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Phobias

A phobia is a constant, extreme or irrational fear of an animal, object, place or situation that wouldn't normally worry the majority of people.

A phobia is when you have an overwhelming need to avoid any contact with the specific cause of the anxiety or fear. Coming into contact, or even the thought of coming into contact with the cause of the phobia, makes you anxious or panic.

If it's unlikely that you will come into contact with the object of your phobia, for example, snakes, it won't tend to affect your everyday life too much. However, phobias such as agoraphobia and social phobia can make it very hard to lead a normal life.
Phobias are divided into two types:

Simple phobias

This type is about a single object, situation, or activity. Common examples are a fear of insects, heights, snakes, enclosed spaces, dentists or flying. If you have a simple phobia you might react with mild anxiety or even with panic when confronted with the prospect of facing source of your fear.

Complex Phobias

Agoraphobia is an example of a complex phobia. It involves several anxieties, including fear of entering shops, crowds, and public places, or of travelling in trains, buses, or planes. It also includes anxiety of being unable to immediately escape to a place of safety; usually home.

Social phobia is another complex phobia. Social phobia is a fear of social e.g. a wedding, or performance situations e.g. public speaking. Those with a social phobia have a fear of embarrassing themselves or of being humiliated in public.

If you have a social phobia, the thought of being in public or appearing at social events will make you extremely anxious and frightened. It's because these types of situations make you feel vulnerable.

Avoiding meeting people in social situations, including parties or eating in restaurants are typical signs of social phobia. In extreme cases, some people are too afraid to leave their home.

Paruresis (also known as 'bashful bladder' syndrome) is another type of social phobia. This anxiety disorder means being unable to use public toilets or urinate when others are nearby. It can make it hard to do normal activities, for example, going to work, social events or taking holidays. Paruresis can start at any age and seems to affect men more than women.

1 to 2 % of men and women have a social phobia and it is usually linked to low self-esteem and fear of criticism.

Symptoms

Although a phobia is not described as an illness, the thought of coming into contact, or the actual contact with your feared object, place or situation can lead to panic.

Panic can create real physical symptoms that include:

  • shaking,
  • feeling confused or disorientated,
  • rapid heart beats,
  • dry mouth,
  • intense sweating,
  • difficulty breathing,
  • feeling sick (nausea),
  • dizziness, and
  • chest pain

In extreme cases, especially if you have a complex phobia, you may experience the above symptoms as well as:

  • a fear of losing control,
  • a fear of fainting, or
  • a fear of dying.

The symptoms of social phobias are very similar but also include blushing, trembling or an urgent need to visit the toilet.

The most common factor of a phobia is the need to avoid the animal, object, place or situation at all costs. This may mean that your daily activities are limited and can lead to depression. Anxiety and panic attacks may also develop.

Causes

Phobias usually develop in late childhood, adolescence, or early adult life in response to a frightening event or situation. However, it's not always clear where phobias come from.

The cause of simple phobias is not always known. Occasionally a simple phobia can be traced to an earlier experience. For example, a child being trapped in an enclosed confined space may develop claustrophobia when they're older.

Sometimes, certain phobias, for example, a fear of spiders, run in families. This is probably because children learn to fear, rather than inherit the phobia from a family member.

The causes of complex phobias, such as agoraphobia and social phobia, are unclear. Social phobias may begin due to an anxious and intense experience in a social situation. Or it may be that your social confidence did not have the chance to fully develop past the normal stage of shyness of a young child.

Diagnosis

Most people with phobias are fully aware that they have a phobia.

Some people with simple phobias tend to live with the phobia (taking great care to avoid whatever makes them anxious) and never ask for a proper diagnosis. Others benefit from seeking help from a private counsellor with expertise in behaviour therapy.

If you have a complex phobia, it is advised that you seek help from your GP who may refer you to a psychologist or psychiatrist, if necessary.

For a diagnosis of social phobia, all of the following factors should be present:

  • Symptoms must be due to anxiety and not secondary to other symptoms, such as delusions or obsessions.
  • The anxiety is the direct result of being in particular social situations; and
  • Avoidance of the phobic situations must be a prominent feature.

Treatment

Many people don't seek professional help for phobias and try to find their own way of coping but there are different treatments available.

Talking treatments

  • These include counselling, psychotherapy and cognitive behaviour therapy:
  • Counselling is usually a weekly session that deals with specific problems.
  • Psychotherapy is more in-depth with a focus on finding and dealing with the root cause and ways for you to cope.
  • Cognitive behaviour therapy explores thoughts, feelings and linked behaviour, combined with practical ways to deal with the phobia.

Speak to your GP to find out whether these treatments are available through your own surgery or if you can have a referral.

Many simple phobias can be treated using desensitization, which is a form of behaviour therapy. The therapist gradually exposes you to the situation or object of fear and as time goes on, you feel less anxious. Support can also be gained from a self-help group where you can speak to others who are going through the same as you.

Treatment for social phobia usually involves a combination of cognitive behaviour therapy and antidepressants.

Medication is only recommended in the short term as it is best to see if other techniques, such as talking therapy, will work.  The three main types of drugs that are used to treat anxiety issues, including phobia, are antidepressants, tranquillisers and beta-blockers.

Complications

People with phobias may be unable to do certain things, for example, those with agoraphobia will have difficulty leaving one's home, meeting other people or holding down a job.

The information shown here is Crown copyright and has been reproduced with the permission of NHS Direct. Last updated June 2007.