Phobias: symptoms, types, causes and treatment
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A phobia is characterised by an overwhelming and debilitating fear of objects, situations, places, feelings or animals. It is not necessary for the affected individual to recognise that their anxiety is excessive or unreasonable although often they acknowledge that it may be an irrational response.
This is associated with a sense of uncontrollable anxiety and avoidance behaviours. There is an inability to function normally when exposed to the trigger.
Whilst it is normal for all of us to have ‘fears’ of particular objects or situations, these fears reach the threshold of becoming a phobia when:
- The imagined threat is out of proportion to the actual danger, accompanied by loss of control when exposed to the source of the fear
- The behaviour lasts for more than 6 months
- It affects the ability to function ‘normally’, impacting significantly on the life of the individual
- It is not directly caused by another disorder
Specific phobia vs complex phobia
While having a specific or simple phobia can be significantly distressing, complex phobias are perhaps the most difficult to manage. This is primarily due to the fact that they tend to be involved with many aspects of modern life, which means an individual has to face their fears on a regularly basis, and is not as easily avoided without having an adverse effect on your relationships, career and overall quality of life and wellbeing.
Symptoms of a phobia
Having a phobia of any kind will involve both psychological and physical symptoms, with panic attacks being particularly common. Panic attacks can occur when coming into contact with your phobia or even when thinking about it, as your brain has actually created an inbuilt reaction to your most feared situation or object even if you are not in a the expected situation which would usually cause worry or panic.
If you have a phobia that is particularly severe, you may experience intense thoughts and emotional difficult which can include the following symptoms:
- Fear of losing control
- Fear that you are going to die
- Overwhelming feeling of dread
- Fear of fainting
- Fear of experiencing the uncomfortable anxiety associated with the phobia
The physical symptoms of having a phobia can be almost as distressing as the fear of the situation or object itself. If you find yourself within the situation or in contact with your phobia, symptoms of overwhelming anxiety and panic can occur, which may involve the following:
- Shortness of breath and problems breathing
- Hot flushes or feeling cold
- Trembling
- Sweating
- Headaches
- Dizziness
- Pain in the chest area
- Nausea
- Feeling as if you are about to faint
- Dry mouth
- Confusion
Less severe forms of selective mutism may see your child become confident enough to communicate through gestures such as shaking or nodding their head to agree or disagree with what is being said, even if the situation is making them feel socially uncomfortable. If your child is diagnosed with more severe selective mutism, they may shy away from using alternative forms of communication for fear of being pressured into talking through this behaviour.
Therapeutic treatment programmes look to reduce the debilitating symptoms of selective mutism, helping your child to feel comfortable showing off their personality in a variety of social settings.
Causes of phobias
Phobias don’t have one single cause, and there can be a number of factors during your lifetime which can make you more likely than others to develop a phobia.
Phobias are most often diagnosed during childhood, adolescence or early adulthood, and can often be linked to a particularly stressful situation or traumatic event in early life, which becomes entrenched in your mind as something to be feared intensely.
To determine why a phobia may happen in some people and not others, it helps to analyse the two different categories of phobia, which include specific or simple phobias and complex phobias.
Causes of specific or simple phobias
Specific or simple phobias involve a fear of a specific object or situation, including animal based phobias, phobias related to nature such as heights or water, and phobias of medical procedures such as having injections or seeing blood.
Negative experiences in childhood are often the root cause of these phobias. As an example, being trapped for an extended period in an enclosed space when you are younger can cause a fear of confined spaces to develop, known as claustrophobia.
If you are living with family members who also have a specific phobia, such as a fear of rodents or spiders, it is also believed that you can learn this behaviour and may develop the same fear yourself. Genetic influences can also be a factor, which include your inherited ability to deal with anxiety inducing situations, and can impact how you cope with your fears in later life.
Causes of complex phobias
The causes of complex phobias such as agoraphobia and social phobia are more unclear, although a combination of genetics, environmental factors and your brain chemistry are believed to play a role.
The abnormal release of adrenalin causing symptoms of panic in situations that present no immediate danger, such as large crowds in agoraphobia or social situations which may cause you severe discomfort in social phobia may have developed from a series of embarrassing or uncomfortable events during childhood.
If you were particular shy or lacking in self-esteem as a child, or have suffered from long-term stress, this can cause symptoms of depression and anxiety which reduces your ability to cope in certain situations.
Types of phobias
There are many types of phobias, including situational phobias (lightning, enclosed/open spaces, darkness, flying and heights), animal phobias (spiders and snakes), mutilation phobias (injections, dentists, injuries) and agoraphobia (fear of places seen as dangerous, uncomfortable or unsafe, leading to a desire to escape). There is also social phobia which focuses more on cognitive than behavioural responses.
Agoraphobia
Fears are very prevalent and phobias occur in up to 13% of the population. They are also twice as common among women. Phobias all come about from a classic conditioning model; they are involuntary reactions which are physiologically driven.
Signs and symptoms vary from person to person, as there are often several different phobias making up an overwhelming fear of being in open or crowded spaces combined with an anxiety of not being able to escape or easily find help if you have a panic attack.
This means that symptoms of intense anxiety and panic can set in to the point where you may fear going shopping or even leaving your house, and can leave you feeling lonely and isolated in the most severe cases.
Triggering situations and psychological symptoms which can cause panic in agoraphobia include:
- Spending too much time alone
- Being in crowded, open or small spaces without a clear exit or help point
- Environments where people may look at you for an extended amount of time
- Fearing death or that a panic attack may cause you to die
- Fear of losing control in a public place
- Fear of being embarrassed because of your panic symptoms
Social phobia
Actively avoiding social situations, particularly those where you may have to meet people you don’t know very well. The very idea of being seen in public or at a social event may cause you to feel frightened or anxious. Much of these symptoms stem from being pre-occupied with what others think of you, or that you will embarrass yourself in some way, no matter how unlikely this may be.
If you have severe social phobia, as with agoraphobia, your levels of fear and anxiety can become so high that you feel unable to leave your home.
Triggering situations and psychological symptoms which can cause panic in social phobia include:
- Job interviews
- Shopping
- Eating in public
- Public speaking
- Talking on the phone
- Formal meetings
- Excessively worrying for days or weeks before a social event
- Worried about being embarrassed and people witnessing
- Using alcohol as a ‘social lubricant’ to mask symptoms of anxiety
- Takings days off work, college or university due to anxiety
- Fear of talking during social situations, particularly if around people you are unfamiliar with
- Fear that people will notice physical signs that you are anxious (blushing, trembling)
What is the best treatment for phobias?
Graded exposure
Most treatment for phobias at Priory involves a variation on what is known as ‘graded exposure’. This involves trying to tackle the fear of a situation by acknowledging how it could be approached, even at first using imagination, before trying to tackle the feared situation in reality.
Interoceptive exposure is used to expose bodily sensations. Exposure to feared bodily sensations is necessary to learn how dangerous they truly are. The aims of interoceptive exposure are:
- To elicit the feared bodily sensations
- To activate any unhelpful beliefs associated with the bodily sensations
- To maintain the feared bodily sensations without distraction or avoidance
- To allow new learning about the bodily sensations to take place
It is important to note that your therapist will work through interoceptive exposure with you.
This involves carefully and systematically learning to face the fear in a gradual and controlled way, thereby reducing the avoidance, which is known to worsen the problem. Safety behaviours that have been put in place in order to attempt to avoid the problem will be identified and challenged. These techniques may, at first, involve imagining exposure to the feared situation rather than in a real life situation.
Cognitive behavioural therapy (CBT)
Treatment for ‘complex phobias’ may take longer and cognitive behavioural therapy is mainstay of treatment at present. It aims to address the dysfunctional thought processes that underpin the person’s anxiety and evaluate more realistic ways of viewing situations and developing healthier thinking processes.
Psychotherapy
Before that can be undertaken, it is often necessary to be able to learn techniques for managing symptoms of anxiety and improving coping techniques before the procedure begins.
Priory can offer specific treatments, including talking therapies such as cognitive behavioural therapy (CBT) and other evidence-based treatments in order to help you understand more about why your phobia exists and how you can reduce associated symptoms.
CBT is widely used across the world to treat a range of mental health conditions, as it helps identify the relationship between your thoughts, feelings and behaviour, before pro-actively challenging any negative thoughts associated with your phobia by learning practical methods of managing patterns of negativity.
It is also very important to properly assess a phobia, as they it could form part of a wider issue involving symptoms of anxiety and depression, or could be exacerbated by these co-existing conditions, in which case these conditions would need to be treated independently of your phobia.
Medication
While exposure therapy and talking therapies such as CBT are the main treatments used to relieve symptoms of phobias, taking medication alongside therapy sessions can help with any severe symptoms of anxiety you may be experiencing, which in turn can make your therapy sessions more effective.
If anxiety linked to your phobia is severe, or if you have co-existing mental health conditions such as anxiety or depression, then the most commonly prescribed drugs which can help improve symptoms include a type of anti-depressants known as selective serotonin reuptake inhibitor (SSRI) antidepressants.
Further drugs which may be recommended for severe anxiety that is impacting your day-to-day life include those with tranquilising effects such as a benzodiazepine, for example Valium. These drugs should only be taken for a short time, as they can be highly addictive.
For physical symptoms of anxiety, beta-blockers such as propranolol can help reduce the rapid-heartbeat, tremors and palpitations associated with intense anxiety and panic attacks, although they won’t help cure the psychological symptoms underpinning your phobia. If you have a specific or complex phobia that only arises occasionally, such as having to go on an aeroplane, then these drugs can be particularly effective.
