Phobias

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have a phobia, or who would like information about them.

A phobia is an inappropriate sense of anxiety or fear triggered by exposure to a specific object or situation. People with phobias have a strong desire to avoid whatever is causing their fears.

About phobias

Fear is a form of anxiety triggered by something in your surroundings. If the situation is a real threat - for example, you're being attacked - fear is a completely sensible and appropriate reaction. With phobias, the fear is inappropriate because you have an exaggerated or unrealistic idea about the harmfulness of the situation.

If you have a phobia, you may realise that your fear is out of proportion to the true danger or threat, but you can't control or explain it. Phobias can be very long-lasting and can cause problems ranging from minor disruption of your life to significant disability.

Types of phobias

There are three main types of phobia.

Specific or simple phobias
These are restricted to very specific situations. They are very common in children, where they are essentially thought of as normal, and usually disappear as children get older. However, some phobias carry on until adult life. Specific phobias can be divided up as fears of:

• animals (eg spiders, snakes, mice, birds and insects)
• the natural world (eg storms, heights, weather)
• blood, injections and injury
• certain situations (eg enclosed spaces, lifts, planes)

Sometimes, people can become phobic about catching illnesses or anything that puts them at risk of vomiting or choking.

Specific phobias are more common in women than men, and they often begin in childhood. People who suffer from these phobias rarely have any other psychiatric or psychological problems.

Agoraphobia
Agoraphobia means a fear of open spaces. However, it's sometimes used to refer to a fear of being away from your home and family, often because of worry about having a panic attack. During a panic attack, you may have overwhelming physical symptoms of anxiety. If you have agoraphobia, you will tend to feel worse the further you are from home. You may also have a fear of enclosed spaces (claustrophobia), main roads and public transport. Agoraphobia often starts in late adolescence or early adulthood. It's more common in women than men.

People with agoraphobia can become depressed, and may use alcohol or illegal drugs to try and help them deal with their problems.

Social phobia
Social phobia is when you have an excessive fear of social situations, such as small groups of people at parties. People with social phobia have no confidence with people they don't know, and fear that strangers are critical of them. You may also fear that you will behave in an embarrassing way, such as blushing or shaking in public. Around five in every 100 people have some degree of social phobia.

In some cases, social phobia may lead to excessive drinking, as some people with social phobia feel they need an alcoholic drink for 'Dutch courage' before a social event. Some people have a particular fear of eating in public, or of any meeting with potential partners. This may lead to people feeling isolated or lonely, because even though they may have social skills, they try to avoid social situations outside their immediate family.

Symptoms of phobias

If you have a phobia, you usually won't have any symptoms until you're faced with your feared situation or object (or, sometimes, if you think about or see a picture of it). You may then develop symptoms of anxiety, including:

• fast breathing (hyperventilation)
• palpitations - the sensation of feeling your heartbeat thumping in your chest
• muscle tension and pains
• sweating
• feeling faint
• numbness and 'pins and needles'
• dizziness
• 'churning' of your stomach
• diarrhoea

These sensations can be so unpleasant that you may change your behaviour to avoid coming into contact with your feared object or situation.

Causes of phobias

There are several different theories as to why phobias develop. They seem to run in families. But how much this is to do with picking up phobias from your parents and how much is inherited through your genes is uncertain.

Young babies seem to be naturally afraid of animals such as snakes and of heights, even though they need to learn to be afraid of man-made objects such as guns. So there is probably a natural fear response that gave our ancestors a survival advantage. It's possible that when phobias develop, this natural fear response has gone wrong.

Long-term stress can make people more vulnerable to problems such as phobias. Sometimes the start of a phobia may be triggered by a frightening situation or place, which caused a panic attack at the time. It may be possible to avoid phobias by encouraging children to face up to feared situations rather than stay away from them. However, this doesn't always work.

Treatment of phobias

Self-help

The best way to get over a phobia is to expose yourself to your feared object or situation and to tolerate the anxiety until it starts to decrease. Some people find that they can do this on their own, perhaps with the help of self-help books, support groups and friends and family.

Talking therapies

If self-help techniques haven't worked, talk to your GP. You may need professional help from a psychiatrist (a doctor who specialises in mental health conditions) or other therapist. For many people, the best treatment for phobias is behavioural therapy.

Behavioural therapy

Behavioural therapy involves one-to-one sessions with a therapist trained in treating phobias. The principle of this approach involves exposure and a gradual desensitisation to the thing that causes your phobia. During the sessions, you learn to tolerate the anxiety triggered by exposure with the help of relaxation techniques.

The amount of exposure is gradually increased during your sessions. For example, if you have a bird phobia, the early sessions might involve only looking at photographs of birds. They would then move on to handling feathers, before going to feed ducks. In a later session you might help to clean out a birdcage and handle the bird. Your therapist might ask you to work on your thoughts about what's going on. For example, when the anxiety associated with phobia begins, and you feel dizzy, you may automatically become alarmed and think you are in danger. Your therapist helps you to replace this with a more realistic thought such as "It's just dizziness and I'm going to be OK".

You can also learn and practise these techniques yourself, with help from your family and friends or trained volunteers from organisations such as Anxiety Care.

Flooding

Flooding is an alternative form of exposure therapy. It involves exposure to your feared object or situation. This is based on the idea that you can't stay anxious indefinitely - 40 minutes is about the maximum your body will stay in an anxious state. If you can bear this, at the end of it you may well be able to see that you have survived unharmed and the basis of your phobia is unfounded. This technique should be supervised by a trained therapist.

Cognitive behavioural therapy

For some people with social phobias, the best treatment is cognitive behavioural therapy (CBT). This involves exercises to alter the inappropriate patterns of thinking you have developed and the behaviour that stems from them. For more information, see Related topics.

Medicines

Medicines are rarely used to treat simple phobias, although your doctor may prescribe you medicines if you also have depression.

Antidepressants are used to treat agoraphobia, especially if you have panic attacks as well. Certain antidepressants (eg paroxetine) can be used for social phobia. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Your doctor may prescribe anti-anxiety medicines called benzodiazepines (such as diazepam) to ease symptoms in the initial stages of a psychological programme. However, you can only take these for a short time.

Other medicines, called beta-blockers (eg propranolol), are sometimes used to reduce the physical symptoms of anxiety (eg palpitations) and have also been used together with psychological treatment programmes. However, treatment with medicines alone is usually not enough to treat your phobias effectively.

Other treatments

Hypnotherapy may be helpful for treating phobias. Hypnotherapy is the use of hypnosis to relieve your symptoms.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.