Brief overview
- Treatment: Psychotherapy and medication
- Symptoms: Exaggerated fear of certain situations or objects
- Causes and risk factors: Interaction of learning experiences, biological and psychosocial factors
- Diagnosis: With the help of clinical questionnaires
- Course of illness and prognosis: Phobias in childhood may fade over time. Phobias in adulthood are usually chronic.
What are phobias?
In principle, fear is a natural reaction to danger. To a healthy extent, fear ensures our survival by making us shy away from threats. In contrast to healthy fear, the fear in a phobia is pathologically exaggerated and impairs the life of those affected.
But what exactly is a phobia and what does it mean for those affected? People with phobias are afraid of situations or objects that, objectively speaking, do not pose a threat, or their fear is unreasonably high. Exposure to the feared situations is almost unbearable for anxiety patients. If possible, they try to avoid them altogether.
Phobias cause a great deal of suffering. The fear is not only accompanied by threatening thoughts, but also by physical symptoms such as trembling, sweating or palpitations. If the phobia is severe, some sufferers even fear that they will die from the physical effects.
Many anxiety patients initially suspect an organic cause for their symptoms and run from one doctor to another. For some, it takes years before a doctor makes the correct diagnosis and offers them appropriate help.
What phobias are there?
There are different types of phobias that occur either alone or in combination. Experts distinguish between the following three forms of phobic disorders: social phobia, agoraphobia and specific phobias.
Social phobia
People with social phobia are very afraid of embarrassing themselves in front of others or of being rejected by others. They therefore avoid social contacts and situations and withdraw. You can read more about this in the article Social phobia.
Agoraphobia
Specific phobia
In contrast to people who suffer from a social phobia or agoraphobia, people with specific phobias fear a very specific situation or a specific object.
There are various phobias. Accordingly, the list of phobias is long. In principle, it is possible for people to develop a phobia of any situation or object. Experts distinguish between five types of specific phobias:
- Animal type (e.g. fear of snakes)
- Environmental type (e.g. fear of heights)
- Blood-injection-injury type (e.g. fainting at the sight of blood)
- Situational type (e.g. fear of flying)
- Other type (e.g. fear of vomiting)
A common phobia is the fear of animals (zoophobia), such as the fear of dogs (cynophobia), cats (ailurophobia), spiders (arachnophobia) or snakes (ophidiophobia).
For some objects and situations, it is quite possible for those affected to avoid them. Those who do not have to fly for work simply switch to other means of transportation. But not everything can be avoided at all times.
Even a visit to the dentist is sometimes necessary. Avoiding it can be very stressful, and in many cases the anxiety can have a severe impact on everyday life. Serious consequences arise when people no longer dare to go to the doctor for fear of needles (trypanophobia) or sharp objects (aichmophobia), for example. Then, at the latest, it is high time to seek help.
While a fear of animals is usually understandable for other people, people with more unusual phobias have a hard time because their social environment often reacts with a lack of understanding. It is important for both those affected and their relatives to recognize the fear as an illness that needs to be treated.
Dental anxiety
Phobias rarely occur alone
In many cases, those affected suffer from other psychological complaints in addition to the phobic disorder. The risk of addiction to medication, drugs or alcohol is also significantly increased.
How are phobias treated?
Anxiety disorders and therefore phobias can usually be treated with the help of psychotherapy and medication. Experts primarily recommend psychotherapy for the treatment of specific phobias. The method of choice is exposure therapy, which is carried out as part of cognitive behavioral therapy. In very severe cases, medication may also be used.
Outpatient treatment is often sufficient for the treatment of specific phobias. If there are no other mental disorders, sometimes just a few therapy sessions are enough to overcome the phobias.
Confronting the fear
Initially, the patient feels great anxiety and strong physical symptoms – but if the patient endures these negative sensations, they eventually subside. The patient thus has a new experience. He learns that the anxiety also disappears again, that it is possible to endure and control it. In this way, the old anxiety pattern can be overwritten and the anxiety can at least be reduced to a tolerable level.
It is important that the patient dares to encounter the object of their fear alone at some point. Only in this way will they learn that they can overcome their fears without help and regain confidence in themselves.
For some, the confrontation means going to a park with dogs. For others, it’s about getting back into an elevator. For situations that are not so easily accessible in everyday life, there is now often exposure therapy in virtual reality. Patients put on VR glasses (virtual reality glasses) and see a seemingly real world in which they move around.
Restructuring thoughts
Cognitive behavioral therapy also involves questioning previous assessments of situations. People with phobias overestimate the danger. Harmless situations develop into a major threat in their minds. The therapist helps the sufferer to replace negative thoughts with realistic interpretations by asking specific questions.
Relapse prophylaxis
Experts recommend that the sufferer regularly visits the feared situations even after the end of therapy. Even if severe anxiety suddenly reappears, this is no reason to despair.
Relapses are possible at any time. It is important not to panic, but to remember the strategies you have learned. If the anxiety intensifies, it is advisable to see a therapist again. Seeking help is a sign of strength. Those who face their fears retain control over them.
Special treatment for blood-syringe injury phobia
Öst’s special method consists of patients tensing the muscles in their arms, legs and chest for 15 to 20 seconds. After a short relaxation break, they repeat this tension. In the event of exposure to blood or injections, many patients use this tensing technique to reduce symptoms such as sweating and discomfort and thus prevent fainting.
What are the symptoms of phobias?
The main symptom of a phobia is always a strong and exaggerated fear of certain situations or objects. Those affected increasingly avoid them. Such avoidance behavior in turn reinforces the fear. In addition, there are other psychological symptoms, but above all severe physical symptoms such as a racing heart or breathing difficulties, which may put the person affected in fear of death.
According to the ICD-10 classification of mental disorders, the following symptoms must be present for a specific phobia to be diagnosed:
- The affected person either has a clear fear of a certain object or situation or avoids such objects and situations.
- It is not an agoraphobia or a social phobia.
The prerequisite is that at least one of the symptoms from the area of vegetative symptoms such as palpitations, sweating, trembling or dry mouth is present.
Other possible symptoms from the abdominal and chest area are
- Breathing difficulties
- Feeling of tightness
- Pain or discomfort in the chest
- Nausea and discomfort in the abdominal region
Typical psychological symptoms are
- Feelings of dizziness, insecurity, weakness or light-headedness
- The feeling that objects are unreal or that you are far away and not really there (derealization and depersonalization)
- Fear of losing control or fear of going crazy or freaking out
- Fear of dying
In addition to the symptoms mentioned above, those affected often suffer from hot flushes or cold shivers as well as numbness or tingling sensations. Those affected are emotionally distressed by the symptoms and the consequences. However, they know that the fear is exaggerated.
How do phobias develop?
For our ancestors, fear played an important role in survival. Dangerous animals and darkness were a real threat. These fears were passed down through generations.
Phobias: learned fear
A phobia begins with a learning process. The affected person negatively evaluates an object or situation that is neutral in itself due to a bad experience. Experts refer to this process as conditioning.
For example, a dental phobia may develop if the patient has had a very unpleasant experience at the dentist. The affected person associates the pain during treatment with the smells and sounds at the dentist. Fear of the dentist and the treatment are the result.
This is because the negative feelings that arose during the treatment resurface the next time the patient visits the dentist or just thinks about it. Those affected then interpret physical symptoms such as strong palpitations or sweating as confirmation that they are in danger.
Phobias: avoidance
Many situations make almost everyone uncomfortable without them developing a phobia. For example, most people associate dental treatment with an uneasy feeling or are even afraid of it. However, it is only a pathological fear if the person concerned avoids going to the dentist in future out of fear.
Phobias: learning from a model
Many phobias, especially animal phobias, develop in childhood. For an animal phobia to develop, it is not even necessary for children to have had bad experiences with an animal themselves. They learn fearful behaviors through the example of adults. The technical term for this is “learning by example”.
Children rely on their parents to assess danger. If a child observes that its mother reacts fearfully at the sight of a dog, it may adopt this fear without knowing the reason. A specific phobia may also develop indirectly in adulthood, for example through media reports. But why doesn’t everyone who has a bad experience develop a phobia?
Phobias: biological roots of fear
Some people are more susceptible to phobias than others. Biological factors presumably have an influence on this susceptibility (vulnerability). Family and twin research suggests that anxiety is partly genetic.
These biological factors promote an anxiety disorder, but upbringing and environmental influences are the decisive triggers.
Phobias: psychosocial factors
Experts believe that parenting style has an influence on the development of phobias. There appears to be a connection between anxiety disorders in children and controlling and insensitive behavior on the part of parents. Children who do not have a secure bond with their parents are at risk of developing an anxiety disorder later on.
Temperament also plays an important role. Anxious people are more susceptible to phobias than others. They are easily frightened because they see harmless situations as dangerous and their thoughts and attention are focused on possible negative consequences.
A tendency towards anxiety can already be seen in childhood, when children are very jumpy, find it difficult to calm down and generally tend to withdraw. Experts summarize these characteristics under the term “behavioral inhibition”.
Phobias: examinations and diagnosis
To rule out other illnesses, he will also carry out a physical examination. This usually consists of a blood sample, an examination of the heart using an electrocardiogram (ECG) and an examination of the thyroid gland using ultrasound and blood values. Magnetic resonance imaging (MRI) can be used to rule out pathological changes in the brain as the cause of the anxiety.
The therapist is responsible for a precise diagnosis of the mental disorder and the appropriate treatment. It is important to check whether other mental disorders are present, such as depression. These also need to be treated in order to restore mental health.
To diagnose phobias, the therapist uses clinical questionnaires that ask about the important symptoms. The doctor often asks the following questions to diagnose the specific phobia:
- Are there certain objects or situations that you are very afraid of (for example heights, spiders, blood or other things)?
- Do you have the impression that your fear is exaggerated?
- Is your fear limited to one object or situation?
If parents suspect a phobia in their child, the therapist will examine whether the fears are age-appropriate or whether treatment is necessary. Some fears that children display are part of the normal course of development.
Phobias: course of the disease and prognosis
Phobias usually emerge in childhood and adolescence. In principle, however, it is possible to develop a phobia at any age following frightening situations: For example, fear of flying, when a person fears crashing during a turbulent flight.
Specific phobias often develop around the age of seven. With an early onset, the specific fear may fade over time. Phobias that are still present in adulthood or only appear then are usually chronic.
