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When Fear Is The Only Enemy

Professor MacDonald, who taught Shakespeare for 35 years, had a sunny disposition, but when it stormed outside, his colleagues escorted him to the faculty lounge where he huddled in a chair until the storm passed.

An estimated 18 million Americans of all ages suffer from at least one phobia. A phobia becomes a problem only when it causes a person to avoid common activities or interferes with work or family. It is defined as an intense, persistent, unrealistic fear of an object, an event or a feeling. Described by their Greek names like arachnophobia (fear of spiders), these fears may sound romantic or humorous. For some, they cause substantial trauma and inconvenience.

Many individuals develop phobias after a frightening experience, either in childhood or in adult life. When a plane she was in narrowly averted a crash, Joanie became focused on plane crashes. Her fear developed into a phobia, bringing out beads of sweat every time she boarded a plane. Eventually, Joanie began to avoid airplanes entirely, canceling important business meetings and turning down a promotion.

Specific Phobias Not So Simple

The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) classifies phobias along with anxiety disorders such as panic attacks, generalized anxiety and obsessive-compulsive disorder. It lists two general types:1) specific or simple phobias and 2) social phobias. Agoraphobia, involving fear of leaving home or of losing control in a public place, is usually considered a separate anxiety disorder and is best covered in a separate article.

Specific phobias are divided into subtypes, listed in order of frequency:

  • Situational: fear of elevators, bridges, flying, tunnels, driving, enclosed places, public transportation; often surfaces in early adulthood.

  • Natural Environment: fear of storms, heights, water or other objects in the natural environment.

  • Blood, injection or injury: fear of a needle, an injection or medical procedure; or a phobia cued by seeing blood or an injury. This type, even more than the others, tends to run in families.

  • Animals: fear of cats, dogs, horses, snakes, mice, spiders or other animals or insects.

Physiologically, a person with a phobia exhibits a fight or flight response, with pounding heart, sweating, trembling and other symptoms of anxiety. However, a phobia of blood, injury or injections produces a brief period of faster heart rate followed by a rapid drop in heart rate and blood pressure that often causes the person to faint.

Sigmund Freud used Little Hans, a five-year-old boy with a fear of horses, to describe his psychoanalytic theory of phobias, which he believed originated with repressed desires. In 1920, John B. Watson countered with Little Albert, a boy whose phobias were ascribed to conditioned responses. Most mental health professionals today believe that phobias can be traced to a variety of sources and are probably at least partly genetic. From 60 to 70 percent of phobia patients have at least one close relative with a phobia of the same subtype.

In some cases, as with Joanie, a specific situation (such as air travel) may become linked to strong emotions (the fear of death) through one or more traumatic experiences, creating a conditioned response. Treatment may include anti-anxiety medications plus systematic desensitization, gradually exposing the patient to the object of his or her fears with the support of a therapist, or relaxation techniques to ease the symptoms.

Social Phobias

Social phobias are the third most common mental disorder after depression and alcohol dependence. About half of Americans say they are shy, at least in some social situations. Having to speak in public, take tests or make small talk on the phone can cause anxiety. In less common forms, persons are unable to use a public toilet, eat in a restaurant or sign a check while someone is watching.

A more generalized type of social phobia leads to anxiety in a wide range of social situations. Particularly vulnerable to rejection, these individuals feel that others are trying to put them down. Afraid of appearing foolish, they find it hard to initiate a conversation, ask questions in a lecture or call others on the phone. Some social phobics work in low paying jobs simply because they fear the social interaction another job would require; others remain single, too shy to ask for a date. Even thinking about social situations may trigger symptoms that include blushing, palpitations, rapid heart beat, sweating, tremulousness, shortness of breath, weakness in the legs and a desire to escape. A person with social phobia is three times more likely than other persons to have at least one close family member with the same problem.

Many researchers now suspect that brain chemicals such as norepinephrine, dopamine and serotonin play an important role in the development of social phobias, probably in combination with stressful experiences and poor social skills.

Treatment often combines behavioral therapy and social skills training with medications such as serotonin specific reuptake inhibitors (SSRIs), monoamine oxidase (MAO) inhibitors or beta blockers. Many SSRIs are approved for the treatment of obsessive-compulsive disorder and panic disorder. Without treatment, a phobia of any type can cause a lifetime of suffering and inconvenience. Those who step forward nearly always find the help they need.

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Last modified: Wednesday, April 23, 2014

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