Facts about Phobias & Fear Factors


Many people fearpublic speaking. Most adjust. They apply extra deodorant, takedeep breaths and get through their presentations just fine.

For some, however, the fear feeds itself. They blush, tremble,sweat profusely, stammer and stutter, perhaps even lose theability to speak. They have a social phobia about publicspeaking, and they're far from alone.

The National Institute of Mental Health estimates at least 5.3million Americans (almost 4 percent) suffer from a social phobia,an overwhelming anxiety and self-consciousness in social settings.The Surgeon General's Report on Mental Health issued at the endof 1999 puts the number of people affected by social phobias ashigh as 7 percent.

But social phobias are only one type of fear. More than one in 10Americans have one or more specific phobias, the instituteestimates, and an additional 2 percent suffer from panic disordereach year.

These numbers are not far from those reported in a telephonestudy of 1,000 adults done recently by Penn, Schoen & BerlandAssociates, Inc. for Discovery Health. While the poll showed 7percent of Americans say they suffer from a phobia, nearly 40percent confess an extreme fear of an object or situation, themost common being fear of snakes and fear of being buried alive.

One in five Americans— 24 percent of women and 17 percent ofmen—say they have some degree of fear of being in crowded orwide-open places.

Almost a third of Americans say they've suffered a panic attack.

One in four say they've experienced intense fear and trembling insocial situations. Many more say they've felt nervousness,blushing, a racing heart or dry mouth and throat, some of thesymptoms of social phobia.

Women ranked snakes as their top fear. Men were most afraid ofbeing buried alive. Both genders also included fear of heights,fear of drowning and fear of public speaking high in theirrankings. One big disparity: While women ranked being bound ortied up as their second-highest fear, men ranked it 36th.

Researchers found broad agreement in fear of:
the Internal Revenue Service (57 percent) more than God (30percent);
dentists (58 percent) more than doctors (22 percent); and
rats (58 percent) more than cockroaches (23 percent.)

While the level of fear in our society is high, only a few of thefearful seek treatment. Among those Americans who say they have aphobia or extreme fear, just 11 percent told pollsters they havesought professional help.

More than one-third of those who sought treatment receivedprescription drugs. About one-third were treated withpsychotherapy. A quarter received training in relaxation, andanother quarter went through behavioral therapy, which involvesgradual exposure to their fears. About 10 percent made use ofhypnosis in their therapy. (Some patients take advantage of morethan one type of therapy.)

Phobias seem to run in families.

"I have often noted that parents bring in children who haveanxieties and phobias, and they admit that they too suffer fromthe same problem," says Roger Burket, M.D., associateprofessor and director of residency training at the University ofFlorida's Division of Child and Adolescent Psychiatry.

He says children may hear words of caution from their parentsabout the feared object or situation, or children may witness aparent's reaction. "It is possible that some childhoodphobias may be learned in this way, in prone children,"Burket says. "Still, I think many or most children in thissituation do not develop the same phobia as their parents."

Most of the phobias people develop have a basis for creating somelevel of fear, says Cary Savage, Ph.D., an assistant professorand director of the Cognitive Neuroscience Group in theDepartment of Psychiatry at Massachusetts General Hospital andHarvard Medical School. Enclosed spaces could lead tosuffocation, for instance, and people could fall from high places.Phobias develop when people's fear responses become exaggerated.

What's unclear in children of parents with specific phobias, saysSavage, is how much of their response is biological, and how muchcomes from early learning. They may physically inherit thetendency for hyper-responsiveness or they may learn itbehaviorally. "It's really hard to tease apart," hesays.

Therapists break phobias into three general categories:

Specific Phobias
More than one in 10 Americans is thought to have a phobia aboutsomething specific, and it usually appears first in adolescenceor adulthood. Most specific phobias in adults do not go away ontheir own - in contrast to those suffered by children thatgenerally disappear over time. Specific phobias often developafter traumatic events.

The Surgeon General's report says about 8 percent of adultssuffer from one or more specific phobias, the most common beinganimals, insects, heights, elevators, flying, automobile driving,water, storms and blood or injections.

People with specific phobias usually recognize that their intensefear of certain objects or situations is irrational. Theygenerally "treat" their phobia by avoiding theirtrigger, and seek professional help only if the phobia begins toimpair their life. Maybe they're up for a job promotion thatwould require air travel. Or maybe they have scheduled surgerythat requires lots of advance blood work.

Social Phobias
Social phobias are thought to be almost twice as prevalent inwomen as in men, though a higher portion of men seek help,according to the National Mental Health Association. The disorderrarely develops after age 25.

Research shows a small structure in the brain, the amygdala, maybe responsible for fear responses. Studies funded by the NationalInstitute of Mental Health suggest social phobias may beinherited, while other scientists are investigating biochemicalroots of the disorder.

Up to half of social phobics may suffer from a simultaneouspsychiatric problem such as panic disorder, substance abuse ordepression.

Some people have "generalized social phobia" in whichthey fear any situation where they may be under the scrutiny ofothers. Others have a fear of only certain social situations,such as public speaking, and therefore have "nongeneralizedsocial phobia."

Dr. Herbert Ward of the University of Florida Brain Institute'sDepartment of Psychiatry, cautions that some people exhibitsymptoms of social phobia, though their fears may be tied tomedical or physical conditions, such as Parkinson's disease,obesity or disfigurement.

Some people with social phobia become so anxious they developpanic disorder.

Panic Disorder
Panic disorder is characterized by unexpected and repeatedepisodes of intense fear (panic attacks) which are oftenaccompanied by chest pain, heart palpitations, shortness ofbreath, dizziness or abdominal distress.

Panic attacks can accompany social phobia, generalized anxietydisorder or major depression. However, they sometimes affectotherwise healthy individuals.

It is not unusual for a person with panic disorder to developphobias about certain places or situations where panic attackshave occurred, such as in supermarkets or other everydaysituations. As the frequency of panic attacks increases, theperson often begins to avoid situations where they fear anotherattack may occur or where help would not be immediately available.This avoidance may eventually develop into agoraphobia, aninability to go beyond known and safe surroundings because ofintense fear and anxiety.

Regardless of the type of phobia, it's important to remember thata variety of treatments are available and usually very effective.

Phobia Guide