Download Date created : 26/01/2011 Phobias Introduction A phobia is an

Date created : 26/01/2011
Phobias
Introduction
A phobia is an anxiety disorder. It is an extreme or irrational fear of:




an animal,
object,
place, or
situation.
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,
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
1
Date created : 26/01/2011




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.
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
2
Date created : 26/01/2011
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,
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
3
Date created : 26/01/2011












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
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
4
Date created : 26/01/2011
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.
If someone 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 persons 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
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
5
Date created : 26/01/2011
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
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
6
Date created : 26/01/2011
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
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
7
Date created : 26/01/2011
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,
tranquilisers, 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
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
8
Date created : 26/01/2011
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
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
9
Date created : 26/01/2011
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
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
10
Date created : 26/01/2011
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:
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
11
Date created : 26/01/2011



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.
Expert view
Psychologist Paul Salkovskis, professor of clinical psychology and applied science at King's
College London, explains what he would want to know if he had a phobia.
When does a fear become a phobia?
A fear becomes a phobia when you have to arrange your life around avoiding the thing youre afraid
of. You have a phobia if you start to change your life to avoid coming into contact with the thing
you're scared of.
What types of phobia are there?
Phobias can be specific (particular objects or situations) or generalised. A phobia of cats, dogs or
heights, for example, is specific. Generalised phobias tend to be either social phobia (a fear of
interacting with other people in social situations) or agoraphobia (a fear of public places that are
difficult to escape from).
Social phobia may begin as shyness, which can grow to the point where it interferes with your life.
Agoraphobia is often caused by panic attacks. If youre afraid of experiencing panic attacks in
particular places, you dont go to those places.
When do phobias develop?
Specific phobias often start in childhood, between the ages of about four and eight. Social phobia
and agoraphobia usually start much later. Social phobia often starts at puberty and agoraphobia
usually starts towards the late-teens and 20s.
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
12
Date created : 26/01/2011
Can you prevent a phobia from developing?
Its a really good idea to familiarise children early on with the things theyre afraid of in a controlled
way. That way, you can reduce a fear of, say, spiders before it becomes a problem in later life.
How serious are phobias?
Agoraphobia and social phobia are usually much more disabling than specific phobias, although
youll occasionally see someone with a specific phobia who is completely handicapped by it. But
generalised phobias are much harder to live with than specific phobias because you cant really
avoid people and going to crowded places.
Can my phobia be treated?
The good news about phobias is that theyre all treatable. For specific phobias, the treatment
always involves some type of exposure in which you confront the thing youre afraid of. For phobias
of small animals, such as snakes and spiders, this treatment can be done in the space of three
hours. Its a highly successful technique and almost all of the people who go through it are cured.
Social phobia and agoraphobia tend to get progressively worse if you dont get help. In these
cases, its really important to get treatment, usually cognitive behavioural therapy (CBT). This
treatment takes weeks rather than hours, but is highly effective.
'Even the thought of going into my garden made me panic'
Claire Ledger was diagnosed with agoraphobia after she had a panic attack
while shopping in her local high street.
Claire, 26, was unable to explain the experience. She initially believed that it may have had
something to do with where she was, so she stopped going there and began to shop elsewhere.
When she had a similar attack in another location, she stopped going there too.
Within five months, she had stopped going to so many places that she only felt truly safe at home.
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
13
Date created : 26/01/2011
She left her job as a nurse and spent the next two-and-a-half years indoors. She read, watched TV,
surfed the web and cared for her husband, who is in a wheelchair, and never went outside.
When I had the first attack, I didnt know what was happening, says Claire, who lives in Bradford,
West Yorkshire. I was inside a shop and I felt suddenly faint and had to crouch down to avoid
collapsing. I was shaking and felt sick.
She went to her GP, who initially thought she was suffering from stress. Claire had just begun a
new job, had recently married and was undergoing IVF (in-vitro fertilisation) treatment.
Every time I went out after that, I got this feeling again, she says. Everywhere it happened, I
avoided that place. Instead of thinking it was me, I associated the panic attack with the place. I was
such an outgoing person, the idea that it was all in my head never occurred to me.
She was eventually diagnosed with agoraphobia, a fear of open spaces, which is estimated to
affect 30 people in every thousand at any one time in the UK.
I got to a point where my stomach dropped as soon as I woke up, she says. Its like a feeling of
grief and despair. Youre shaking, tired and you dont really feel there. Its like youre watching
yourself.
I tried to get through it but I reached a stage when even the thought of going into my own garden
made me panic. It was like coming up against an invisible wall.
"It was hard on my husband. Hes a big sports fan and likes going out to watch live events.
The couples elderly neighbours helped out with getting food and household supplies. I felt
ashamed that someone in their 70s was doing my shopping, says Claire.
She became determined to get treatment and had a course of cognitive behavioural therapy. She
found the treatment helpful, but it didnt change her thought process.
What made the difference was sharing her experience with fellow sufferers, whom she contacted
through support groups on the internet.
You feel like a freak, she says. Talking to other people in the same position was what helped me
most. We worked on breaking down our boundaries together.
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
14
Date created : 26/01/2011
She became friends with a woman in another town. They made the same trips together in their
respective neighbourhoods, slowly increasing the time and length of their journeys.
We would call each other before leaving the house and we would remain on the phone to each
other until we got back in, says Claire. Even though she was not there in person, her voice was
really reassuring.
For the next two years, this was how Claire expanded her boundaries from her doorstep. My
husband changed our mobile provider when he saw the monthly bills I was running up, she says.
Claire has learned to cope with her moods and has now regained enough confidence to go back to
work.
Its important for people to know that you can recover, she says. You may think its like a death
sentence but the treatments do work. I never thought Id return to work.
"I still have my down days but Ive learned to accept that you cant feel your best every day.
'Vomit makes me panic'
Most of us find vomit unpleasant, but even the mention of it makes Hilary
Fraser panic.
In fact, as this page contains the words vomit, sick and throwing up, she probably won't be able to
read it.
Her condition, known as emetophobia, is one of the 10 most common phobias in the UK, according
to Anxiety UK.
Vomiting is a momentary loss of control and a cause of embarrassment for Hilary, 55, who lives in
Bournemouth. If I'm sick, I always need someone with me to reassure me, she says. Being sick on
my own is my worst nightmare.
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
15
Date created : 26/01/2011
She has a similar but much milder reaction to sneezing or hiccups in public. If I sneeze more than
three times, I go into a panic, she says. The sickness itself isnt so much of a problem. Its the
unexpected loss of control that I cant deal with. Im a control freak. Im comfortable when Im in
control. I dont like surprises.
Seeing other people vomit is enough to make her sick. The sight and smell can make me gag, she
says. I was out on my own the other day and somebody in a shop said 'six' and I misheard it as
'sick'. I suddenly went bright red and started shaking and sweating. I had a full-blown panic attack.
Hilary's phobia began when she was at school. She remembers one year when several pupils had
a sickness bug. People were being sick in front of me, says Hilary.
The only time she has been able to control her phobia was when her three children were growing
up. My daughter could throw up at the drop of a hat so I kind of became desensitised to it, she
says. But when they all left home and I was no longer exposed to it, the symptoms returned.
Hilary has never seriously considered treatment. She believes that nothing is effective. A doctor
told her that it was normal to be put off by vomit. I dont think people understand how paralysing it
can be, she says.
Her fear of sickness means she avoids public transport and most public lavatories, doesnt go on
holiday and does all of her shopping online.
Shes a full-time carer for her husband, who suffers from the effects of a head injury. My life is
based around the home. I stick to my safe places: my house, my garden and my sisters place, she
says. Gardening is a passion. Depending on the weather, I spend two hours a day gardening.
Her other passion is distance learning and she is very proud of being an Open University graduate.
"Distance learning is my window on to the world, she says.
I accept that I cant do some things. I dont live a life that other people would like but I manage. Im
happy most of the time.
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle
decisions about things like smoking, drinking and excercise, through to the practical aspects of
finding and using NHS services when you need them.
www.nhs.uk
16