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Phobias

Published by BUPA's health information team, healthinfo@bupa.com, February 2008.

This factsheet is for people who have a phobia, or who would like information about them.

A phobia is an inappropriate sense of anxiety or fear triggered by exposure to a specific object or situation. People with phobias have a strong desire to avoid whatever it is that is causing their fears.

About fear and phobias
Symptoms
Causes
Treatment
Further information
Sources
Related topics

About fear and phobias

Fear is a form of anxiety triggered by something in your surroundings. If the situation is a real threat - for example, you are being attacked - fear is a completely sensible and appropriate reaction. With phobias, the fear is inappropriate because you have an exaggerated or unrealistic idea about the harmfulness of the situation.

If you have a phobia, you may realise that the fear is out of proportion to the true danger or threat, but you cannot control or explain it. Phobias can be very long-lasting and can cause problems ranging from minor disruption to significant disability.

Types of phobias

There are three main types of phobia.

Specific or simple phobias

These are very common in children, where they are essentially thought of as normal. But some phobias carry on until adult life. These specific phobias can be divided up as fears of:

animals (eg spiders, snakes, mice, birds and insects)
the natural world (eg storms, heights, weather)
blood, injections and injury
certain situations (enclosed spaces, lifts, planes)

Sometimes, people can become phobic about catching illnesses or anything that puts them at risk of vomiting or choking.

Specific phobias are more common in women, and they often begin in childhood. People who suffer from these phobias rarely have any other psychiatric or psychological problems.

Agoraphobia

Agoraphobia often starts in late adolescence and early adulthood. It's more common in women than men. Although it's less common than simple phobias, six in 10 people who see a psychiatrist for help with phobias have agoraphobia.

Agoraphobia means a fear of open spaces. However, it's often used to refer to a fear of being away from home and family, often because of worry about having a panic attack. During a panic attack, there are overwhelming physical symptoms of anxiety. People with agoraphobia, tend to feel worse the further they are from home. They may also have a fear of enclosed spaces (claustrophobia), main roads and public transport.

People with agoraphobia can become depressed, and may use drugs or alcohol to try and help deal with their problems.

Social phobia

Social phobia occurs when there is an excessive fear of social situations, such as small groups of people at parties. People with social phobia have no confidence with people they don't know, and fear that strangers are being critical of them. They may also fear that they will behave in an embarrassing way, such as blushing or shaking in public.

In some cases, social phobia may lead to excessive drinking, as some people with social phobia feel they need "Dutch courage" before a social event. Some people have a particular fear of eating in public, or of any meeting with potential partners. This may lead to people being very lonely, because even though they may have social skills, they try to avoid social situations outside their immediate family.

Symptoms

If you have a phobia, you usually won't have any symptoms until you are faced with your feared situation or object (or, sometimes, if you think about, or see a picture of it). You may then develop symptoms of anxiety, including:

fast breathing (hyperventilation)
being aware of a fast heart beat (palpitations)
a choking sensation
flushing
sweating
feeling faint
numbness and "pins and needles"
tension headaches
dizziness
"churning" of the stomach
diarrhoea

These sensations can be so unpleasant that you may change your behaviour to avoid coming into contact with the feared object.

Causes

There are several different theories about why phobias develop. They do seem to run in families. But how much this is to do with picking up phobias from your parents and how much is inherited through your genes is uncertain.

Young babies seem to be naturally afraid of animals such as snakes and of heights for instance, even though they need to learn to be afraid of man-made objects such as guns. So there is probably a natural fear response that gave our ancestors a survival advantage. It's possible that when phobias develop this natural fear response has gone wrong.

Sometimes the start of a phobia may be triggered by a stressful life event, such as bereavement, illness or divorce. It might be possible to avoid phobias by encouraging children to face up to feared situations rather than stay away from them. However, this doesn't always work.

Treatment

Self-help

The best way to get over a phobia is to expose yourself to the feared object or situation and to tolerate the anxiety until it starts to decrease. Some people find that they can do this on their own, perhaps with the help of self-help books, support groups (see Further information) and friends and family. Others may need professional help from a psychiatrist or other therapist.

Talking therapies

If self-help techniques haven't worked, you should talk to your GP. For many people, the best treatment for phobias is a treatment called behavioural therapy. It's successful for three-quarters of people with specific phobias.

Behavioural therapy

Behavioural therapy involves a one-to-one session with a therapist trained in treating phobias. The principle of this approach involves exposure and a gradual desensitisation to the thing that causes your phobia. During the sessions, you learn to tolerate the anxiety triggered by exposure with the help of relaxation techniques.

The amount of exposure is gradually increased during the sessions. For example, if you have a bird phobia, the early sessions might involve only looking at photographs of birds. They would then move on to handling feathers, before going to feed ducks. In a later session you might help to clean out a birdcage, handling the bird in the process. Your therapist might ask you to work on your thoughts about what's going on. For example, when the anxiety associated with phobia begins, and you feel dizzy, you may automatically become alarmed and think you are in danger. Your therapist helps you to replace this with a more realistic thought such as "It's just dizziness and I'm going to be OK".

These techniques can also be learned and practised as self-help techniques, with help from family, friends or trained volunteers from organisations such as Anxiety Care.

Cognitive behavioural therapy

For some people with social phobias, the best treatment is cognitive behavioural therapy (CBT). This involves exercises to alter the inappropriate patterns of thinking you have developed and the behaviour that stems from them. Social skills training or relaxation techniques probably don't help.

Flooding

This is an alternative form of exposure therapy. This involves being exposed in one go to the feared object or situation. This is based on the idea that you can't stay anxious indefinitely - 40 minutes is about the maximum your body will stay in an anxious state. If you can bear this, at the end of it you may well be able to see that you have survived unharmed and the basis of your phobia is unfounded. This technique should be supervised by a trained therapist.

Medicines

Medicines are rarely used to treat simple phobias, though if you also have depression, this may be treated with medication. Antidepressants are used to treat agoraphobia, especially if you have panic attacks as well. SSRI antidepressants (eg paroxetine) can also be used for social phobia. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Your doctor may prescribe anti-anxiety medicines called benzodiazepines (such as diazepam) to ease symptoms in the initial stages of a psychological programme. However, you can only take these for short periods because they can lead to dependence.

Other medicines, called beta-blockers (eg propanolol), are sometimes used to reduce the symptoms of anxiety and have also been used together with psychological treatment programmes. Social phobias can be treated with SSRI antidepressants such as Prozac. However, treatment with medicines alone is usually not enough to treat your phobias effectively.