Phobia

Phobia has been recognized as a separate diagnostic label in the International Classification of disease since 1947, while the Diagnostic and Statistical Manual (DSM) has introduced phobia as a mental disorder in 1952 (Maj, Akiskal, Lopez-Ibor & Okasha, 2004). Today, phobia is placed by the DSM-IV under the broad classification of anxiety disorders and is defined as a persistent fear towards a certain object or situation that the subject wants to avoid, feeling towards that object or situation a disproportionately irrational fear compared to the actual threat that the respective object or situation poses.

Types:

DSM-IV (2000) regards phobias as sub-categories of anxiety disorder, dividing them in:

1) Social phobia – “When the normal slight anxiety at social occasions becomes so great as to disrupt everyday life, then it is a social phobia.” (Maj et al., 2004, p. 20). So, even eating or drinking in front of someone could be a very difficult task, that makes a phobic individual shiver, blush, sweat, grow nauseous and feel a gradually tightening knot form at the throat, preventing him/her from swallowing. The fear that others are looking at him/her, of drawing attention becomes overwhelming and stops those suffering from phobia from being functional, from behaving naturally or, for example, from getting out in public at other times of the day than midnight. Social phobia is divided in generalized social phobia (social anxiety disorder) and specific social phobia (the person feels embarrassed only in certain contexts)

2) Specific phobias: a constant fear of a specific object or situation: snakes, heights, flying by plane, water, dentist, ghosts etc. Although many people can fear such objects or situations, most of them can control their fear and interact with that which specifically triggers the fear, while phobic people totally avoid it.

3) Agoraphobia – fearing open spaces and feeling insecure in unfamiliar areas. Due to intense fear, panic attacks can happen.

Symptoms:

Even though the criteria for establishing a diagnosis are different for each sub-category of phobia, some of the common symptoms are:
• marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (both in specific phobias and social phobia);
• exposure to the panic trigger leading to strong anxiety and even panic attacks; the person admits that the fear is excessive and irrational;
• confronted with the panic trigger, the person manifests intense anxiety and distress;
• due to avoidance, anxious anticipation or distress in the feared situation(s), the person will function ineffectively (bad job or school results, difficulties in relationships etc);
• the situation of anxiety in relation to a trigger should last more than 6 months.

Causes:

Multiple causes are thought to be at the root of phobia apparition: learning through conditioning (behavioural model), unconscious desires (psychoanalytical model), a traumatic event or even genetic factors (as proven by studies made on twins) (Craighead & Nemeroff, 2002). However, a polemic debate is still going on between psychiatrists in relation to what causes phobias and the topic is still open to extensive research (Honavec, 2000).

Treatment:

Many treatment alternatives have been used across time for treating phobias. Most of them are not based on medication, psychotherapy proving to be sufficiently effective. The most popular approaches to healing phobias are: cognitive behavioural intervention (especially in specific phobias), interpersonal treatment (especially in social phobia), eye movement desensitization and reprocessing (EMDR), hypnotherapy and NLP.

The patient can only find the approach that best fits him/her together with a certified mental health specialist. This way, he/she can make genuine progress in exploring the illness and understanding its causes to finally overcome the symptoms of this condition.

References:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.
Craighead, W. E., & Nemeroff, C. B. (2002). The Corsini Encyclopedia of Psychology and Behavioral Science (2002). England: John Wiley & Sons, Ltd.
Hovanec, E. M. (2000). Everything you need to know about phobias. New York: The Rosen Publishing Group, Inc.
Maj, M., Akiskal, H. S., Lopez-Ibor, J. J, & Okasha, A., (2004). Phobias. England: John Wiley & Sons, Ltd.