Types of Phobias & Different Phobia Types
Mental healthprofessionals now recognize three types of phobia - simplephobia, social phobia, and agoraphobia (with and without panicattacks) - and a separate diagnosis for people who repeatedlyexperience severe attacks of panic.
The most common of the various phobias is simple phobia, theunreasonable fear of some object or situation. Bees, germs,heights, odors, illness, and storms are examples of the thingscommonly feared in simple phobias.
If you have a simple phobia, it might have begun when youactually did face a risk that realistically provoked anxiety.Perhaps, for example, you found yourself in deep water before youlearned to swim. Extreme fear was appropriate in such a situation.But if you continue to avoid even the shallow end of a pool, youranxiety is excessive and may be of phobic proportions.
Simple phobias, especially animal phobias, are common inchildren, but they occur at all ages. The best evidence to datesuggests that between 5 and 12 percent of the population havephobic disorders in any 6-month period.
The recognition by most phobics that their fears are unreasonabledoesn't make them feel any less anxious. Simple phobias do notoften interfere with daily life or cause as much subjectivedistress as most other anxiety disorders.
The person with a social phobia is intensely afraid of beingjudged by others. Even at a gathering of many people, the socialphobic expects to be singled out, scrutinized, and found wanting.Thus, the person with a social phobia feels compelled to avoidsocial situations with such apprehensions.
If you have a social phobia, you might be afraid to go to a partybecause you fear that other people will laugh at your clothing orthink you are hopelessly stupid because you won't be able tothink of anything to say. Like people with simple phobias, youwork hard to avoid these anxiety-provoking situations.
People with social phobias are usually most anxious over feelinghumiliated or embarrassed by showing fear in front of others.Ironically, they are often so crippled by the inhibitionsresulting from such fears that they, in fact, may have difficultythinking clearly, remembering facts, or expressing themselves inwords. Even success in social situations fails to make them feelmore confident. They are likely to think something like, "Nexttime I'll fall on my face."
Although studies of the incidence of social phobias are so faronly preliminary, most experts believe social phobias are not ascommon as simple phobias. But because they result in considerabledistress, people who suffer from them are more likely to seektreatment than are people with simple phobias. Social phobiastend to begin between the ages of 15 and 20 and, if leftuntreated, continue through much of the person's life. Often,social phobias suffer from symptoms of depression, and many alsobecome dependent on alcohol.
Another group of anxious people are subject to devastatingepisodes of panic that are unexpected and seemingly without cause.Such unpredictable panic attacks are marked by an overwhelmingsense of impending doom and a host of bodily symptoms. Theperson's heart races and breathing quickens, as he gasps for air.(In the interest of brevity and grace of style, the pronoun"he" will be used throughout this pamphlet when eithersex could be the topic of discussion). Sweating, weakness,dizziness, and feelings of unreality are also common. The personhaving a panic attack fears he is going to die, go crazy, or atleast lose control.
Panic disorder is diagnosed when patients experience repeatedepisodes of such panic. Although people with simple or socialphobias may sometimes experience panic, they are clearlyresponding to an encounter - or an anticipated encounter - withthe object or situation they fear. Such is not the case withpanic disorder, when the fear strikes from nowhere, seemingly"out of the blue."
People with simple and social phobias can also predict that theywill feel fear every time they come close to a cat, climb to theroof of a tall building, or encounter whatever else they fear.People with panic disorder, by contrast, never can predict whenthey will suddenly be struck by panic. Some situations may seemmore "dangerous," especially those that make escapedifficult, but an attack does not invariably occur in thosesituations.
Panic disorder, which runs in families, afflicts some 1.2 millionAmericans. For most, panic attacks begin sometime between theages of 15 and 19.
Many people who suffer from panic attacks go on to developagoraphobia, a severely handicapping disorder that often preventsits victims from leaving their homes unless accompanied by afriend or relative - a "safe" person. The first panicattack may follow some stressful event, such as a serious illnessor the death of a loved one. (The agoraphobic often doesn't makethis connection, though.) Fearing more attacks, the persondevelops a more-or-less continual state of anxiety, anticipatingthe next attack, avoiding situations where he would be helplessif a panic attack occurred. It is this avoidance behavior thatdistinguishes agoraphobia from panic disorder. Two differenttypes of anxiety appear to afflict the person with agoraphobia -panic and the "anticipatory anxiety" engendered byexpectations of future panic attacks.
If you have agoraphobia, chances are it developed something likethis: One ordinary day, while tending to some chore, taking awalk, driving to work - in other words, just going about yourusual business - you were suddenly struck by a wave of awfulterror. Your heart started pounding, you trembled, you perspiredprofusely, and you had difficulty catching your breath. Youbecame convinced that something terrible was happening to you,maybe you were going crazy, maybe you were having a heart attack,maybe you were about to die. You desperately sought safety,reassurance from your family, treatment at a clinic or emergencyroom. Your doctor could find nothing wrong with you, so you wentabout your business, until a panic attack struck you again. Asthe attacks became more frequent, you spent more and more timethinking about them. You worried, watched for danger, and waitedwith fear for the next one to hit.
You began to avoid situations where you had experienced anattack, then others where you would find it particularlydifficult to cope with one - to escape and get help. You startedby making minor adjustments in your habits - going to asupermarket at midnight, for example, rather than on the way homefrom work when the store tends to be crowded.
Gradually, you got to the point where you couldn't ventureoutside your immediate neighborhood, couldn't leave the housewithout your spouse, or maybe couldn't leave at all. What startedout as an inconvenience turned into a nightmare. Like a creaturein a horror movie, fear expanded until it covered the entirescreen of your life.
To the outside observer, a person with agoraphobia may look nodifferent from one with a social phobia. Both may stay home froma party. But their reasons for doing so are different. While thesocial phobic is afraid of the scrutiny of other people, manyinvestigators believe that the agoraphobic is afraid of his orher own internal cues. The agoraphobic is afraid of feeling thedreadful anxiety of a panic attack, afraid of losing control in acrowd. Minor physical sensations may be interpreted as theprelude to some catastrophic threat to life.
Agoraphobics may abuse alcohol in an effort to keep theanticipatory anxiety in check. Their pattern of abuse appears tobe different from the binging characteristics of alcoholism,however. The agoraphobic usually takes small amounts of alcohol,avoiding loss of control. Other drugs may also be abused.
Agoraphobia typically begins during the late teens or twenties.The best surveys done to date show that between 2.7 percent and 5.8percent of the U.S. adult population suffer from agoraphobia.Women are affected two to four times more often than men. Thecondition tends to run in families.
Recent surveys have found that many people are afraid to leavetheir homes. Most likely, they are not all suffering fromagoraphobia. Some people may stay confined because of depression,fear of street crime, or other reasons. These surveys also show,however, that many agoraphobics may have never suffered a panicattack. This finding suggests that their agoraphobia may havedeveloped in ways different from that outlined above.
Panic and agoraphobia have received a great deal of attentionfrom clinical investigators in recent years. Some believe thatpanic attacks are a severe expression of general anxiety, whileothers think that they constitute a biologically distinctdisorder, possibly related to depression, possiblyindistinguishable from agoraphobia. This controversy willprobably be resolved through more research in the coming years.
THE MASQUERADE: PHOBIAS AND OTHER CONDITIONS
Given the dramatic symptoms of phobic and panic disorder, it issurprising that they are sometimes difficult to recognize, evenfor medical professionals. Some patients, especially those withsimple phobias, are able to conceal the severity of theirhandicap. Agoraphobia is often not detected because its physicalsymptoms become the center of concern for both patient and doctor.Health problems, such as peptic ulcer, high blood pressure, skinrashes, tics, tooth grinding, hemorrhoids, headaches, muscleaches, and heart disease, often occur together with anxietydisorders.
Phobias may cover up other problems. School phobia, a complexcondition in which a youngster refuses to attend school, is oneexample; often the underlying problem is the child's anxiety overseparating from his parents. (A mental health professional caneasily distinguish between school phobia and other causes ofmissing school.)
Just as panic and phobias can masquerade as other illness, somephysical diseases may be mistaken for anxiety disorders. Forexample, people can become anxious as the result of such medicalconditions as head injury, withdrawal from alcohol and drugs, andeven pneumonia. In these cases, the panicky feelings usuallydisappear when the condition clears up. Phobic behavior alsooccurs in conditions that are not diagnosed as phobias, such asthe phobic-like avoidance of sexual contact in a person whoseprincipal problem is sexual.
Reactive hypoglycemia - a rapid decline in blood sugar followedby compensatory changes in adrenalin and other hormones - canproduce many symptoms of panic, such as sweating, heartpalpitations, and tremor. Most likely, this medical conditionmimics panic disorder.
More puzzling is the relationship between panic attacks andagoraphobia, on the one hand, and depression, on the other. Abouthalf of people subject to phobias and panic are demoralized ordepressed more often than the average person. Many agoraphobicpatients develop their symptoms shortly after suffering a loss (whichcan trigger depression), and some either have histories ofdepressive episodes themselves or have relatives who do.
Whether phobias cause depression or depression causes phobias isunknown. Panic and anxiety can wear down a person until he or shefeels demoralized. Alternatively, phobia and panic might resultfrom depression and its symptoms - difficulties with sleep,appetite, and concentration, fatigue, lack of pleasure, andfeelings of worthlessness.
Yet another possibility is the simple coexistence of anxiety anddepression, neither causing the other. Some underlying biologicalprocess - an inherited vulnerability, perhaps - may be common toboth anxiety and depression.