Phobias

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Phobias are excessive, intense or irrational fears that cause people to avoid certain objects, creatures, situations or activities.

These are creatures, activities or situations that pose little or no danger, but for some people their fear is so great that it becomes a phobia.

Their fear becomes amplified and interferes with everyday life. Experiencing phobias can be an overwhelming, frightening and isolating experience. People may feel intense fear or that their world has fallen apart. Phobias place limitations on people's lifestyles. Many people are bewildered by their emotions when confronted with their phobias but feel powerless to control them.

Phobias fall into four main types:

Fear of specific animals or insects, or of situations such as being in lifts, aeroplanes, high places or storms

Phobias of dogs, cats, or spiders (arachnophobia) are common. If you are phobic of dogs you will feel extremely anxious anywhere near a dog and want to get away from it quickly. You will avoid dogs if at all possible. This happens even though you may realise that your fear is unreasonable. Once you leave the situation you feel fine.

Fear of blood, injury and injections

Most people don’t like being injured or having injections. But some people are so phobic they feel extremely anxious just hearing about injuries, needles, operations or blood.They avoid reading or talking about these subjects. They find it hard to visit a friend in hospital. They may avoid going to the dentist. The sight of blood might make them panic or faint. Away from these subjects and situations they feel quite okay.

Fear of social activities or situations (social phobia)

While almost anyone would be anxious if they had to give a talk to an audience of 100 people, people with social phobia fear everyday social situations. People with social phobia are especially afraid people will think badly of them, criticise them or treat them unkindly because of the way they act in a social setting.

You might fear being seen to shake, sweat or blush. Sometimes this is a fear of only one activity such as eating in public, writing in public, or using a public toilet. For some it includes most social situations. Some social anxiety is common in the teenage years and social phobia usually starts during this time. Social phobia, if untreated, can last for years with varying levels of severity.

Fear of being away from home or safety and fear of places where you might have a panic or anxiety attack (agoraphobia)

Agoraphobia is a more complicated phobia. Most people with agoraphobia also have panic attacks − sudden severe attacks of anxiety during which the fear that something dreadful is going to affect their physical or mental health.

People fear having these attacks and avoid places where they might have them − such as shops and public places, being in cars or other forms of transport. They also fear being away from safety or help in case they collapse. They feel safest at home or in the company of someone they trust. Agoraphobia tends to vary from day to day and people with it don’t panic every time they go to the supermarket or into some previously feared situation. 

Agoraphobia is usually the most severe of the phobias. People with agoraphobia may have anxiety or depression at other times and they may sleep poorly. Agoraphobia usually starts between the ages of 16 and 35.

Who gets phobias?

All phobias are more common in women. Phobias vary from country to country. For example, in Northern Australia crocodile phobia is common because of the higher crocodile population. Conversely in New Zealand some people may have a phobia about snakes even though we don’t have them here. Most phobias last for years or are lifelong unless you get treatment.

The main problem with phobias is that it takes continual effort to have to continually worry about how to make sure you avoid what it is you fear. This is particularly so of social phobia and agoraphobia and can stop you living a fulfilling life.

People with phobias can develop other problems. These can include agoraphobia, alcohol or other drug abuse and depression. For that reason, if you suspect you or a loved one is experiencing a phobia, it’s important to see your doctor and talk to them about what you are going through. Most people with phobias make a good recovery once they seek help.

But even if you continue to have episodes you can still experience recovery and live a happy and worthwhile life.

What causes phobias?

Often there is no obvious cause for a phobia. Phobias do run in families, especially phobias about blood, injury and injections, as well as agoraphobia. Some specific phobias start after a frightening experience like being attacked by a dog, but most do not. Most people with spider phobia have not been bitten by spiders.

Agoraphobia and social phobia are more common in people who are anxious or nervous by nature. Some people with social phobia are generally shy, but some are not and only have problems in certain social situations. Specific phobias happen just as often in people who are not otherwise anxious.

People with phobias may believe they developed problems because of stress or because things have gone wrong in their lives. Other people with phobias cannot find things that have gone wrong in their lives. They may agree with the view that their problem is genetic in origin.

A lot of people with phobias believe it’s a combination of these things. Sometimes people think their problem is a punishment for their moral or spiritual or cultural failure. It's important to remember that it’s not your fault if you are experiencing anxiety or a phobia.

Signs to look for (symptoms)

Phobias are an anxiety related condition and the way you experience a phobia is unique to you. Symptoms will vary depending on which type of phobia you are experiencing. They range from mild anxiety or concern, through to a full blown panic attack when confronted with the creature or situation you’re most concerned about.

The types of panic symptoms you may experience could include:

  • a racing or pounding heart
  • feeling dizzy or light-headed
  • shortness of breath, or feeling smothered
  • nausea or stomach pains
  • shaking
  • choking feelings
  • sweating, or alternating between hot and cold.

Through all of this you may feel you need to escape before you lose control. You may also know that you are over-reacting but feel powerless to control your reactions.

How the doctor determines if you have a phobia (diagnosis)

Many people with serious phobias, sooner or later, go to see their doctor or a counsellor or are referred to mental health services or a clinical psychologist. When you see your doctor it’s important to tell them as much as you can about how you are feeling and what you are going through. If you have agoraphobia and panic attacks your doctor may suggest you have a physical check up to make sure your symptoms do not have a physical cause. 

If you fear you might harm or kill yourself it is vital that you seek help immediately.

Treatment options

Understanding your phobia is an important step in overcoming or learning how to live with it. The majority of people who suffer from phobias find relief from their symptoms when treated with therapy, medications and education, or a combination of these.

Psychoeducation (providing education)

Education can be extremely important to help you, your family/whānau and supporters to understand phobias and help in the recovery. Your doctor or mental health professional will give you information about the disorder, suggest different ways to handle it, and discusses any complications which may occur. 

There are also numerous self-help books available in the shops which some find to be a useful first stage in getting help. They can teach you about some of the ways of dealing with your phobia and they can also get you used to reading about or discussing problems that you have previously kept completely to yourself. They are generally written by medical experts but draw on the experience of people who have phobias.

Psychosocial treatments (therapy)

These are non-medical treatments that address your emotional needs such as your thinking, behaviour, relationships and environment. This involves talking with a trained professional who uses clinically researched techniques, usually talking therapies, to assess and help you understand what has happened, and to help you make positive changes in your life.

Cognitive-behavioural therapy (CBT) − a psychological therapy that largely focuses on overcoming unhelpful beliefs, has been shown to work well with phobias.

People with social phobias may benefit from specific training in social skills or assertiveness techniques. These may be taught either individually by a therapist or counsellor or in a group. Counselling may include some techniques used in psychological therapies, but is mainly based on supportive listening, practical problem solving and information giving.

Medication

Antidepressant or tranquilliser medication in conjunction with therapy has proven effective in improving the symptoms of phobia. You should be told what effects you should notice from any medication, receive clear instructions about how you should take them and what precautions are necessary.

If you are pregnant or breast feeding no medication is entirely safe. 

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It is also really important to look after your physical wellbeing. Make sure you get an annual checkup with your doctor. Being in good physical health will also help your mental health.

Important strategies that support recovery

Learn about phobias and what works in recovery from them. Face up to your phobia. This is the main therapy.

If your fear is great you may need to have some professional help to do this. But you can do a lot for yourself. If you are aware that you have a phobia and feel that you are able to confront it, then the best strategy is to face the object or situation as often as possible. If you have recovered from a phobia it is good to keep in practice at being in a situation you used to fear. For example, if you know you are quite anxious about meeting new people, do not avoid doing this. If you take every opportunity to meet new people your confidence will grow.

Other strategies that help include:

  • Make sure you go out often if you have mild agoraphobia and have some anxieties about leaving home because of panic or feeling unsafe. Ask family/whānau and friends to keep you company if this helps. Explain your problem to them. If they know that you might have to wait for a panic attack to pass, or even to go home, this can help you feel less pressured or embarrassed.

  • Learn to relax. If you are anxious much of the time (in addition to having a phobia) relaxation can be helpful. If you already have some way of relaxing, do this regularly. If you need to, learn a relaxation technique or find something to do with your family/whānau or friends that is relaxing and enjoyable. Phobias usually affect only one part of your life. Keep up all your other activities, especially those you enjoy.

  • Avoid alcohol and other drugs are not good ways of relaxing to overcome a phobia. You’ll probably feel more anxious afterwards and you risk becoming addicted. Many people without social phobia feel a bit more relaxed socially with a few drinks, but if you are unable to socialise without drinking you are at risk of becoming dependent on alcohol.

  • Know if you are sensitive to caffeine and nicotine. These have no special effect on phobias unless you have agoraphobia and panic in which case you may be sensitive to these substances. Stopping alcohol and cannabis can also be very helpful. Breathing exercises are good if you over-breathe (hyperventilate)
Thanks to Janet Peters, registered psychologist for reviewing this content. Date last reviewed: September, 2014