Is the fear of spiders a phobia or a normal fear? If you are afraid of taking the subway or the bus, do you suffer from a phobia? Should a child who refuses to go to school be considered phobic? How does one distinguish between a normal fear and a phobia? So many questions, so many different fears... hence the importance of attempting to clarify some of these fears, which in some cases can significantly impact quality of life.
The term “phobia” refers to an excessive fear of a particular situation, object or circumstance, and is generally accompanied by avoidant behaviour. Fears and phobias may be differentiated by the intensity of the sufferers’ reactions to the object of their fears (i.e. “I’m afraid of cats, but I can stay in the same room as one”, as opposed to “Whenever I see a cat, I run out of the room and avoid any settings where I’m likely to encounter one!”).
Phobic individuals recognize their fears without however being able to explain their origins, which is irrational. They are completely controlled by their fears; unlike the majority of people who may experience fear in situations such as job interviews or sleeping alone at home, but are able to use coping strategies to “get through it”. Therefore, distinguishing “normal fears” from phobias is typically based on the severity of an individual’s inability to cope with a given situation.
A specific phobia is defined as a severe and persistent fear of a specific object or situation. Common phobias include heights, animals, germs, flying, elevators, injections or blood. Individuals suffering from specific phobias generally adopt avoidant behaviours; however, despite their intense fear, they will typically agree to be placed in certain unavoidable situations. In most cases, the onset of specific phobias occurs in late adolescence or early adulthood - except for the fear of heights, which usually presents in childhood.
The DSM-IV-TR defines five types of specific phobias:
- Animal type: including insects, snakes, dogs, cats, birds, fish and mice. Women comprise 75-90% of this group.
- Natural environment type: may include heights, proximity to water, storms. Women comprise 75-90% of this group, except for the fear of heights, where the number of women falls to 55-70%.
- Blood-injection-injury type: may include fears of seeing blood, receiving a blood test or injection, watching a medical procedure. 55-70% of subjects are women.
- Situational type: may include public transit, bridges, elevators, flying, driving, and enclosed places. Women comprise 75-90% of this group.
Other type: including choking, vomiting, hypochondria, phobia related to spatial orientation.
Thus, a phobia is an irrational fear that engenders conscious avoidance of a given situation, object or activity. Moreover, the presence and/or anticipation of the phobic trigger generates excessive fear, which may impair the individual’s normal functioning.
Finally, exposure to the phobic stimulus or object almost invariably provokes an immediate anxiety response, which can either trigger panic attacks or predispose the individual to the development of such attacks. However, it is wrong to believe that phobias are always accompanied by panic attacks.
Therefore, anyone is susceptible to the development of a phobia, literally overnight. It is equally likely that many individuals do not seek treatment for their phobias; they simply adapt to them through a number of mechanisms such as avoidance, a “phobia buddy” or other “coping” mechanisms. Not all phobics are able to do so, however. Phobias can significantly impair day-to-day functioning and quality of life, and can cause considerable conjugal, domestic and social problems.
It should be noted that children express their anxiety and/or fear in far different ways than adults do. Children may cry, scream, become unruly or refuse to play with others. Careful observation of children’s behaviours will often help parents detect and identify the specific object or situation that their child fears.
Moreover, individuals suffering from specific phobias may be at risk of developing other anxiety disorders, experiencing depression, or abusing substances such as drugs or alcohol. In fact, these substances help reduce anxiety, thereby giving them the illusion that they are better able to cope or handle the phobic situation.
A phobia may lead to dangerous behaviour. For instance, it may trigger a catastrophic reaction in an individual driving down the highway, who suddenly notices a spider on the windshield of her car. A phobia may also jeopardize health; a patient with a blood or injection phobia may refuse or fail to undergo crucial medical tests needed for proper diagnosis or treatment of an illness.
According to a Government of Canada report entitled The Human Face of Mental Health and Mental Illness in Canada 2006, anxiety disorders develop from a complex interplay of genetic, biological, cognitive, developmental and other factors, such as personal, socio-economic and workplace stress. A variety of theories has been proposed to explain how these factors contribute to the development of anxiety disorders. The first is experiential: people may learn their fear from an initial experience, such as an embarrassing situation, physical or sexual assault, or the witnessing of a violent act. Similar subsequent experiences serve to reinforce the fear.
A second theory relates to cognition or thinking, in that people believe or predict that a specific situation will take an embarrassing or harmful turn. This may occur, for example, if parents are overprotective and continually warn against potential dangers.
A third theory focuses on a biological basis. Research suggests that the amygdala, a structure deep within the brain, signals the presence of a threat and triggers a fear or anxiety response. The amygdala also stores emotional memories, and may play a role in the development of anxiety disorders.
The children of adults with anxiety disorders are at much greater risk of developing an anxiety disorder than the general population, suggesting that genetic factors may play a role as well. Numerous studies have also confirmed that neurotransmitters in the brain such as serotonin and norepinephrine, as well as hormonal factors, can influence the onset and course of anxiety disorders.
Who is at risk?
Specific phobias are fairly common among the general adult population, with a prevalence of 12.5%, mostly in women. The onset of specific phobias typically occurs in childhood, between the ages of 5 and 12 years. Age varies depending on the specific subtype of the phobia. Animal and blood-injection-injury type phobias usually present during childhood, while situational phobias (fear of driving, claustrophobia) usually occur in late adolescence or early adulthood.
Prevention and care
As individuals suffering from specific phobias rarely seek medical treatment, obtaining relevant information to properly track the course of these phobias has proven difficult. However, phobias rank among the most easily treatable anxiety disorders as they respond very well to exposure therapy, which provides rapid relief from symptoms. Drug therapy is rarely necessary. Without treatment, however, the onset of specific phobias in childhood will often carry over into adulthood and persist for many years, with no attenuation in symptomatic intensity.
The current recommended approach, exposure therapy, consists of gradual exposure to the phobic object or situation. Exposure to computer-assisted virtual reality has also proven effective to treat phobias such as the fear of flying or of heights, with promising results.
- Medication therapy
Medication is rarely used, as exposure therapy is extremely effective in treating specific phobias.
However, benzodiazepines may be used to lessen acute symptoms, as needed, in patients suffering from specific phobias who must confront a particularly frightening situation.
Seeking treatment is justified in patients who believe they are suffering from specific phobias, as treatment can greatly improve these individuals’ quality of life. First and foremost, it is crucial that patients visit their family physician, who can provide a diagnosis, prescribe drugs as needed and refer patients to more highly specialized resources (psychological or other), based on the intensity of the phobia.
Association / Troubles Anxieux du Québec (Anxiety Troubles Association)
Canadian Network for Mood and Anxiety Treatments
L’Ordre des psychologues du Québec (Quebec’s Psychologists Order)
(514) 738-1881 ou 1-888-731-9420
Revivre (Association for people suffering from anxiety, bipolar disorder or depression)
Ligne d’écoute : (514) 738-4873 ou 1.866.REVIVRE
La Clé des Champs (Peer network for people living with an anxiety disorders)
Phobies-Zéro : (Help groups for youth and adults suffering from anxiety disorders – all around Quebec)
Ligne d’écoute et de soutien : (514) 276-3105 ou 1-866-0002
Groupe d’Entraide G.E.M.E. (Help group for better living)
(450) 462-4363, numéro sans frais : 1-866-443-4363
FFAPAMM (Friends and families of people suffering from mental illness)
Association québécoise de prévention du suicide (Suicide prevention)
24 heures/ jour, 7 jours/7 partout au Québec
1-866 APPELLE (277-3553)