Specific Phobia

INTRODUCTION

Fears and phobias

Are phobias and fears the same, the answer is ‘no’. Fear, derived from the ancient English word “Faer” refers to life saving mechanisms enabling avoidance of harm. Fears may be instinctive, that is, hardwired into the brain or learnt i.e., sharp knives are dangerous. Regardless of origin, fear has a biological function increasing survival when danger is perceived. In response to danger, the brain is activated triggering bodily changes that enhance avoidance and management to that which is dangerous. The response is rational, normal and protective.

Every society has a manner of protecting its people from enemies. In ancient Greek times, “Phobos” (a Greek god) was responsible for frightening the enemy. This was achieved by striking fear and panic into the hearts and minds of the enemy, in part using the likeness of “Phobos” painted on shields and masks. The word phobia is derived from “Phobos” and first appeared in medical literature 2000 years ago.

In contrast to fear, a phobia is an irrational fear leading to a compelling desire to avoid the focus of the phobia, which if experienced, dread, anxiety and panic attacks occur. Phobias are persistent. Sufferers are hypervigilant, their personal radars hyper-alert roaming and searching for that which they are phobic about.

SPECIFIC PHOBIAS

Specific phobias have been acknowledged throughout history, i.e., the great Roman warrior Julius Caesar was known to have a fear of the dark. Today, specific phobias are defined as a strong, persistent fear and avoidance of a particular object, situation or activity. If the phobic concern is confronted, anxiety or panic attacks occur. For most, anticipatory anxiety is experienced prior to exposure. This anxiety may be as distressing as the anxiety and panic attacks experienced while in the phobic situation. To make the diagnosis of specific phobia, the sufferer must recognise the phobia as unrealistic, excessive and show that life is compromised socially or occupationally by the phobia.

HOW COMMON ARE SPECIFIC PHOBIAS

Community studies suggest that up to 11.3% of the population at sometime experience a specific phobia. They are more common in women even in the elderly. This sex difference may arise from the under - reporting of phobias by men.

TYPES AND ONSET OF SPECIFIC PHOBIAS

Today, for convenience, specific phobias are divided into sub - types shown in Table 1. The division is based on the focus of the phobia. Examples of different sub - types of specific phobias are shown in Table 2. Animal and medical phobias frequently have childhood onset. In contrast, situational phobias have onset in childhood and early adulthood. Specific phobias can commence suddenly and tend to persist with only 20% disappearing spontaneously. You can have a phobia about anything as highlighted in Table 3. The list of phobias continues to expand; over five hundred are presently listed.

Animal

Natural

Medical

Situational

Others

SPECIFIC PHOBIAS DO NOT EXHIBIT THEIR SYMPTOMS ALONE AND OFTEN RUN IN FAMILIES

Those with specific phobias often present with co-occurring psychiatric illnesses. Panic disorder and depression are the most common, their onset occurring sometime after the onset of the specific phobia; for example, those who have a childhood fear of the dark often develop a mood disorder in adolescents or adulthood. Specific phobias tend to run in families. This is particularly true in those with medical and blood or injury phobias. Sixty-one percent with blood phobia and 29.9% with injection phobia report having a relative with a similar phobia.

CAUSES OF SPECIFIC PHOBIAS

Factors that may lead to the onset of specific phobias include: -

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