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 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.
