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Phobias Incidence
Phobias such as social phobia, specific phobia, and panic
disorder (including panic disorder with agoraphobia, the inability to go into
certain situations due to the fear of entrapment) are the most common form of
clinical disorder associated with fear and anxiety, affecting 10-15% of the U.S.
population. Phobias are the most common psychiatric difficulty among men older
than 25 and among women of all ages. Genesis
Phobias originate from both learning and psychophysiology,
including genetic influence and biological “hard wiring” in the brain. For
example, human beings appear to be biologically “prepared” to learn fears of
certain stimuli: It is typically much easier to learn to be afraid of a snake or
a spider in lab experiments than it is to learn a fear of a flower or a lamp.
Once fear is learned experimentally in a laboratory, it persists much more
tenaciously to prepared stimuli than to neutral stimuli. It is also true that
identical twins tend to “share” anxiety disorders more often than do fraternal
twins and that anxiety disorders tend to run in families.
Clinical fears may also be learned from a direct, traumatic
experience with a stimulus of some sort or from observing someone else exhibit a
phobic level of fear upon exposure to a specific stimulus.
The amygdala, an “organ” of the brain and part of the limbic system, may be
responsible for the way the brain reacts to feared and prepared stimuli. For
example, due to activity in the amygdala, a person with a pre-existing fear of
spiders (but not snakes) will have a prolonged fear reaction to a picture of a
spider but only a temporary and subdued reaction to a picture of a snake.
Clinical Phobias We describe 3
types of phobia just below:
1) Social phobia is a fear of the scrutiny of others,
especially in situations in which social, occupational, or athletic performance
in front of others is involved.
2) Specific phobia is an intense and irrational fear of a
specific object, animal, or situation; e.g., spiders, snakes, non-threatening
dogs, heights, ladders, knives, and water. A specific phobia may also include
fear of flying, but the fear must be distinguished from panic disorder. People
who are true flying phobics are afraid of their plane crashing. People who have
panic disorder may also avoid planes, but this is due not to fear of a crash but
to fear of being in an enclosed area with no means of escape.
3) Panic Disorder - at first glance - appears to be multiple
phobias because the patient may express fear of elevators, bridges, airplanes,
movie theatres, shopping malls, haircuts, driving, and being stuck in traffic.
In actuality, patients suffering from panic disorder are not afraid of these
situations per se; rather they are afraid of having a panic attack in these
situations. Treatment The
most prolifically studied therapy for specific phobia is systematic
desensitization, a technique which combines gradual exposure to the feared
object – at first via imagination – with relaxation. This therapy is easy to
tolerate and effective; however, it typically takes longer to complete than
exposure therapy described below. Exposure therapy, the
primary component of behavioral treatment approaches to specific phobia, social
phobia, and panic disorder, involves a graduated, "real time" confrontation with
the feared stimulus, starting with mid levels of fear and working up. The
patient is asked to practice on a daily basis and each time to remain in the
feared situation for a prolonged period of time. The patient is also given much
correcting and therapeutic information as a way of reducing the fear. This is a
highly effective and efficient form of care, but it is difficult to tolerate. |
