Anxiety: A Very Short Introduction - Daniel Freeman, Jason Freeman 2012
What are phobias?
Matthew is a nine-year-old boy so frightened of newspapers that he cannot bear even to see them from a distance. Sheila is a twenty-eight-year-old mother of three; she is terrified of thunder and lightning, and will do all she can to avoid experiencing them alone. Robin’s fear of flying means that he will make train journeys lasting several days to avoid the misery of a few hours on a plane.
The names are fictitious, but in all other respects, these case studies are based on fact. Fears and phobias are endlessly varied, and extremely common. Think of a situation or object, and someone somewhere is probably afraid of it (you can find a comprehensive — and somewhat mind-boggling — catalogue at phobialist.com).
It’s quite usual to hear people discussing their ’phobias’ — by which they often mean a mild fear or dislike. But being frightened is not the same as having a phobia. So let’s begin by setting out the precise, technical meaning of the term ’phobia’, as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
Here are the key symptoms a mental health professional will look for to decide whether a fear is severe enough to be termed a phobia:
• Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation.
• Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response.
• The person recognizes that the fear is excessive or unreasonable.
• The avoidance, anxious anticipation, or distress in the feared situation interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
There are literally hundreds of different phobias. But experts have identified five broad categories:
• Animal phobias. Among the most common animal phobias are fears of insects, snakes, rats, and dogs.
• Natural environment phobias. These include fears of heights, storms, and water.
• Situational phobias. For example, fears of flying, enclosed spaces, public transport, tunnels, bridges, elevators, and driving.
• Blood-injection-injury phobias. These phobias include the fear of seeing blood or an injury, or of having an injection or similar medical procedure.
• Other types. Everything else! Common ’other’ phobias are the fear of choking or of catching an illness (as opposed to hypochondriasis, the fear of actually being ill).
Most of the several hundred phobias recorded by doctors affect a tiny number of people. (How often have you met someone who is afraid of teeth or sitting down?) A very limited number of situations or objects account for the vast majority of phobias. These are, in descending order:
• Enclosed spaces
When someone with a phobia encounters (or even anticipates encountering) the situation they fear, they usually experience a feeling of panic. This can involve some very unpleasant sensations: for example, shortness of breath, sweating, chest pains, trembling, a choking feeling, dizziness, numbness, tingling in the limbs, and nausea.
It’s not uncommon for people when highly anxious, especially with panic disorder (see Chapter 7), to believe that they are about to faint, but this is an impossibility. When we’re frightened, our blood pressure increases. Fainting, however, occurs when blood pressure drops dramatically.
Like most rules, though, this one has an exception. People with blood-injection-injury phobias often experience a dramatic fall in blood pressure, sometimes causing them to faint (this reaction is called a vasovagal syncope). No one knows for sure why this occurs, but it makes evolutionary sense. Besides fainting, an additional consequence of lowered blood pressure is reduced blood flow. If you happened to be badly wounded, this might just save your life.