A phobia is a persistent and irrational fear of a specific object, activity, or situation resulting in an anxiety reaction. A phobia causes a compelling desire to avoid the perceived hazard. This avoidance usually results in an alteration of occupational or social functioning. The patient recognizes that his fear is out of proportion to any actual danger, but he can't control it or explain it away. Panic attacks can be triggered by the phobia.
Common phobias include claustrophobia (fear of enclosed spaces), fear of blood, and fear of flying. Social phobias are specific fears of certain situations and people, such as meeting strangers, using public rest rooms, or talking at a party.Life-long phobias occur in 10% to 11% of the population; phobias lasting a year occur in 9% of the population. Onset is usually childhood to early adulthood, and there is a familial tendency.
A phobia develops when anxiety about an object or a situation compels the patient to avoid it. In each case, the patient is aware that the fear is excessive and unreasonable for the situation.
Types of Phobias
Most people have no symptoms until they are faced with their feared situation or object. When they are confronted by this, they have severe symptoms of anxiety. These can be so unpleasant that the person takes elaborate steps to avoid coming into contact with their feared object.
Symptoms of anxiety include:
In severe cases, these symptoms can occur even when the person is thinking about being close to the feared object or simply seeing a picture of it.
Beta blockers are useful in the treatment of "performance anxiety" but not social phobias because they can prevent the occurrence of perspiration, tachycardia, palpitations, and tremors. Monamine oxidase inhibitors alleviate social phobias independently of their antidepressant activity. Serotonin re-uptake inhibitors are also effective. Benzodiazepines are helpful in reducing fearful avoidance but, because of the chronic nature of phobias, are limited.
Relapse rates are high when medication is used alone as treatment. Behaviorally focused psychotherapy is important in treatment. Cognitive-behavioral strategies, individual and group sessions, and desensitization therapy are particularly effective. Systematic desensitization, a behavioral therapy, may be more effective than drugs, especially if it includes encouragement, instruction, and suggestion. Such therapy should help the patient understand that his phobia is symbolic of a more fundamental anxiety and that he must deal with it directly.
In some cities, phobia clinics are available in which people who have recovered from phobias can often help other phobic patients.
Self help for phobias
The personal motivation to expose oneself to the feared object and to tolerate the anxiety is the most important aspect of treatment. Some people find that they can do this on their own, perhaps with the help of books and support from friends and family.
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