Fear is a natural response to a real danger to yourself or someone else. A specific phobia, on the other hand, is an extreme fear of an object or situation that has little or no basis in reality.
While a phobia might be triggered by a real experience — such as a spider bite, an airline disaster, or an elevator accident — the fear eventually becomes disproportionate to reality. The distress associated with a phobia is so great that it can interfere with all aspects of a person’s life, including relationships, jobs, or social activities.
What are Phobias?
By definition, a phobia is an irrational fear of an object, animal, situation, or activity. But the fact that this fear is unreasonable or unjustified doesn’t make it any less powerful to the individual who suffers from a phobia. These people will go out of their way to avoid the subject of their fear, even if it means restricting their lives to a self-destructive degree.
Types of Phobias
Specific phobias often go hand in hand with other disorders, such as generalized anxiety, obsessive-compulsive disorder, depression, or post-traumatic stress disorder. They are also frequently associated with substance abuse. Drugs and alcohol may be used to soothe the intense reactions or a phobia or to calm the obsessive dread about encountering the object of fear. Alternatively, substance abuse may make the individual more vulnerable to phobias and other anxiety disorders by altering the brain chemicals that regulate moods and emotions.
Social phobia affects different individuals in different ways. Some people are frightened of specific situations, like being enclosed in a confined space with other people or speaking at a public meeting. Others have a general, all-consuming dread of interacting with other people, no matter what the situation may be. The following anxiety disorders have been associated with an overwhelming fear of social situations:
- Generalized social anxiety disorder. Generalized anxiety disorder is characterized by a fear and avoidance of all situations involving the public, regardless of the setting or context. Evidence-Based Mental Health estimates that approximately 5 percent of the US population has experienced social anxiety disorder in their lifetime.
- Panic disorder. Panic disorder is characterized by intense, overwhelming episodes of fear. The physical symptoms of panic disorder — choking sensations, heavy sweating, chest pain, heart palpitations, tremors, and an overpowering sense of doom — can resemble a heart attack. Because these episodes often occur in public places, people who suffer from panic disorder will frequently go to great lengths to avoid social activities that might trigger their symptoms. Ironically, the fear of having a panic attack is more debilitating than the fear of the social situation itself. According to the National Alliance on Mental Illness, one out of every 20 Americans is treated for panic disorder in any given year.
- Agoraphobia. Agoraphobia literally means the “fear of open spaces.” Agoraphobics are so fearful of social situations that they isolate themselves in their home, sometimes for months or years at a time. Panic disorder is common among people who have agoraphobia, as panic attacks can reinforce their dread of social situations. Agoraphobia is much less common than social anxiety disorder or panic disorder (affecting less than 1 percent of the US population, according to the NIMH); however, over 40 percent of those who have agoraphobia have severe anxiety symptoms.
- Glossophobia. Glossophobia, or the fear of public speaking, is one of the most common phobias. Even individuals who are self-assured and confident in other situations may be terrified of the idea of speaking in front of others. Glossophobia is especially debilitating for people who must speak before an audience or give public presentations as part of their professional lives, like politicians, teachers, salesmen, consultants, and others.
Phobias affect a significant percentage of the US population. According to the National Institute of Mental Health:
- Over 8.5 percent of American adults suffer from the symptoms of a specific phobia in any given year.
- Out of this group, the largest percentage is between the ages of 45 and 59.
- In nearly 22 percent of these cases, symptoms can be classified as severe.
- Just over 32 percent of the Americans with specific phobia are receiving treatment for the disorder.
- On average, Americans experience the symptoms of phobia for the first time at the age of 7.
While some people may experience only mildly phobic symptoms when they encounter the object of their fear, over 20 percent have reactions so intense that they may verge on a panic attack. The symptoms include sweating, dizziness, fainting, chest tightness, choking sensations, tremors, nausea, and overwhelming feelings of dread.
- Fear of animals, birds, or insects, such as spiders (arachnophobia)
- Fear of specific situations, such as being in water (aquaphobia), being in public places (agoraphobia), or being trapped in an enclosed space (claustrophobia)
- Fear of natural phenomena, such as thunder and lightning (astraphobia)
- Fear of blood (hematophobia) or injuries
- Fear of other things, such as vomiting, choking, dirt and germs (mysophobia), or clowns (coulrophobia)
Out of the dozens of phobias that have been identified, there are a few that predominate in our culture. According to Current Opinion in Psychiatry, the most common phobias involve animals, closed spaces, high places, being alone, or being injured. But just because these fears occur the most frequently doesn’t mean that they are necessarily more debilitating than the more exotic phobias.
- An extreme, irrational fear triggered by an encounter with a specific situation or object, or by thoughts of encountering that object
- Physical symptoms of anxiety — shortness of breath, rapid heart rate, dizziness, sweating, or tremors — in the presence of the source of fear
- Deliberate avoidance of the object or situation, to the point of limiting one’s own activities
- An inability to control one’s response to the subject of fear, in spite of being aware that the fear is irrational
People with specific phobias usually understand that their reactions are exaggerated and out of proportion to reality. However, they are unable to rationalize their fear or to reassure themselves when they are faced with the subject of their phobia. To qualify as a phobia from a clinical standpoint, the fear must not be attributable to another disorder, such as obsessive-compulsive disorder, social anxiety, or PTSD. Physical symptoms like dizziness, sweating, or chest pain must not be related to a medical condition such as high blood pressure, diabetes, or lung disease.
For someone with a phobia, the fear of the specific object or situation can cause painful social isolation, occupational impairment, and difficulty maintaining relationships.
When an individual can no longer function in society in a healthy way because of irrational fear, it’s time to seek help. A number of effective therapies are available to help these individuals break free from their phobias, recover from substance abuse, and lead the happy, rewarding lives they deserve.
Several therapeutic strategies have proven successful in treating specific phobias. These therapies can be integrated into a comprehensive rehab program for co-occurring disorders so that substance abuse can be addressed along with the anxiety disorder:
- Cognitive behavioral therapy (CBT). Originally developed for the treatment of depression, CBT has been applied to the treatment of anxiety disorders and substance use disorders. This therapeutic approach aims to change the repetitive thought patterns that lead to self-defeating behaviors and distorted perceptions of the world. A person with a specific phobia, for instance, might learn to replace persistent worries about a situation or object with positive, reassuring self-talk. Phrases such as “I can handle this situation,” “I’m stronger than that spider,” or “I’m so much better than I used to be,” may help avert a phobic reaction. In substance abuse treatment, CBT is used to help the patient overcome the self-destructive thoughts and perceptions that lead to addictive behavior.
- Exposure therapy. In exposure therapy, the patient is gradually exposed to the object of fear in a controlled environment. The ultimate goal is to introduce the patient to the subject of the phobia in a real-world setting. A person who is afraid of enclosed spaces (claustrophobia), for example, might set a goal of riding alone in an elevator without panicking. Exposure therapy must be performed at an appropriate pace to avoid overwhelming the patient. But according to the University of Pennsylvania’s Department of Psychiatry, exposure therapy is often so effective that it may begin to work in as few as one or two sessions.
- Psychiatric medication. Antidepressants in the SSRI (selective serotonin reuptake inhibitor) category have been used to treat specific phobias and other anxiety disorders. These medications are well tolerated by many patients and can help to relieve depressive symptoms as well as anxiety. Drugs in the benzodiazepine family, such as alprazolam (Xanax) and lorazepam (Ativan) may be prescribed on a short-term, as-needed basis for individuals whose anxiety attacks are limited to very specific situations. However, because benzodiazepines have a high potential for dependence and abuse, their use must be carefully controlled in patients with a history of drug addiction.
- Relaxation techniques. Guided meditation, yoga, exercise therapy, music and art therapy, and massage are just a few of the relaxing practices that can help reduce stress and minimize anxiety symptoms in people with specific phobias. The leading rehab facilities offer these holistic therapies to their patients in order to encourage recovery on a spiritual and psychological level as well as a physical one.
Treating Phobias and Co-Occurring Substance Abuse
When addiction co-occurs with a specific phobia, both conditions must be treated at the same time for the individual to receive any lasting benefits. If the substance use disorder is treated separately, and the phobia is never addressed, the patient is likely to return to drug or alcohol abuse when the psychiatric symptoms flare up again.
The specialized treatment programs at The Recovery Village are designed with the individual patient in mind. Our staff members have the experience and expertise to treat the most complex, challenging disorders, including phobic disorders complicated by substance abuse. If you, or someone you love, are struggling with addiction and mental illness, we encourage you to call our intake specialists at any time for information and support.