Depression and Mood Disorders

A phobia is an uncontrollable, irrational and persistent fear of a specific object, situation or activity. The fear experienced by people with phobias can be so great that some individuals will do almost anything to avoid the source of their fear. One extreme response to the source of a phobia is a panic attack.
Three more common types of phobias include: 
  • Specific phobias - to common objects, places or situations
  • Social phobia - extreme anxiety and self-consciousness in everyday social situations
  • Agoraphobia - fear of being in any place or situation where escape might be difficult or help unavailable

According to the National Institute of Mental Health, every year approximately 19 million Americans experience one or more specific phobias that range from mild to severe. About 15 million American adults experience social phobia in a given year as compared with about 1.8 million American adults with agoraphobia.

Causes of Phobia 
Research suggests that both genetic and environmental factors contribute to the onset of phobias. Specific phobias have been associated with a fearful first encounter with the phobic object or situation. It remains unknown, however, whether this conditioning exposure is necessary or if phobias can develop without the phobic exposure in genetically predisposed individuals.
Phobias can occur in early childhood, but they usually are first evident between the ages of 15 and 20 years. They affect both genders equally, although men are more likely to seek treatment for phobia.
Symptoms of Phobia
Specific phobia
The most common or known phobias are classified as specific phobias and include the following:
  • Flying (fearing the plane will crash)
  • Dogs (fearing the dog will bite/attack)
  • Closed-in places (fear of being trapped)
  • Tunnels (fearing a collapse)
  • Heights (fear of falling)

People with specific phobias know that their fear is excessive, but are unable to overcome their emotion. The disorder is diagnosed only when the specific fear interferes with daily activities of school, work or home life.
Social phobia
Social phobia is an anxiety disorder in which a person has significant anxiety and discomfort caused by a fear of being embarrassed, humiliated or scorned by others in social or performance situations. Thus, the individual tries to avoid the situations that provoke dread or cause distress. Even when they manage to confront their fear, persons with social phobia have difficulty before, during and after an event or outing.
Common settings in which social phobia frequently occurs include the following situations:
  • Public speaking
  • Meeting people
  • Dealing with authority figures
  • Eating in public
  • Using public restrooms

Although a social phobia is often thought of as shyness, the two are not the same. Shy people can be very uneasy around others, but they do not experience extreme anxiety in anticipating a social situation and do not necessarily avoid circumstances that make them feel self-conscious. In contrast, people with social phobia are not necessarily shy and can be completely at ease with some people most of the time.

Social phobia often runs in families and may be accompanied by depression or alcoholism. It often develops around early adolescence or even at a younger age.
Agoraphobia is a Greek word that literally means "fear of the marketplace." Persons with agoraphobia are afraid of having a panic attack in a place or situation from which escape may be difficult or embarrassing. Thus, individuals with agoraphobia typically try to avoid the location or cause of their fear.

Following are situations that cause fear in a person with agoraphobia that are not generally considered stressful by others:
  • Being alone outside the home
  • Traveling in a vehicle
  • Spending time at home alone
  • Being in a crowd
  • Being in an elevator or on a bridge

Because these common settings cause fear, people with agoraphobia typically avoid crowded places like streets, stores, churches and theaters.
Most people with agoraphobia develop the disorder after first suffering a series of one or more panic attacks. The attacks occur randomly and without warning and make it impossible for a person to predict what situations will trigger the reaction. The unpredictability of the panic causes the person to anticipate future panic attacks and, eventually, fear any situation in which an attack may occur. As a result, persons with agoraphobia avoid any place or situation where a previous panic attack has occurred.
People with the agoraphobia often become so disabled that they literally feel that they cannot leave their home. Others who have this disorder face potentially "phobic" situations, but only with great distress or when accompanied by a trusted friend or family member.
Because agoraphobia often is accompanied by depression, fatigue, tension and alcohol or drug abuse, as well as obsessive disorders, it is crucial that affected persons seek treatment as early as possible.
Diagnosing Phobias
Persons with a phobia usually consult a health care professional when their fear or avoidance of particular places significantly interferes with their normal routines or is excessively upsetting. Your doctor will make the diagnosis on the basis of a thorough medical and social history and psychiatric evaluation.
Treating Phobias 
Specific treatment for your phobia will be determined by your individual circumstances, but take into account:
  • Your age, overall health, and medical history
  • The severity and extent of your disease
  • Your tolerance for specific medications, procedures or therapies
  • Your expectations for the course of the disease
  • Your opinion or preference

Treatment for phobia is dictated by the specific type and usually consists of a psychotherapy and/or medication. Patients with specific phobias usually undergo a cognitive-behavioral therapy called desensitization, or exposure, therapy. With this approach, patients are gradually exposed to what frightens them until the fear begins to subside. Relaxation and breathing exercises also help to reduce anxiety symptoms.
For patients with social phobia, exposure therapy may be useful, and drug treatment (typically an antidepressant or a beta blocker, which can reduce physical symptoms) is another option. Exposure treatment and medication are the more common treatments for persons with agoraphobia (especially in the presence of panic disorder).