Phobias are among the most common anxiety disorders. An estimated 10% of all people experience a phobia at some time in their lives.
When we are children, most of us go through periods when we are afraid of monsters, or the unknown, or the dark; such fears are part of the natural development process.When we are adolescents, our self-image and the way that others see us often become sources of anxiety. Once again, such anxieties are part of a normal process, and they usually diminish with time. But when these fears persist and become incapacitating, they can start to be called phobias.
PHOBIAS
A phobia is a fear of a particular situation
or thing, a fear so excessive that it drives the sufferer to do anything
possible to avoid that situation or thing. If there is nothing the
person can do to avoid it, he or she suffers from a form of anxiety
whose symptoms are well known: sweating, noisy breathing, rapid heartbeat,
dizziness, and even fainting.
Unlike normal fear,
which is a useful reaction to avoid a real danger, the fright
reactions generated by phobias are completely irrational
and disproportionate to the actual risks involved. Sometimes
the anxiety induced by the feared situation or thing (or
sometimes even by a mere picture of it!) can become so intense
that it triggers a panic
attack.
In what are known as specific phobias, the object
of the phobia is clearly defined. The situations or things that
are the objects of specific phobias generally belong to categories
that seem to have had particular
significance in the course of human evolution.
Thus, some of the most
common objects of specific phobias, such as insects, snakes,
or high places, represented real potential dangers for our
ancestors. Other objects of specific phobias include
blood, germs, thunderstorms, flying in airplanes, vomiting,
or even simply arriving late someplace.
In addition to specific phobias, there are other
types of phobias that are, in many respects, even
more disabling.
An avoidance
behaviour is a behavioural response learned as
the result of negative
reinforcement. For example,
an animal who goes to drink at a particular watering hole
and encounters a hungry predator there would be wise to
get in the habit of avoiding that watering hole. The same
thing might apply to a human being who got mugged in a
particular park.
Avoidance behaviours quickly become unconscious habits that
can help phobic people to manage their fears. But pushed to
the extreme, these behaviours can also cut people off from
a wide range of worthwhile activities.
Different anxiety
disorders can coexist (in other words, somebody can have
two anxiety disorders at the same time). For instance,
people who have a social phobia or a panic disorder are
also susceptible to agoraphobia. In addition, phobias and
panic disorders are often associated with other mental
health problems, such as depression or alcoholism.
PANIC
DISORDERS
A panic attack is
an acute episode of anxiety accompanied by often very painful
physical sensations (such as dizziness, heart palpitations,
chills, hot flashes, and feeling as if you are suffocating
or have “had the wind knocked out of you”).
People experiencing panic attacks may also fear that they
are going crazy or even dying.
When a doctor diagnoses
a panic disorder in a patient, it means that this person has
suffered more than just one isolated panic attack. Panic disorders
are characterized by panic attacks that occur repeatedly and
unpredictably, with no apparent triggers. Unlike phobias,
panic attacks can occur in the absence of any particular external
stimuli. Instead, they appear to be triggered by internal
psychological reactions.
Patients who suffer from panic disorders
thus live with the constant fear that they will suffer an attack
despite themselves. They may also experience additional anxiety
from thinking about how their attacks may affect the people around
them. When someone has panic disorder and is afraid of situations
where it might be hard to hide this condition, or flee, or get
help if they did suffer a panic attack, then they are said to have panic
disorder with agoraphobia. Such people consciously
try to avoid situations that might cause them to have panic
attacks.
Anyone who is exposed
to a traumatic event generally feels some repercussions
for the first few weeks aftewards. In most people, these
symptoms will disappear within a month. From 50 to 65%
of people who have had a traumatic experience will recover
from it within the first year. But around 10 to 20% will
be incapacitated for several years. Among combat veterans,
this figure can be as high as 50%, and years can pass before
the first symptoms appear.
POST-TRAUMATIC STRESS DISORDER (PSTD)
Post-traumatic stress disorder
(PTSD) is the term now used for the condition that was
known as “traumatic psychosis” in the early
20th century. This disorder occurs when someone witnesses
or is the victim of a traumatic event and subsequently
becomes so haunted by memories of it that they interfere
with his or her normal functioning.
Survivors of rape, child abuse, war, and natural disasters are among the groups
that often develop PTSD. This disorder is manifested first of all by flashbacks
of the terrifying event. The memories of images, sounds, and smells associated
with this event seem more real than ordinary memories and can be extraordinarily
precise. People often say that they can see the scene as if they were living
it again. If someone with PTSD suddenly becomes distracted in the middle of a
conversation and starts staring blankly, he or she is very likely being assailed
by memories of the traumatic event.
Post-traumatic stress disorder is
almost inevitably accompanied by sleep disorders. Nightmares
are common, and even when people with PTSD do not have conscious
thoughts about the traumatic event, their sleep may still
be disturbed.
People with this disorder also have trouble taking pleasure
in the things that they used to enjoy. They avoid other people
and generally become more passive. Very often, they are so
numbed emotionally that they cannot experience feelings such
as affection or sexual desire.
OCD can occur with
various degrees of severity. For example, there was one
case of a woman who had to touch every paving stone around
her house before she left it, because she was convinced
that something bad would happen to her if she didn't. But
that's nothing next to the man who took as much as three
hours to tidy up his room every morning.
Some famous people
have suffered from OCD—for instance, business tycoon
Howard Hughes and pop star Michael Jackson with their morbid
fear of germs. Louis XIV was obsessed with a need for symmetry.
The English poet, playwright, and biographer Samuel Johnson
(1709-1784) always made certain gestures when he passed
through a doorway, never stepped on the cracks in the sidewalk,
and so on.
OBSESSIVE-COMPULSIVE DISORDER (OCD)
All of
us sometimes go back to check whether we really locked
the front door, or imagine giving a punch in the nose to
somebody at work whom we really can't stand. But when someone
goes back to check the door 20 or 30 times, or keeps thinking
so much about punching that person in the nose that they
can't concentrate on their work, then they may be suffering
from the strange condition known as obsessive-compulsive
disorder (commonly known as “OCD”).
OCD basically affects
people's freedom to think and to act and is rightly regarded
as a veritable “prison of the mind”. It represents
a disturbance of a distinctly human function: doubt.
But unlike bulimics or compulsive gamblers, who also have an
irrepressible desire to keep repeating the same behaviours, victims
of OCD do not get any pleasure from
it. They recognize the irrational, ridiculous nature of their
compulsions and suffer from them tremendously. For this reason,
many compulsive behaviours are carried out in secret, which only
reinforces the stress associated
with this affliction.
In
talking about OCD, a distinction is made between the
obsessions, which are the undesired thoughts, and the
compulsions, which are the uncontrollable behaviours
designed to calm the obsessions. For example, to calm
an obsession with cleanliness, a person may follow a
compulsion to keep washing his hands repeatedly until
his skin is raw. Or someone may be obsessed by the thought
that she may have hit someone with her car, and keep
driving around the neighbourhood compulsively looking
for a body until she has quelled her doubts. Some people
compare compulsions with “mental hiccups” that
can't be stopped, because even though they are very disturbing,
they temporarily dispell the even greater anxiety caused
by obsessions.
OCD affects slightly
more than 2% of the world's population, or about 1 out
of every 40 people. It does not spare any ethnic group,
and it is equally common among men and women.
In half the cases of OCD, the symptoms appear in childhood,
but the disorder often is not diagnosed until adolescence
or early adulthood. In fact, people who suffer from OCD tend
to deal with their problems in secret, for fear of being
considered crazy. As a result, on average, 10 years pass
between the time someone's OCD symptoms first appear and
the time they begin receiving treatment,
which is often highly effective. Typically, someone
may have to consult three or four doctors before getting
OCD diagnosed correctly.
Two-thirds of all people with OCD will also experience a depressive
episode at some time in their lives.
Generalized anxiety
disorder is one of the most common anxiety disorders. Studies
show that at least one out of every 20 people (5% of the
population) will experience this disorder at some time
in their lives. The first time people with this disorder
consult a doctor about it is generally in their early twenties,
when they may even report that they have been extremely
anxious ever since they were children.
Generalized anxiety disorder is twice as common in women
as in men.
Like all people with chronic disorders, people with
generalized anxiety disorder go through some periods
that are calmer and others that are rougher.
GENERALIZED ANXIETY DISORDER (GAD)
If you have been out
of work for a while and are worried that you may languish
in poverty, that is normal, just as it is normal if you
are a parent and experience anxiety when your kids are
sick.
But if you have a steady job and healthy children, and
you still spend the whole day worrying about your finances
or your children's health, then you may well be suffering
from generalized anxiety disorder (GAD).
People with GAD have the same kinds
of concerns as everyone else—their money, health, families,
jobs, and so on—but worry too much about them all the
time. They are almost always anxious and always expect the
worst, even if there
is no objective reason for them to be so concerned. It
then becomes extremely hard for them to set their worries
aside and concentrate on their day-to-day activities.
Because having GAD means constantly having one's nerves on edge, people with
this disorder experience all kinds of characteristic symptoms, such as chronic
fatigue, irritability, difficulty in concentrating, headaches, muscle tension,
and insomnia.
When a patient has experienced these kinds of anxiety symptoms for over six months
and no precise reason for them can be identified, a diagnosis of GAD is usually
made.
