Psychiatric Associates

Specific Phobia

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What is a Specific Phobia?

       A Specific Phobia is an intense, irrational fear of something that actually poses little or no threat. Some of the more common Specific Phobias are heights, escalators, tunnels, highway driving, closed-in places, water, flying, dogs, spiders, and injuries involving blood. People with Specific Phobias may be able to ski the world's tallest mountains with ease but be unable to go above the fifth floor of an office building. While adults with phobias realize that these fears are irrational, they often find that facing, or even thinking about facing, their fears brings on a panic attack or severe anxiety.
 
       Specific Phobias affect about 19.2 million American adults and are twice as common in women as in men. They usually appear in childhood or adolescence and tend to persist into adulthood. The causes of Specific Phobias are not well understood, but there is some evidence that the tendency to develop them may run in families. 
 
       If what they fear is easy to avoid, people with Specific Phobias may not seek help; but if avoiding their fears interferes with their careers or their personal lives it can become disabling and lead them to pursue treatment. 
 
One Person's Story:
 
        "I'm scared to death of flying, and for years I couldn't do it. I used to start dreading a plane trip a month before I was due to leave. It was an awful feeling when the airplane's doors were shut—I'd feel trapped. My heart would pound, I'd sweat bullets, I'd get sick to my stomach, the plane would spin around me, and I wouldn't be able to breathe. I was especially scared during take-offs and landings. Just thinking about flying was enough to make me feel like I was going to die.
 
       "It was okay as long as I didn't have to travel too often—and when I had to travel I'd either drive or take the train. But I got promoted at work and had to fly to other offices as part of my new job duties. I became a nervous wreck. My boss noticed and talked to me about it. She encouraged me to get some help, so I called my doctor. I was surprised when he didn't prescribe something for me. Instead, he referred me to a therapist. I've been going for a few months now, and I've learned how to keep my fears under control. I can fly now without feeling like I'm going to die, and I look forward to being able to enjoy flying some day."
 
What types of Specific Phobias are there?

       There are five types of Specific Phobias:
  • Animal Type — characterized by fear of animals or insects, it generally starts in childhood;
  • Natural Environment Type — characterized by fear of storms and other weather phenomena, heights, or water, it, too, generally starts in childhood;
  • Blood, Injection, and Injury Type — characterized by fear of having blood drawn, receiving immunizations, having surgery, or even seeing blood or an injury,it tends to run in families and to cause fainting;
  • Situational Type — characterized by fear of specific environments or activities such as using public transportation, traveling in tunnels or on bridges, flying in an airplane, driving or being a passenger in a vehicle, or being in a small enclosed space such as an elevator, it’s most common during childhood and the mid-twenties;
  • Other Type — characterized by fear of anything else, such as choking, vomiting, germs, or clowns.
What are the symptoms of a Specific Phobia?

       A Specific Phobia is characterized by significant and lasting fear that is excessive or unreasonable and is caused by the presence or anticipated presence of a specific object or situation, called the trigger, such as flying, heights, animals, receiving an injection, or seeing blood. Exposure to the trigger almost always provokes an immediate anxiety response, which may take the form of a situationally-bound or situationally-predisposed Panic Attack. Situationally-bound Panic Attacks almost always occur immediately on exposure to or in anticipation of exposure to the trigger; situationally-predisposed Panic Attacks don't necessarily happen with every exposure to the trigger and don't necessarily occur immediately after exposure to the trigger. Panic Attacks are sudden attacks of terror accompanied by at least four of the following:
  • an irregular heart beat, a pounding heart, or accelerated heart rate;
  • sweating;
  • trembling or shaking;
  • sensations of shortness of breath or smothering;
  • a feeling of choking;
  • chest pain or discomfort;
  • nausea or abdominal distress;
  • feeling dizzy, unsteady, lightheaded, or faint;
  • derealization (feelings of unreality) or depersonalization (feelings of being detached from oneself);
  • fear of losing control or going crazy;
  • fear of dying;
  • paresthesias (numbness or tingling sensations, especially in the hands, feet, and/or face);
  • and chills or hot flushes.
What disorders often accompany a Specific Phobia?

       A Specific Phobia, depending on type, can be associated with certain medical conditions. About 75% of individuals with Blood-Injection-Injury Type report a history of fainting. Certain general medical conditions may worsen as a consequence of phobic avoidance. For example, Blood-Injection-Injury Type may have a negative impact on dental or physical health if the person avoids necessary medical care. Similarly, fear of choking may have a negative impact on health if the person limits his food intake to things that are easy to swallow but nutritionally incomplete, or if he refuses to swallow medications. Other Anxiety Disorders, Mood Disorders, and Substance-Related Disorders are also common. From 50% to 80% of people diagnosed with a Specific Phobia are also diagnosed with another Anxiety Disorder.

What causes a Specific Phobia?

       There's no single cause for a Specific Phobia. Rather, it most likely results from a combination of genetic, biochemical, environmental, and psychological factors. A Specific Phobia is a disorder of the brain. Brain-imaging scans such as magnetic resonance imaging (MRI) have shown that the parts of the brain responsible for regulating mood, thought, sleep, appetite, and behavior function abnormally in phobic people. In addition, important neurotransmitters (chemical messengers) are out of balance. This knowledge doesn't explain WHY people become phobic, however.

       Some Specific Phobias appear to run in families, suggesting a genetic component. Specific Phobias also occurs in people without family histories of phobias, however. The probability that anyone will experience a Specific Phobia results from the interaction between multiple genes and environmental or other factors. In addition, trauma, the loss of a loved one, a difficult relationship, or any other significantly stressful situation may trigger a Specific Phobia. Subsequent episodes of phobia may not have an identifiable trigger, though.

How is a Specific Phobia diagnosed?

       Even the most severe Specific Phobias are highly treatable. As is true of most medical and psychological disorders, the earlier that treatment begins the more effective it is and the higher the likelihood that recurrences can be prevented.

       The first step toward getting help is to see your Primary Care Provider (PCP), the medical provider whom you see for other disorders. Certain medications and medical conditions can cause the same symptoms as a Specific Phobia. Your PCP can rule out these conditions by conducting a physical examination, asking questions, and/or ordering lab tests. If medications and medical conditions can be ruled out, your PCP will then prescribe an appropriate medication and/or refer you to a mental health professional for further evaluation.

       A mental health professional will conduct a complete diagnostic evaluation, including a discussion of any family history of Specific Phobias and other psychological disorders and a complete history of symptoms. This history will include when your phobia started; how long you've been phobic; how severely phobic you are; whether or not you've had a Specific Phobia before; if so whether or not you received treatment and how successful that treatment was; whether or not alcohol and/or substance abuse are involved; whether or not there are other psychological disorders present; and whether or not you feel suicidal and/or are planning to harm or kill yourself.  

How is a Specific Phobia treated?

       Effective therapies for Specific Phobias are available, and research is uncovering new treatments that can help most people with Specific Phobias lead productive, fulfilling lives. The most common treatments are medication, psychotherapy, and a combination of the two. Medication can’t cure a Specific Phobia, but it can keep it under control while you participate in psychotherapy. The most common medications used to treat a Specific Phobia are antidepressants, anti-anxiety drugs, and beta-blockers. Antidepressant medications were developed to treat depression but are also effective for anxiety. Although these medications begin to alter brain chemistry after the very first dose, their full effects require a series of changes to occur in the brain, so it usually take about four to sixs weeks for symptoms to begin to fade. It’s therefore important to take an antidepressant long enough for it to work for you.

       Antidepressants normalize the functioning of neurotransmitters (chemical messengers) in the brain, primarily serotonin, norepinephrine, and dopamine. These particular chemical messengers are involved in regulating mood, although there's still no complete understanding of how this occurs. These medications include newer types, such selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), and older types, such as tricyclics/tetracyclics (TCAs) and monoamine oxidase inhibitors (MAOIs). Wellbutrin (bupropion) is a unique antidepressant, unrelated to any other, which, while it's more effective for depression than anxiety, is sometimes used to treat anxiety by itself or in conjunction with an SSRI.
 
       Anti-anxiety medications, primarily benzodiazepines, reduce daytime anxiety and excessive excitement and generally quiet or calm people. At low doses they have few side effects other than drowsiness and dizziness; at higher doses they produce significant drowsiness and facilitate sleep. (WARNING; It is especially important to limit or better yet avoid alcohol while taking any benzodiazepine.) Because they are potentially addictive, benzodiazepines are typically prescribed for only short periods of time, especially for people with histories of alcohol and/or drug abuse.
Buspar (buspirone), which is not a benzodiazepine, is a unique anti-anxiety medication primarily used to treat Generalized Anxiety Disorder (GAD). Unlike benzodiazepines, Buspar must be taken consistently for at least two weeks before it begins to provide significant benefit. Beta blockers such as Inderal (propranolol) are used to treat heart conditions, but can also be used to prevent the physical symptoms of Specific Phobia. Inderal can be used preventitively to treat stage fright, which is classifiable as a Specific Phobia, Situational Type. If one medication doesn't work, be open to trying another. People who don't improve after taking one medication increase their chances of getting better by switching to a different medication or adding a second medication.

       Psychotherapy involves talking with a trained mental health professional, such as a Counselor, Psychiatrist, Psychologist, or Social Worker, to explore what is causing the Specific Phobia and how to manage or eliminate the symptoms. Some types of psychotherapy are short-term (10 to 20 weeks) and others are long-term (more than 20 weeks). Which might be suitable for you can be determined between you and the mental health professional whom you see. There are many types of psychotherapy, all of which can be effective in treating Specific Phobias, but two types, Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), have well-established histories of being effective. CBT helps people change negative and self-critical styles of thinking and behaving that contribute to or worsen anxiety, replacing them with more positive, functional, and adaptive ways. For example, CBT can help people experiencing Panic Disorder learn that their Panic Attacks are not really heart attacks and help people experiencing Social Phobia learn how to overcome the false belief that other people are always observing and judging them. CBT often lasts about 12 weeks. IPT helps people understand and work through dysfunctional and/or maladaptive relationships that contribute to or worsen anxiety. It emphasizes the relationships between a person and other people rather than that person’s internal psychological processes. It’s intended to change the person’s symptoms by helping him deal more realistically and effectively with his family, marital, parental, and work situations.
 
       For those who are mildly or moderately anxious, psychotherapy alone is often the best treatment option. However, for certain people, especially those who are severely anxious, a combination of psychotherapy and medication may be necessary.

How can I help someone who is suffering from a Specific Phobia?

       If you know someone who has a Specific Phobia, odds are that his or her anxiety affects you, too. The first and most important thing that you can do to help a friend, family member, or coworker who has a Specific Phobia is to help him get diagnosed and treated. You might have to schedule an appointment on behalf of the person or even go with him to see a provider. Encourage him to stay in treatment or to seek different treatment if no improvement occurs after six to eight weeks of medication or eight to 12 weeks of psychotherapy. In addition:
  • don’t downplay or trivialize the anxiety;
  • don’t demand improvement if the person isn't in treatment;
  • offer emotional support, understanding, and patience;
  • engage the person in conversation and, most importantly, listen nonjudgmentally;
  • never criticize or belittle feelings the person expresses, but rather point out realities and offer hope;
  • never ignore comments about suicide. Encourage the person to share these thoughts with his provider and/or mental health professional, and report them yourself if you believe the person won't;
  • invite the person to participate in walks, outings, and other activities. Keep trying even if he declines, but don't push him to do too much too soon. Making the person feel as if you have too many expectations of him may inadvertently cause feelings of failure;
  • and remind the person that with time and treatment the anxiety will inevitably improve.
© 2010
Dr. Thomas E. Hranilovich
Licensed Psychologist

Psychiatric Associates / 4084 Okemos Rd. / Suite A / Okemos, MI 48864
Phone: (517) 347-4848 / Fax: (517) 347-4844