Facing Fears: Most Patients Can Overcome Phobias

The number of phobias - things and situations that trigger fear in certain individuals - is vast. An online search for "phobias and definitions" can turn up lists of more than 600 entries, from ablutophobia (fear of washing or bathing) to zoophobia (fear of animals).

According to the National Institute of Mental Health (NIMH), phobias are the most common form of anxiety disorder, which as a category of illness affects up to 28% of the US population. Other anxiety disorders include post-traumatic stress disorder, obsessive-compulsive disorder, generalized anxiety disorder, and panic disorder. NIMH estimates that anywhere from 5% to more than 20% of the population suffers from one or more phobias.

With so many different phobias affecting so many different people, it might seem that they would be difficult to treat. Generally, though, phobias can be overcome with fairly simple therapies, medication, or a combination of the two. And, as a Medical College of Wisconsin psychiatrist notes, a high percentage of people with phobias handle them well by simply avoiding that which makes them fearful.

"When discussing phobias, it's helpful to backtrack a bit and talk about anxiety disorders in general," said Carlyle H. Chan, MD, Medical College of Wisconsin Professor of Psychiatry. Dr. Chan is Vice Chair for Professional Development and Educational Outreach and Associate Director of the Columbia St. Mary's Center for Psychotherapies, a low-fee clinic staffed by MCW Psychiatry Residents. Dr. Chan also practices at the Medical College's Behavioral Health Center.

"The whole series of anxiety disorders fall into two classes," said Dr. Chan. "There are generalized anxiety disorders, with a low level of discomfort that people feel that is sometimes ongoing, perhaps for hours, days and weeks at a time. Generalized anxiety disorders are 'free-floating' types of conditions."

Situational Panic and Avoidance
"Then there is panic disorder, which is an acute anxiety attack that usually goes on for fifteen minutes or so," said Dr. Chan. "This is an intense fear. The heart starts pounding, hands sweat, and a person may think they're having a heart attack or that they are going to die. If you have one of those panic attacks you can be afraid you're going to have another one, and that brings on what's called anticipatory anxiety. You get a little anxious that an acute attack is going to happen again."

Phobias, generally, are panic attacks that occur in certain situations, said Dr. Chan. "Some people have a phobia for spiders (arachnophobia), or high places (acrophobia), or the number 13 (triskaidekaphobia)," he said. "There are all sorts of phobias. Claustrophobia is fear of being in a tight space. Some people have social phobias, for example getting anxious giving a talk or in other social settings."

Many articles, including some NIMH publications, make a clear distinction between "specific" phobias and "social" phobias and often describe them in separate sections. In practical terms, though, specific and social phobias have similar effects if not similar causes.

"Fears of specific things, like spiders, are called 'simple' phobias," said Dr. Chan. "Social phobias involve a more general situation. But from a practical standpoint, it's the same sort of symptomatology (the set of signs of a disease)."

The term "phobia" comes from the Greek word for fear, fobos, and refers to several physiological and psychological conditions. A phobia may be a quirk that doesn't significantly affect quality of life, or a common fear that causes obvious lifestyle changes, or a matter of very severe consequence such as when a person is unable to leave their residence (agoraphobia, the fear of leaving a safe place or of being in crowded, public places).

Common, and Commonly Underreported
One NIMH study found that phobias were the most common mental illness among women in all age groups and the second most common illness among men older than 25. Even with such prevalence, doctors may never hear about a patient's phobia because it is under control.

"People tend to avoid the things that make them anxious, and most people are successful in avoiding them, particularly the simple phobias," said Dr. Chan. "For example, I may have a fear of heights, but I can hire people to wash upper windows or clean the gutters of my house. Avoidance is a common phenomenon. Most people don't present (come forward) to psychiatrists with phobias as their chief complaint because they've been able to adjust their lives to avoid those specific things that make them anxious.

"So, while panic disorders are fairly common, phobias aren't always the number one complaint in the doctor's office. What we tend to see are panic attacks separate from phobias. A panic disorder can come on, out of the blue, several times a day. When that starts happening it becomes very disruptive to the person's life. Panic attacks can also be 'cued' in that they occur in specific situations, e.g. driving over a bridge. We don't see simple phobias all that often."

"But if you ask people, you can see just how common phobias are. I once asked a group of residents (doctors in training) if there was anything that made them particularly anxious. Everybody in the room had something. Studies show that one out of five people may have an anxiety disorder at some point in their life, but that number could be higher due to under-reporting because people are not inclined to talk about it."

Dan Ullrich
HealthLink Contributing Writer

For more information on this topic, see Dr. Chan's article Phobias, Part 2: Causes and Treatments.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.