Chapter 4

...Phobia...

A phobia is a type of anxiety disorder defined by a persistent and excessive fear of an object or situation.

It is recommended that the terms distress and impairment take into account the context of the person's environment during diagnosis.

Phobias can be divided into specific phobias, social phobia, and agoraphobia. Specific phobias include those to certain animals, natural environment situations, blood or injury, and specific situations.The most common are fear of spiders, fear of snakes, and fear of heights.Specific phobias may be caused by a negative experience with the object or situation in early childhood.Social phobia is when a person fears a situation due to worries about others judging them.Agoraphobia is a fear of a situation due to a difficulty or inability to escape.

It is recommended that specific phobias be treated with exposure therapy, in which the person is introduced to the situation or object in question until the fear resolves.Medications are not useful for specific phobias.Social phobia and agoraphobia are often treated with some combination of counselling and medication. Medications used include antidepressants, benzodiazepines, or beta-blockers.

Specific phobias affect about 6–8% of people in the Western world and 2–4% of people in Asia, Africa, and Latin America in a given year.Social phobia affects about 7% of people in the United States and 0.5–2.5% of people in the rest of the world.Agoraphobia affects about 1.7% of people. Women are affected by phobias about twice as often as men.Typically, the onset of a phobia is around the ages of 10–17, and rates are lower with increasing age.Those with phobias are at a higher risk of suicide.

Classification

Most phobias are classified into three categories and, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), such phobias are considered sub-types of anxiety disorder. The categories are:

1. Specific phobias: Fear of particular objects or social situations that immediately results in anxiety and can sometimes lead to panic attacks. Specific phobia may be further subdivided into four categories: animal type, natural environment type, situational type, blood-injection-injury type.

2. Agoraphobia: a generalized fear of leaving home or a small familiar 'safe' area, and of possible panic attacks that might follow. It may also be caused by various specific phobias such as fear of open spaces, social embarrassment (social agoraphobia), fear of contamination (fear of germs, possibly complicated by obsessive-compulsive disorder) or PTSD (post traumatic stress disorder) related to a trauma that occurred out of doors.

3. Social phobia, also known as social anxiety disorder, is when the situation is feared as the person is worried about others judging them.

Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer relatively mild anxiety over that fear. Others suffer full-fledged panic attacks with all the associated disabling symptoms. Most individuals understand that they are suffering from an irrational fear, but are powerless to override their panic reaction. These individuals often report dizziness, loss of bladder or bowel control, tachypnea, feelings of pain, and shortness of breath.

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