Introduction

Phobia is a recurring, excessive, unreasonable and unexplained fear of certain objects, situations or their anticipated presence that causes uneasiness and anxiety which leads to its avoidance whenever possible. Unlike the anxiety that is faced before an important exam which regresses by itself, phobia causes physical and psychological tension which also interferes with normal functioning and routine.

Phobias can be generalised such as of going out in public or specific which may be related to an object or objects. The anxiety or nervousness is an immediate reaction which is created by exposure to the object or situation or simply by the thought of it. The nervousness or anxiety associated with the phobia causes the learned behaviour of avoiding the situation. It may even interfere with the daily functional routine of the individual.

What are the different types of phobia?

Phobias can be broadly classified into following main types which are:

• Social phobia: fear of being in a social gathering or meeting people
• Agoraphobia: fear of being in open or public spaces where escape might be difficult
• Specific phobia: fear of a particular object or situation such as spider, ants, injection, heights etc.

What are the symptoms of phobia?

There is no single symptom that can define a phobia. A wide array of symptoms present in phobia are:

1. Anxiety
2. Unexplained or irrational fear on exposure to the object you fear
3. Avoiding a particular situation or an object
4. Muscle tightness
5. Sweating
6. Rapid heart rate
7. Difficulty breathing
8. Chest tightness
9. Dizziness
10. Disorientation
11. Nausea or vomiting

It resembles panic attack. The learned behaviour of avoiding these situations makes the diagnosis even more difficult.

What are the causes of phobia?

Both genetic and environmental factors seem to play an important role, with a keen suggestion for stronger role for the environment. Many theories have been put forward to explain phobias in general.

• Psychoanalytical theory: It states the manifesting fear is the symbolic representation of an unconscious conflict, which has been repressed and displaced into phobic symptoms, which means it has deep rooted cause in the unconscious which manifests itself as a phobia.

• Learning theory: It explains phobia as a conditioned fear response related to a traumatic situation, with learned avoidance (the trigger to the conditioned fear response may be a reminder of the original situation). Observational learning also appears to be important.

• The preparedness theory (Marks): It states that fear of certain objects may be evolutionarily adaptive (related to survival of the individual or species); selectively acquired and difficult to extinguish as this is a non-cognitive process.

What are the associated complications?

The co-occurrence of phobias in general increases when there is occurrence of other anxiety related disorder or mood disorder. The anxiety disorders such as panic, social phobia and agoraphobia are seen in patients with specific phobia. Mood disorders such as mania, depression and dysthymia also are seen along with social phobia.

Who is at risk of having phobia?

Phobias do have a genetic predisposition. So if you have someone in your family who has phobia of height, snake etc. Chances are there you may too have that phobia may either be inherited or as a learned behaviour. Being overly sensitive can also increase your risk of having a phobia. If you had a traumatic experience in childhood such as near drowning or a wild beast encounter, you may be sensitized and hence may cause phobia.

What are the treatment options available?

There is a wide array of treatment options available depending on the stage, complexity and severity of the disease. According to the above mentioned factors your doctor will chose the best possible treatment option for you.The major difficulty in treatment and management of most of the phobias is that the affected individual learns to avoid these situations and objects and reports only when it becomes chronic i.e it starts hindering the daily routine and it becomes too necessary to confront the feared object. The treatment can be psychological or pharmacological. So, the different treatment options are:

1. Psychological

   1. Behavioural therapy: It is the treatment of choice. It aims to reduce the fear, anxiety and apprehension related with the fear causing object or situation. The repeated exposure of the phobia causing agents desensitizes the individual and makes the person resistant to fears.
   2. Cognitive methods: It aims at educating the individual about the fears and anxieties and helps the individual to cope up with the fear causing situations. It makes the individual more confident and is more beneficial in the long run.

2. Pharmacological

   Pharmacological management is generally not used as the cause for phobias is psychological. It is used only in severe cases to reduce fear and reduce anxiety while behaviour and cognitive therapy is being carried out.

Without treatment, phobia tends to run a chronic course. However, individuals may not present unless life changes force them to confront the feared object or situation.

References

1. Kendler KS, Neale MC, Kessler RC,et al. (1992) The genetic epidemiology of phobias in women. The interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Archives of General Psychiatry 49, 273–81.
2. Marks IM (1969) Fears and Phobias Academic Press: New York.
3. Wolpe J (1973) The practice of behaviour therapy (2nd ed.) Pergamon: New York.
4. Oxford handbook of psychiatry, 1st edition.Editors: Semple, David; Smyth, Roger; Burns, Jonathan; Darjee, Rajan; McIntosh, Andrew
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Treatment Revision. Washington, D.C., 2000.