Phobias are a common problem. About 7% of people suffer from a mild phobia, but only less than 1% of the population is affected by a severe phobia.
What is a phobia?
An exaggerated fear of specific situations or things is called a phobia. There are three types of phobias. In agoraphobia, there is a fear of public places or of crowds. In a social phobia, there is a general fear of other people. In a specific phobia, the fear relates to specific things, such as spiders or diseases. The affected person is usually aware that their behavior is nonsensical. However, they cannot defend themselves against their own behavior because the fear is obsessive and cannot be controlled.
Causes
There are three groups of explanatory models of the causes of phobias. The learning theory approach assumes that fear is “learned.” In this process, fear is experienced in an originally neutral situation. By avoiding this and similar fearful situations in the future, the fear is intensified and the affected person gets into a vicious circle from which they cannot get out without help. The neurobilogical approach assumes that phobias have a biological cause. It is assumed that phobics have a more unstable autonomic nervous system, which can be irritated more quickly and fears develop more quickly due to this. The depth psychology approach assumes that normal conflict resolution through compromise fails in phobics in certain situations, resulting in anxiety.
Symptoms, complaints, and signs
A phobia manifests itself with typical vegetative symptoms and may also affect the psyche. It can trigger symptoms due to a specific trigger (such as in arachnophobia or claustrophobia) or lead to a permanent state of anxiety. This depends on what form of anxiety disorder is present. Anxiety disorders with non-ordinary triggers (airplanes, clowns, or the like) do not result in long-lasting anxiety attacks. Phobias that relate to ubiquitous triggers, on the other hand, can. The vegetative symptoms here include profuse sweating, palpitations, nausea, urge to defecate, urge to urinate, and trembling. All in all, the flight instinct is activated and those affected want to get out of the situation quickly. The longer they are confronted with the trigger of their fear, the more the symptoms intensify. In some cases, they also include a fainting spell. On the psychological level, the fear of losing control dominates. In addition, there is occasionally a feeling of being beside oneself (depersonalization) or a fear of the environment changing (into the negative). Accordingly, a phobia can lead to strong avoidance behavior in the person affected. He then does everything in his power not to encounter the trigger of his fear. The avoidance behavior is impairing to varying degrees, but not infrequently leads to negative moods.
Diagnosis and course
To make a definite diagnosis of phobia, other mental illnesses and also some physical illnesses must first be ruled out. These include depression, schizophrenia, bipolar disorder, and obsessive-compulsive disorder. Physically, hyperthyroidism or heart disease should be ruled out as causes. Special questionnaires help in making the diagnosis. A distinction is made between third-party and self-assessment questionnaires. Agoraphobia usually occurs in situations and places where the affected person fears not being able to escape. Agoraphobia is a type of claustrophobia and means an ever increasing restriction of freedom of movement, which can ultimately make a normal life impossible. Agoraphobia is often accompanied by panic disorder. In a social phobia, the affected person fears failing in the presence of other
to fail in the presence of other people. The fears sometimes have severe effects on social life and go far beyond normal shyness. Often, social phobia is accompanied by other psychological problems, such as depression, other phobias or addictions. Men are less often affected by social phobias than women. The fears in specific phobias only occur in certain situations or with certain objects.Typical situations for specific phobias may include confined spaces, air travel, tunnels, highway travel, or dental work (see Fear of the Dentist). Typical objects that trigger specific phobias are animals, such as spiders, snakes or mice, blood, syringes and injuries. People with a specific phobia know very well that their fear is actually unfounded. However, they cannot control it and therefore come to terms with their phobia by avoiding the fear-inducing situations or objects. A specific phobia only reaches an actual disease value when everyday life is very severely restricted or impaired by it.
Complications
Phobias often occur together with other phobias and other anxiety disorders. Many sufferers have more than one specific phobia and are afraid of dogs (canophobia) and spiders (arachnophobia), for example. A possible complication is agoraphobia, in which sufferers become increasingly withdrawn and avoid situations in which they might expose themselves. Agoraphobia can lead to complete social isolation: Some agoraphobics hardly ever leave their homes. All types of phobias also often show up together with depressive disorders. To regulate anxiety, some phobics turn to medication, alcohol, tobacco or drugs. Others engage in self-harming behaviors or develop conspicuous eating behaviors. Phobias and other anxiety disorders can also promote physical illness. Increased stress levels increase the risk of cardiovascular disease. Phobics who are afraid of doctors, needles or blood also often avoid medical examinations. As a result, further complications are possible: people with dental phobia often only go to the dentist when they are in severe pain. As a result, they not only suffer physically longer and more than necessary, but the condition of their teeth usually worsens as well.
When should you go to the doctor?
People who suffer from severe anxiety that goes far beyond a natural feeling of fear should see a doctor or therapist. If stressful experiences occur in various situations, the number of anxiety triggers increases, or everyday responsibilities can no longer be met, a visit to the doctor is necessary. Restrictions in lifestyle, social isolation as well as changes in personality indicate the need for treatment. A visit to the doctor is advisable so that a treatment plan can be drawn up and a gradual improvement in health can occur. A reduced quality of life, a diminished sense of well-being, and a loss of zest for life are signs of a mental disorder. Sweating, rapid heartbeat, insecurities, or a physical freeze in an anxiety-provoking situation should be discussed with a therapist. In case of hyperventilation, weepiness as well as inner restlessness, a doctor should be consulted. Typical for a phobia is an avoidance behavior. The way of life is continuously restricted and the inner discomfort increases. Characteristic of the disease is a steady increase in symptoms over several years. Often, professional activities can no longer be performed and participation in leisure activities hardly takes place. If the affected person no longer leaves his own home, he needs help. If interpersonal conflicts increase or vegetative dysfunction sets in, a physician should be consulted.
Treatment and therapy
Most often, phobia is treated by behavioral therapy. In some cases, additional treatment with medication is necessary. Systematic desensitization and flooding therapy are particularly effective. In systematic desensitization, complete relaxation is first ensured in the patient. This is followed by a gradual approach to the fear trigger. This procedure ensures that the phobic person gradually loses his fear and, after successful therapy, can face the fear trigger without fleeing from it. Flooding therapy “floods” the patient with the fear trigger. During therapy, the phobic person learns, with the support of the therapist, that the greatest fear will eventually subside if he or she endures and perseveres through the fear-inducing situation. After such an experience, the phobia’s trigger has virtually no power over the sufferer. Medication is sometimes used to treat social phobias in particular.These are mainly antidepressants. But sedatives and beta blockers are also used.
Outlook and prognosis
Phobia in adulthood rarely heals completely. The disease accompanies the affected person for years. If the affected person is aware of his fears and has learned how to deal with the phobia appropriately during behavioral therapy, the prognosis is usually favorable. Nevertheless, the outlook depends on the severity of the disease and cannot be generalized. In the case of a mildly pronounced phobia, the (treated) patient is able to lead a largely symptom-free life. Severe anxiety disorders will continue to affect the sufferer even after treatment is complete. They usually become chronic. In the case of severe social phobia, the affected person often cannot return to work. The consequences are a change of job or even disability. This course can additionally cause depression. Further psychotherapy becomes necessary. Consequential diseases always have a negative effect on the prognosis. The patient can do his own part by applying the advice of his psychotherapist in everyday life. He has become aware of which situations trigger anxiety in him and for what reason. An agoraphobic will purposefully avoid free places. Such behavior is not a sign of weakness, but of a conscious approach to the disorder.
Prevention
Those who do not flee from anxiety-provoking situations or experiences and do not switch to active behavior to avoid them can protect themselves in the best possible way from the outbreak of a phobia. In addition, one should, in case of suspicion, visit a doctor or psychologist in time, in order to nip the phobia in the bud already in its beginnings.
Aftercare
Phobia is a mental illness in which the success of treatment is ideally supported by consistent aftercare. It is important, as is usually learned in behavioral therapy, not to avoid contact with anxiety-provoking objects or situations. It is important for those affected to keep learning, even after treatment, that these things are harmless and not associated with any danger. The more often this is practiced, the more stable the success of the therapy with regard to the phobia in question. Visiting a self-help group can be a valuable support in this context, as conversations can bring a good exchange of experiences and helpful tips. Often, in the case of illnesses associated with anxiety, relaxation methods are also an effective element that can be effectively integrated into the aftercare by those affected. There are several methods available here. For example, progressive muscle relaxation according to Jacobsen and autogenic training come into question. In addition, yoga often restores balance and healing through a combination of physical exercises (asanas), breathing exercises (pranayama), meditation and relaxation. Confidence in one’s own body returns and mind and soul can regenerate. Walks and endurance training also reinforce the normal body perception of the affected person and complement the aftercare sensibly.
What you can do yourself
The quality of life of a person affected by a phobia depends on its nature. For example, if the phobia relates to animals, such as spiders or cats, and activities such as driving a car or train or flying, life can be managed relatively well by avoiding these things. However, other phobias can significantly affect everyday life. In the case of fear of large crowds, small spaces, and certain noises, the sufferer must limit himself or herself in the choice of housing and occupation alone. The people with whom one interacts on a daily basis should be made aware of the condition so that embarrassing incidents do not occur and help can be provided immediately. If a situation arises in which the phobia comes to light, the person affected should not be afraid to inform those around him that he must get out of it immediately. In any case, it is helpful to go to a doctor or therapist with a phobia in order to get it under control or at least to be able to live with it. Affected people must learn that the situations they are afraid of are not dangerous. They can only do that if they put themselves in these situations.A therapist, or in milder cases a close friend or relative, can accompany this so that the person does not overextend themselves.
