Facts about Phobias & Fear Factors

Many people fear public speaking. Most adjust. They apply extra deodorant, take deep 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 the ability to speak. They have a social phobia about public speaking, and they're far from alone.

The National Institute of Mental Health estimates at least 5.3 million 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 end of 1999 puts the number of people affected by social phobias as high as 7 percent.

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

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

One in five Americans— 24 percent of women and 17 percent of men—say they have some degree of fear of being in crowded or wide-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 in social situations. Many more say they've felt nervousness, blushing, a racing heart or dry mouth and throat, some of the symptoms of social phobia.

Women ranked snakes as their top fear. Men were most afraid of being buried alive. Both genders also included fear of heights, fear of drowning and fear of public speaking high in their rankings. One big disparity: While women ranked being bound or tied 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 (30 percent);
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 the fearful seek treatment. Among those Americans who say they have a phobia or extreme fear, just 11 percent told pollsters they have sought professional help.

More than one-third of those who sought treatment received prescription drugs. About one-third were treated with psychotherapy. A quarter received training in relaxation, and another quarter went through behavioral therapy, which involves gradual exposure to their fears. About 10 percent made use of hypnosis in their therapy. (Some patients take advantage of more than one type of therapy.)

Phobias seem to run in families.

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

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

Most of the phobias people develop have a basis for creating some level of fear, says Cary Savage, Ph.D., an assistant professor and director of the Cognitive Neuroscience Group in the Department of Psychiatry at Massachusetts General Hospital and Harvard Medical School. Enclosed spaces could lead to suffocation, 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, says Savage, is how much of their response is biological, and how much comes from early learning. They may physically inherit the tendency for hyper-responsiveness or they may learn it behaviorally. "It's really hard to tease apart," he says.

Therapists break phobias into three general categories:

Specific Phobias
More than one in 10 Americans is thought to have a phobia about something specific, and it usually appears first in adolescence or adulthood. Most specific phobias in adults do not go away on their own - in contrast to those suffered by children that generally disappear over time. Specific phobias often develop after traumatic events.

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

People with specific phobias usually recognize that their intense fear of certain objects or situations is irrational. They generally "treat" their phobia by avoiding their trigger, and seek professional help only if the phobia begins to impair their life. Maybe they're up for a job promotion that would require air travel. Or maybe they have scheduled surgery that requires lots of advance blood work.

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

Research shows a small structure in the brain, the amygdala, may be responsible for fear responses. Studies funded by the National Institute of Mental Health suggest social phobias may be inherited, while other scientists are investigating biochemical roots of the disorder.

Up to half of social phobics may suffer from a simultaneous psychiatric problem such as panic disorder, substance abuse or depression.

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

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

Some people with social phobia become so anxious they develop panic disorder.


Panic Disorder
Panic disorder is characterized by unexpected and repeated episodes of intense fear (panic attacks) which are often accompanied by chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress.

Panic attacks can accompany social phobia, generalized anxiety disorder or major depression. However, they sometimes affect otherwise healthy individuals.

It is not unusual for a person with panic disorder to develop phobias about certain places or situations where panic attacks have occurred, such as in supermarkets or other everyday situations. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety.

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