Phobias

Giving a public presentation makes many people nervous. But it makes you worry for weeks ahead of the event, and you may even start to feel sick if you just think about it. Or, perhaps you're so anxious about driving through a tunnel you go miles out of your way to avoid it.

If so, you may have a phobia. A phobia is a persistent irrational fear of an object or a situation that's generally considered harmless. Accompanying the fear is a strong desire to avoid what you fear and, in some cases, an inability to function at normal tasks in your job and in social settings.

Phobias are among several anxiety disorders, which also include panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder and generalized anxiety disorder.

Treatment may help you reduce your fears and help you better manage the object or situation that makes you anxious.


Signs and symptoms

Common phobias include:

Specific phobias. These include a fear of: enclosed spaces (claustrophobia); animals, particularly spiders, snakes or mice; heights (acrophobia); flying (pterygophobia); water (hydrophobia); storms; dentists; tunnels; bridges; not being able to get off public transportation quickly. There are many other simple phobias.
Social phobia. More than just shyness, social phobia involves a combination of excessive self-consciousness, a fear of public scrutiny or humiliation in common social situations, and a fear of negative evaluation by others.
Fear of public places (agoraphobia). Most people who have agoraphobia developed it after having one or more panic attacks. Agoraphobia is a fear of being alone in a place such as a mall or an elevator or a room full of people, with no easy means of escape if a panic attack should occur.
Having a phobia may produce the following signs and symptoms:

A persistent, irrational fear of a specific object, activity or situation.
An immediate response of uncontrollable anxiety when exposed to the object of fear.
A compelling desire to avoid and unusual measures taken to stay away from what you fear.
An impaired ability to function at normal tasks because of the fear.
Often, the knowledge that these fears are out of proportion with the stimulus.
When facing the object of your phobia, an experience of panicky feelings, such as sweating, rapid heartbeat, avoidance behavior, difficulty breathing and intense anxiety.
In some cases, anxious feelings when merely anticipating an encounter with what you fear.

Causes

Much is still unknown about what causes phobias. However, there may be a strong correlation between your phobias and the phobias of your parents. Children may learn phobias by observing a family member's phobic reaction to an object or a situation. An example of a common learned phobia may be the fear of snakes.


When to seek medical advice

Simply feeling uncomfortable or uncertain about an object or situation may be normal and common. If your phobia isn't disrupting your life, it's not considered a disorder and you may not need treatment. But if your fear becomes irrational and uncontrollable to the point that it affects your social interactions or job duties, you may have a disorder that requires medical or psychological treatment. See your doctor or a mental health professional such as a psychiatrist or psychologist. If you first see a mental health professional who is not a psychiatrist — psychiatrists are medical doctors — be sure to see your medical doctor as well to rule out other causes for your anxiety.


Screening and diagnosis

Your doctor will likely ask you to describe your symptoms, how often they occur and what triggers them. Sometimes physical disorders occur along with anxiety disorders. As with other anxiety disorders, you'll probably undergo a complete physical exam so that your doctor can determine whether health conditions other than phobias could be causing your symptoms of anxiety. Phobias sometimes occur along with other anxiety disorders and may be accompanied by depression, abuse of alcohol or other substances, or eating disorders. Your doctor may try to identify other mental disorders that may exist before suggesting a course of treatment.


Complications

Having a phobia may cause other problems, including:

Social isolation. If you have a phobia, you may find that you avoid social situations and public places.
Depression. The avoidance of many activities that other people find enjoyable in their personal and professional lives may lead you to become depressed.
Substance abuse. Some people with phobias turn to alcohol or other drugs to deal with stress. This unwise and unhealthy choice can lead to abuse of alcohol or other drugs.

Treatment

Your doctor or a mental health professional may suggest medications or behavior therapy or both to treat phobias. Most people don't get better on their own and require some type of treatment. The objective of treatment is to reduce anxiety and fear and to help you better manage your reactions to the object or situation that causes them.

Medications

Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They block some of the peripheral signs of adrenaline's stimulation and anxiety, including increased heart rate, elevated blood pressure, pounding of the heart, and shaking voice and limbs. These can be very effective for people who have stage fright but must give a presentation before other people. However, not all beta blockers are effective for this purpose, and they're only available by prescription, so check with your doctor.
Antidepressants. Antidepressants also can reduce anxiety. The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs). These medications act on the chemical serotonin, a neurotransmitter in your brain that's believed to influence mood. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft). Monoamine oxidase inhibitors (MAOIs) block the chemical monoamine oxidase in the nervous system. MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate).
Sedatives. Medications called benzodiazepines help you relax by reducing the amount of anxiety that you feel. They include lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax) and chlordiazepoxide (Librium). Sedatives need to be used with caution because they can be addictive. It's generally safe to use low doses of sedatives infrequently or only for short periods. However, sedatives should be avoided if you have a previous history of abusing alcohol or other drugs.
Behavior therapy
Desensitization or exposure therapy focuses on changing your response to the feared object or situation. Gradual, repeated exposure to the cause of your phobia may help you learn to conquer your fear. For example, if you're afraid of flying, your therapy may progress from having you think about flying to looking at pictures of airplanes, to going to an airport, to sitting in an airplane, and to finally taking a flight. Some major airlines offer programs to help you adjust to flying. For example, a group of people with the same fear may all sit in an airplane together, but the airplane won't take off.

Cognitive behavior therapy is a more comprehensive form of therapy. It involves you and your therapist learning ways you can view and cope with the feared object or situation differently. You learn alternative beliefs about the feared object or situation and the impact it has on your life. There's special emphasis on learning to develop a sen