The Things That Go Bump in the Mind
From 50 yards away, you see the animal approaching. Silently it watches you as it slinks ever so much closer with each padded step. Stay calm, you tell yourself. There's nothing to fear.
But suddenly, panic seizes you in a death grip, squeezing the breath out of you and turning your knees to Jell-O. Your heart starts slam-dancing inside your chest, your mouth turns to cotton, and your palms are so sweaty you'd swear they'd sprung a leak. You'd escape this terrifying confrontation, if only you could make your legs work!
Just what is this wild and dangerous animal making you hyperventilate and turning your legs to rubber? A man-eating tiger, hungry for a meal? A lioness bent on protecting her cubs? Guess again. That's Tabby, your neighbor's ordinary house cat, sauntering your way. Ridiculous, right? How can anyone experience so much fear at the sight of such an innocuous animal? If you're one of the thousands who suffer from galeophobia--the fear of cats--or any one of hundreds of other phobias, sheer panic at the appearance of everyday objects, situations or feelings is a regular occurrence.
A phobia is an intense, unrealistic fear of an object, an event, or a feeling. An estimated 18 percent of the U.S. adult population suffers from some kind of phobia, and a person can develop a phobia of anything--elevators, clocks, mushrooms, closed spaces, open spaces. Exposure to these trigger the rapid breathing, pounding heartbeat, and sweaty palms of panic.
There are three defined types of phobias:
No one knows for sure how phobias develop. Often, there is no explanation for the fear. In many cases, though, a person can readily identify an event or trauma--such as being chased by a dog--that triggered the phobia. What puzzles experts is why some people who experience such an event develop a phobia and others do not. Many psychologists believe the cause lies in a combination of genetic predisposition mixed with environmental and social causes.
- Specific or simple phobias - fear of an object or situation, such as spiders, heights or flying
- Social phobias - fear of embarrassment or humiliation in social settings
- Agoraphobia - fear of being away from a safe place
Phobic disorders are classified as part of the group of anxiety disorders, which includes panic disorder, post-traumatic stress disorder, and obsessive-compulsive disorder. Several drugs regulated by the Food and Drug Administration are now being used to treat phobias and other anxiety disorders.
Dogs, Snakes, Dentists . . .
A person can develop a specific phobia of anything, but in most cases the phobia is shared by many and has a name. Animal phobias--cynophobia (dogs), equinophobia (horses), zoophobia (all animals)--are common. So are arachnophobia (spiders) and ophidiophobia (snakes). And, of course, there's the fear of flying (pterygophobia), heights (acrophobia), and confined spaces (claustrophobia).
"One of the most common phobias is the fear of dentists [odontiatophobia]," says Sheryl Jackson, Ph.D., a clinical psychologist and associate professor at the University of Alabama at Birmingham. "People who suffer with this phobia will literally let their teeth rot out because they are afraid to go to a dentist."
Jackson says that most specific phobias do not cause a serious disruption in a person's life, and, consequently, sufferers do not seek professional help. Instead, they find ways to avoid whatever it is that triggers their panic, or they simply endure the distress felt when they encounter it. Some may also consult their physicians, requesting medication to help them through a situation, such as an unavoidable plane trip for someone who is phobic about flying.
Drugs prescribed for these short-term situations include benzodiazepine anti-anxiety agents. These medications include two approved for treating anxiety disorders: Xanax (alprazolam) and Valium (diazepam). Beta blockers such as Inderal (propranolol) and Tenormin (atenolol), approved for controlling high blood pressure and some heart problems, have been acknowledged, partly on the basis of controlled trials, to be helpful in certain situations in which anxiety interferes with performance, such as public speaking.
Some phobias cause significant problems that require long-term professional help. "People usually seek treatment when their phobia interferes in their lives--the person who turns down promotions because he knows public speaking will be required, someone who must travel frequently but who is afraid of flying, or a woman who wants to have children but who has a fear of pain or blood. These are the people who seek long-term treatment," says Jackson.
While anti-anxiety medication sometimes may be used initially, systematic desensitization may also be an effective initial approach. Jackson explains that this nondrug treatment works on the theory that the more a person is exposed to the object of his phobia, the less fear that object generates.
First, the patient and therapist establish a hierarchy of feared situations, from the least to the most feared. For someone who fears elevators, for example, stepping onto the elevator causes a certain level of anxiety; going up one flight causes another level of anxiety. With each additional flight the anxiety increases until it becomes intolerable.
Therapy begins with the patient and therapist practicing the least fearful event, riding out the anxiety until the physiological symptoms subside. This step is repeated until the anxiety level is acceptable. Then the person progresses to the next step in the hierarchy. Each successive step is repeated until the physical reactions and anxious mood decrease to the point where the person can step onto an elevator and ride to the top floor without panicking.
Everyone's Looking at Me!
Social phobia is a complex disorder, characterized by the fear of being criticized or humiliated in social situations. There are two types of social phobias: circumscribed, which relates to a specific situation such as "stage fright," and generalized social phobia, which involves fear of a variety of social situations.
People suffering from social phobia fear the scrutiny of others. They tend to be highly sensitive to criticism, and often interpret the actions of others in social gatherings as an attempt to humiliate them. They are afraid to enter into conversations for fear of saying something foolish, and may agonize for hours or days later over things they did say.
"I always believed that everybody else knew the secret to enjoying themselves in social situations, that I was the only one who was so afraid," says Lorraine from Birmingham, AL, who asked that her last name not be used. "For a long time, I avoided as many situations as possible, even talking on the telephone. After a while, the loneliness and boredom would overwhelm me, and I would try again. I wanted to have fun, but I never really enjoyed myself because of the anxiety I felt. I always believed that others were looking at me and judging me."
Many people with social phobia are so sensitive to the scrutiny of others that they avoid eating or drinking in public, using public restrooms, or signing a check in the presence of another. Social phobia may often be associated with depression or alcohol abuse.
Neurotransmitter-receptor abnormalities in the brain are suspected to play a part in the development of social phobias. Neurotransmitters are substances such as norepinephrine, dopamine and serotonin that are released in the brain. The substance then either excites or inhibits a target cell. Disorders in the physiology of these neurotransmitters are thought to be the cause of a variety of psychiatric illnesses.
Negative social experiences, such as being rejected by peers or suffering some type of embarrassment in public, and poor social skills also seem to be factors, and social phobia may be related to low self-esteem, lack of assertiveness, and feelings of inferiority.
Treatment can include cognitive-behavior therapy and medications, though no drug is approved specifically for social phobia. In addition to the anti-anxiety drugs and beta-blockers, medications may include the monoamine oxidase (MAO) inhibitor antidepressants Nardil (phenelzine) and Parnate (tranylcypromine), and serotonin specific reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), and Luvox (fluvoxamine). Of the latter four drugs, Prozac, Zoloft and Paxil are approved for depression; Prozac, Paxil, Luvox, and Zoloft are approved for obsessive-compulsive disorder; and Paxil is approved for panic disorder.
Chris Sletten, Ph.D., a clinical psychologist and behavioral medicine specialist at the Mayo Clinic, says the use of SSRIs with behavior therapy is becoming more popular in the treatment of social phobia. Because there are fewer side effects associated with these drugs and a very low addiction potential, practitioners are more comfortable prescribing them. Plus, the antidepressant action of these drugs is helpful in treating patients who suffer from depression in addition to social phobia, he says.
"My therapist prescribed Prozac, and it has been an absolute godsend for me," Lorraine says. "After only a couple of months taking it, those voices in my head, the ones that always assured me that everyone was judging me--and finding me lacking--just seemed to shut up. I didn't feel high or drugged in any way. I felt like I always thought a "normal" person would feel. It's not a complete cure, of course. I still feel anxiety in social situations. But I don't avoid them as much. In fact, I actually pick up the phone now and ask friends to dinner, and I can relax enough to have fun. It's a whole new life for me."
The Wide Open Spaces
Agoraphobia comes from Greek, meaning literally "fear of the marketplace," but it usually is defined as a fear of open spaces. Sletten says it stems more from the fear of being someplace where you will not be able to escape. It is closely identified with panic disorder, and in many cases, agoraphobia is directly related to the fear of experiencing a panic attack in public.
A person with panic disorder suffers sudden bouts of panic for no apparent reason. These attacks can occur anywhere at any time. One minute everything is fine, the next the person is engulfed by a feeling of terror. The heart races, breathing comes in gasps, and the entire body trembles. The attack may last only minutes, but its memory is etched indelibly in the brain, and the anticipation of another causes almost as much terror as the attack itself.
People who suffer agoraphobia avoid places and situations where they feel escape would be difficult in case an attack occurs. This could be anywhere--the grocery store, a shopping mall, the office. As the fear of an attack increases, the agoraphobic's world narrows to only a few places where he or she feels safe. In the most severe cases, this is limited to the home.
Agoraphobia is the most disabling of all the phobias, and treatment is difficult because there are so many associated fears--the fear of crowds, of elevators, of traffic. As with social phobias, treatment involves behavioral therapy combined with anti-anxiety or antidepressant medications, or both. Paxil has received FDA approval for use in treating panic disorders with or without agoraphobia, and at press time, Zoloft was being considered for this additional use.
"The most important thing for people with phobias to remember," says Sletten, "is that phobic disorders do respond well to treatment. It's not something they have to continue to suffer with."
FDA Consumer Magazine
Date: March 1997
By Lynne L. Hall
Page last modified or reviewed by athealth.com on March 8, 2010