Types of Phobias & Different Phobia Types

Types of phobias, different phobias, different phobia types, different kinds of

phobias, simple phobia, social phobia, specific phobia, panic disorders
Mental health professionals now recognize three types of phobia - simple pho
bia, social phobia, and agoraphobia (with and without panic attacks) - and a sep
arate diagnosis for people who repeatedly experience severe attacks of panic.
SIMPLE PHOBIAS
The most common of the various phobias is simple phobia, the unreasonable fe
ar of some object or situation. Bees, germs, heights, odors, illness, and storms
are examples of the things commonly feared in simple phobias.
If you have a simple phobia, it might have begun when you actually did face
a risk that realistically provoked anxiety. Perhaps, for example, you found your
self in deep water before you learned to swim. Extreme fear was appropriate in s
uch a situation. But if you continue to avoid even the shallow end of a pool, yo
ur anxiety is excessive and may be of phobic proportions.
Simple phobias, especially animal phobias, are common in children, but they
occur at all ages. The best evidence to date suggests that between 5 and 12 perc
ent of the population have phobic disorders in any 6-month period.
The recognition by most phobics that their fears are unreasonable doesn't ma
ke them feel any less anxious. Simple phobias do not often interfere with daily
life or cause as much subjective distress as most other anxiety disorders.
SOCIAL PHOBIAS
The person with a social phobia is intensely afraid of being judged by other
s. Even at a gathering of many people, the social phobic expects to be singled o
ut, scrutinized, and found wanting. Thus, the person with a social phobia feels
compelled to avoid social situations with such apprehensions.
If you have a social phobia, you might be afraid to go to a party because yo
u fear that other people will laugh at your clothing or think you are hopelessly
stupid because you won't be able to think of anything to say. Like people with
simple phobias, you work hard to avoid these anxiety-provoking situations.
People with social phobias are usually most anxious over feeling humiliated
or embarrassed by showing fear in front of others. Ironically, they are often so
crippled by the inhibitions resulting from such fears that they, in fact, may h
ave difficulty thinking clearly, remembering facts, or expressing themselves in
words. Even success in social situations fails to make them feel more confident.
They are likely to think something like, "Next time I'll fall on my face."
Although studies of the incidence of social phobias are so far only prelimin
ary, most experts believe social phobias are not as common as simple phobias. Bu
t because they result in considerable distress, people who suffer from them are
more likely to seek treatment than are people with simple phobias. Social phobia
s tend to begin between the ages of 15 and 20 and, if left untreated, continue t
hrough much of the person's life. Often, social phobias suffer from symptoms of
depression, and many also become dependent on alcohol.
PANIC DISORDER
Another group of anxious people are subject to devastating episodes of panic
that are unexpected and seemingly without cause. Such unpredictable panic attac
ks are marked by an overwhelming sense of impending doom and a host of bodily sy
mptoms. The person's heart races and breathing quickens, as he gasps for air. (I
n the interest of brevity and grace of style, the pronoun "he" will be used thro
ughout this pamphlet when either sex could be the topic of discussion). Sweating
, weakness, dizziness, and feelings of unreality are also common. The person hav
ing a panic attack fears he is going to die, go crazy, or at least lose control.
Panic disorder is diagnosed when patients experience repeated episodes of su
ch panic. Although people with simple or social phobias may sometimes experience
panic, they are clearly responding to an encounter - or an anticipated encounte
r - with the object or situation they fear. Such is not the case with panic diso
rder, when the fear strikes from nowhere, seemingly "out of the blue."
People with simple and social phobias can also predict that they will feel f
ear every time they come close to a cat, climb to the roof of a tall building, o
r encounter whatever else they fear. People with panic disorder, by contrast, ne
ver can predict when they will suddenly be struck by panic. Some situations may
seem more "dangerous," especially those that make escape difficult, but an attac
k does not invariably occur in those situations.
Panic disorder, which runs in families, afflicts some 1.2 million Americans.
For most, panic attacks begin sometime between the ages of 15 and 19.
AGORAPHOBIA
Many people who suffer from panic attacks go on to develop agoraphobia, a se
verely handicapping disorder that often prevents its victims from leaving their
homes unless accompanied by a friend or relative - a "safe" person. The first pa
nic attack may follow some stressful event, such as a serious illness or the dea
th of a loved one. (The agoraphobic often doesn't make this connection, though.)
Fearing more attacks, the person develops a more-or-less continual state of anx
iety, anticipating the next attack, avoiding situations where he would be helple
ss if a panic attack occurred. It is this avoidance behavior that distinguishes
agoraphobia from panic disorder. Two different types of anxiety appear to afflic
t the person with agoraphobia - panic and the "anticipatory anxiety" engendered
by expectations of future panic attacks.
If you have agoraphobia, chances are it developed something like this: One o
rdinary day, while tending to some chore, taking a walk, driving to work - in ot
her words, just going about your usual business - you were suddenly struck by a
wave of awful terror. Your heart started pounding, you trembled, you perspired p
rofusely, and you had difficulty catching your breath. You became 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 emergency room. Y
our doctor could find nothing wrong with you, so you went about your business, u
ntil a panic attack struck you again. As the attacks became more frequent, you s
pent more and more time thinking about them. You worried, watched for danger, an
d waited with fear for the next one to hit.
You began to avoid situations where you had experienced an attack, then othe
rs where you would find it particularly difficult to cope with one - to escape a
nd get help. You started by making minor adjustments in your habits - going to a
supermarket at midnight, for example, rather than on the way home from work whe
n the store tends to be crowded.
Gradually, you got to the point where you couldn't venture outside your imme
diate neighborhood, couldn't leave the house without your spouse, or maybe could
n't leave at all. What started out as an inconvenience turned into a nightmare.
Like a creature in a horror movie, fear expanded until it covered the entire scr
een of your life.
To the outside observer, a person with agoraphobia may look no different fro
m one with a social phobia. Both may stay home from a party. But their reasons f
or doing so are different. While the social phobic is afraid of the scrutiny of
other people, many investigators believe that the agoraphobic is afraid of his o
r her own internal cues. The agoraphobic is afraid of feeling the dreadful anxie
ty of a panic attack, afraid of losing control in a crowd. Minor physical sensat
ions may be interpreted as the prelude to some catastrophic threat to life.
Agoraphobics may abuse alcohol in an effort to keep the anticipatory anxiety
in check. Their pattern of abuse appears to be different from the binging chara
cteristics of alcoholism, however. The agoraphobic usually takes small amounts o
f alcohol, avoiding loss of control. Other drugs may also be abused.
Agoraphobia typically begins during the late teens or twenties. The best sur
veys done to date show that between 2.7 percent and 5.8 percent of the U.S. adul
t population suffer from agoraphobia. Women are affected two to four times more
often than men. The condition tends to run in families.
Recent surveys have found that many people are afraid to leave their homes.
Most likely, they are not all suffering from agoraphobia. Some people may stay c
onfined because of depression, fear of street crime, or other reasons. These sur
veys also show, however, that many agoraphobics may have never suffered a panic
attack. This finding suggests that their agoraphobia may have developed in ways
different from that outlined above.
Panic and agoraphobia have received a great deal of attention from clinical
investigators in recent years. Some believe that panic attacks are a severe expr
ession of general anxiety, while others think that they constitute a biologicall
y distinct disorder, possibly related to depression, possibly indistinguishable
from agoraphobia. This controversy will probably be resolved through more resear
ch in the coming years.

THE MASQUERADE: PHOBIAS AND OTHER CONDITIONS

Given the dramatic symptoms of phobic and panic disorder, it is surprising t
hat they are sometimes difficult to recognize, even for medical professionals. S
ome patients, especially those with simple phobias, are able to conceal the seve
rity of their handicap. Agoraphobia is often not detected because its physical s
ymptoms become the center of concern for both patient and doctor. Health problem
s, such as peptic ulcer, high blood pressure, skin rashes, tics, tooth grinding,
hemorrhoids, headaches, muscle aches, and heart disease, often occur together w
ith anxiety disorders.
Phobias may cover up other problems. School phobia, a complex condition in w
hich a youngster refuses to attend school, is one example; often the underlying
problem is the child's anxiety over separating from his parents. (A mental healt
h professional can easily distinguish between school phobia and other causes of
missing school.)
Just as panic and phobias can masquerade as other illness, some physical dis
eases may be mistaken for anxiety disorders. For example, people can become anxi
ous as the result of such medical conditions as head injury, withdrawal from alc
ohol and drugs, and even pneumonia. In these cases, the panicky feelings usually
disappear when the condition clears up. Phobic behavior also occurs in conditio
ns that are not diagnosed as phobias, such as the phobic-like avoidance of sexua
l contact in a person whose principal problem is sexual.
Reactive hypoglycemia - a rapid decline in blood sugar followed by compensat
ory changes in adrenalin and other hormones - can produce many symptoms of panic
, such as sweating, heart palpitations, and tremor. Most likely, this medical co
ndition mimics panic disorder.
 More puzzling is the relationship between panic attacks and agoraphobia, on
the one hand, and depression, on the other. About half of people subject to phob
ias and panic are demoralized or depressed more often than the average person. M
any agoraphobic patients develop their symptoms shortly after suffering a loss (
which can trigger depression), and some either have histories of depressive epis
odes themselves or have relatives who do.
Whether phobias cause depression or depression causes phobias is unknown. Pa
nic and anxiety can wear down a person until he or she feels demoralized. Altern
atively, phobia and panic might result from depression and its symptoms - diffic
ulties with sleep, appetite, and concentration, fatigue, lack of pleasure, and f
eelings of worthlessness.
Yet another possibility is the simple coexistence of anxiety and depression,
neither causing the other. Some underlying biological process - an inherited vu
lnerability, perhaps - may be common to both anxiety and depression.
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