing control,
• fear of fainting,
• feelings of dread, or
• fear of dying.

Complex phobias

Like simple phobias, complex phobias, such as agoraphobia and social phobia, can affect your wellbeing.

Agoraphobia often involves a combination of several interlinked phobias. For example, someone with agoraphobia may also have a fear of being left alone (monophobia), a fear of situations where they feel trapped (claustrophobia) and a fear of going outside or leaving their home (agoraphobia).

The symptoms experienced by agoraphobics vary in severity. Some people feel very apprehensive and anxious if they have to leave their home to visit the shops, whereas others may feel relatively comfortable travelling a short distance from their home.

If you have a social phobia, the thought of being seen in public or appearing at social events can make you feel very anxious and frightened. This is because these situations can make you feel vulnerable.

Intentionally avoiding meeting people in social situations, such as at a dinner party, is a sign of social phobia. As with agoraphobia, in extreme cases of social phobia, some people are too afraid to leave their home.

Causes of phobias

Phobias usually develop during childhood, adolescence or early adulthood following a frightening event or a stressful situation. However, it is not always clear why some phobias occur.

Simple phobias

Simple phobias usually develop in early childhood, often between the ages of four and eight. A simple phobia can sometimes be traced to an early childhood experience. For example, if a young child is trapped in a confined space, they may develop a fear of enclosed spaces (claustrophobia) when they are older.

Fusional shares the same phobia with another family member, such as a fear of spiders (arachnophobia), they may have learned to fear spiders as a child, rather than the phobia being passed on genetically (running in families).

Complex phobias

The exact causes of complex phobias, such as agoraphobia and social phobia, are unknown. However, it is thought that genetics, brain chemistry and life experiences may all play a part in the development of these phobias.

Social phobias may be caused by a previous intense or anxious experience in a social situation. Alternatively, a person’s social confidence may not have had the chance to fully develop past the normal stage of shyness experienced as a young child.

Diagnosing phobias

Most people with a phobia are usually fully aware that they have one. Many people live with a phobia without having it formally diagnosed and take great care to avoid the thing they are afraid of.

However, if you have a phobia,getting help from your GP and a specialist with expertise in behavioural therapy, such as a psychologist, can often be beneficial.

Complex phobias

If you have a complex phobia, such as agoraphobia (a fear of open spaces and public places) or social phobia, see your GP. They may refer you to a mental healthcare specialist, such as a psychologist or psychiatrist, who can help.

Agoraphobia

The anxiety disorder charity Anxiety UK has produced a list of questions to help people identify whether they have agoraphobia. If you answer yes to most of the questions below, it is likely that you have agoraphobia.

During the past six months:

• Do you regularly avoid situations because you are frightened of having a panic attack?

Do any of the following situations make you feel anxious:

• going outside away from your home,
• standing in long lines,
• being in a confined space, such as in a tunnel or the underground,
• being at home alone,
• being in wide open spaces, such as in a field or park, or
• being in crowded places.

Do you avoid being in any of the above situations?

If you answer yes to most of these questions, see your GP, who will be able to make a formal diagnosis of agoraphobia and provide you with further information and advice.

Social phobia

Anxiety UK has produced a list of questions to help people identify whether they have social phobia. If you answer yes to most of the questions listed below, it is likely that you have social phobia.

During the past six months:

• Do you worry a lot about embarrassing yourself in front of others?
• Do you worry about what people might think of you?
• Do you feel anxious in social situations?
• Do you worry about behaving anxiously in any of the following situations:
• public speaking,
• eating and drinking in front of other people,
• writing in front of other people, or
• going to parties and other social gatherings.

Do you avoid any of the above situations because they make you feel anxious?

If you answer yes to most of these questions, see your GP, who can make a formal diagnosis of social phobia and provide you with further information and advice.

In diagnosing social phobia, your GP will use the following criteria:

• your symptoms must be caused by anxiety and not secondary to other symptoms, such as delusions or obsessions,
• the anxiety must be the direct result of being in social situations, and
• avoiding social situations must be a prominent feature of your condition.

Treating phobias

Many people with a phobia do not need treatment and find that avoiding the object of their fear is enough to control the problem.

However, with certain phobias, such as a fear of flying, avoidance may not always be possible, so you may want to get professional help and advice to find out about treatment options.

Most phobias are curable, but no single treatment is guaranteed to work for all phobias. In some cases, a combination of different treatments may be recommended. The main types of treatment are outlined below.

Talking treatments

Talking treatments are often very effective for people with phobias. There are several different types of talking therapy, including:

• Counselling:a trained counsellor listens to your problems, such as feeling anxious in certain situations, and helps you to overcome them.
• Psychotherapy: a psychotherapist uses an in-depth approach to find the cause of your problem and suggests ways to deal with it.
• Cognitive behavioural therapy: a type of counselling that explores your thoughts, feelings and behaviour in order to develop practical ways of effectively dealing with the phobia.

Speak to your GP to find out if talking treatments would be suitable for you and whether they are available on the NHS in your area.

Desensitisation

Many simple phobias can be treated using a form of behaviour therapy known as desensitisation or self-exposure therapy. It involves being gradually exposed over a period of time to the object or situation of your fear so that you start to feel less anxious about it.

Sometimes, a combination of behaviour therapy and medication may be recommended.

Medication

Medication is not usually recommended for treating phobias because talking therapies are normally successful. However, medication is sometimes prescribed for treating the effects of phobias, such as anxiety.

Three types of medication are recommended for treating anxiety. These are:

• antidepressants,
• tranquillisers, and
• beta-blockers.

Antidepressants

Antidepressants are often prescribed to help reduce anxiety. Paroxetine (Seroxat), a selective serotonin reuptake inhibitor (SSRI), is licensed to treat social phobia. Citalopram (Cipramil) and escitalopram (Cipralex) are licensed for the treatment of panic disorder. Venlafaxine (Efexor) is licensed for generalised anxiety disorder (GAD).

Common side effects of these treatments include:

• nausea,
• headaches, and
• sleep problems.

Initially, they may make your anxiety worse.

Clomipramine (Anafranil) is a type of tricyclic antidepressant (TCA) that is licensed to treat phobias. Side effects include:

• dry mouth,
• drowsiness,
• blurred vision,
• tremors (shaking),
• palpitations (irregular heartbeat),
• constipation, and
• difficulty urinating.

Moclobemide (Manerix) is a type of antidepressant from the monoamine oxidase inhibitors (MAOIs) group of antidepressants. It is sometimes prescribed to treat social phobia. Moclobemide interacts with certain types of food, so if you are prescribed this medication, read the information leaflet that comes with it to find out which foods you should not eat.

Other possible side effects include:

• sleep problems,
• dizziness,
• stomach problems,
• headaches,
• restlessness, and
• agitation.

Antidepressants can cause withdrawal symptoms. If you are prescribed antidepressants,do not suddenly stop taking them. See your GP, who will lower your dose gradually over time.

Tranquilisers

Benzodiazepines are a group of medicines that are also known as minor tranquilisers. They are sometimes used to treat severe anxiety, but are usually only prescribed in the lowest possible dose for the shortest possible time. This is because they are associated with withdrawal and dependence problems.

Benzodiazepines are usually only prescribed for a maximum of four weeks at a time. Like antidepressants, their use should be stopped gradually. Benzodiazepines that are commonly used include:

• diazepam (Valium),
• alprazolam (Xanax),
• chlordiazepoxide,
• clorazepate (Tranzene),
• lorazepam (Ativan), and
• oxazepam.

Side effects of these medications include:

• drowsiness,
• tiredness, and
• confusion.

Two other types of tranquilisers that are licensed to treat severe anxiety are buspirone and meprobamate. Like benzodiazepines, they are only prescribed on a short-term basis.

The side effects of meprobamate are similar to those of benzodiazepines. Side effects of buspirone include:

• nausea,
• dizziness,
• headaches,
• nervousness, and
• light-headedness.

Beta-blockers

Beta-blockers are commonly used to treat cardiovascular conditions, such as heart problems and high blood pressure (hypertension). They are also sometimes prescribed to help reduce the symptoms of anxiety, such as palpitations (irregular heartbeat).

Beta-blockers slow down your heart rate and decrease your blood pressure. Propranolol (Inderal) is a beta-blocker that is commonly used to treat anxiety. Side effects include:

• stomach problems,
• cold fingers,
• tiredness, and
• sleep problems

Self-help advice for phobias

Self-help programme

Each individual phobia is different and no single self-help programme will work for everyone. You may decide to use your own self-help strategy to overcome your phobia, or get help from a mental healthcare specialist, such as a psychologist.

A self-help programme could include:

• having a course of cognitive behavioural therapy (CBT),
• attending a self-help group,
• using self-exposure therapy to try to overcome your fear, or
• a combination of these.

Self-exposure therapy

Self-exposure therapy (desensitisation)involves gradually increasing the length of time that you are exposed to the object of your phobia.

If you have agoraphobia (a fear of open spaces and public places), you might begin by going outside your house for a very short time, then gradually increasing the length of time you spend outside and the distance you travel from your house. This technique is often effective in allowing someone with a phobia to cope with their anxiety.

Other self-help techniques

Other self-help techniques include:

• Relaxation techniques: a series of physical exercises that may help you relax and control your breathing.
• Visualisation: combines relaxation and breathing techniques with mentally visualising how you will successfully deal with a situation that could cause anxiety.
• Self-help groups: a useful way of meeting others with similar experiences and sharing ways of coping.

Depression Alliance supports a network of self-help groups across England and has details of groups in your area.