What are phobias?

Phobias are excessive, intense or irrational fears which cause people to avoid certain objects, creatures, situations or activities. We all have some fears. A fear becomes a phobia when it is unrealistic and it interferes with our everyday life.

All phobias are more common in women. Phobias vary from country to country. For example, in Northern Australia, crocodile phobia is common. Most phobias last for years or are lifelong unless you get treatment.

 Phobias fall into four main types:

• fear of specific creatures, or situations, such as being in lifts, aeroplanes, high places or storms
• fear of blood, injury and injections
• fear of social activities or situations (social phobia)
• fear of being away from home or safety and fear of places where you might have a panic attack (agoraphobia).

The main problem with phobias is that avoiding what you fear adversely affects your life. This is particularly so of social phobia and agoraphobia.

Specific phobias
Specific phobias are very common but most people are not greatly affected by them. They are fears of specific individual objects, situations or activities. Some specific phobias are about things like heights, water or flying.

Phobias of dogs, cats or spiders (arachnophobia) are common. If you are phobic of dogs you will feel extremely anxious anywhere near a dog and want to get away from it quickly. You will avoid dogs if at all possible. This happens even though you may realise your fear is unreasonable. Once you leave the situation you feel fine.

Blood, injury and injection phobias
Most people do not like being injured or having injections. But some people are so phobic they feel extremely anxious just hearing about injuries, needles, operations or blood. They avoid reading or talking about these subjects. They find it hard to visit a friend in hospital. They may avoid going to the dentist. It would be very hard for them to agree to have an injection or blood test. The sight of blood might make them panic or faint. Away from these subjects and situations they feel okay.

During your life there is about a one in eight chance of having a specific phobia or blood/injury/injection phobia. They most often start in childhood or in your 20s.

Social phobias
While almost anyone would be anxious if they had to give a talk to an audience of 100 people, people with social phobia fear everyday social situations. One person in five has some fear of public speaking, but only one in 10 will have social phobia, at some time in their life bad enough to significantly affect them. They are especially afraid people will think badly of them, criticise them or treat them unkindly because of the way they act in a social setting.

They might fear being seen to shake, sweat or blush. Sometimes this is a fear of only one activity such as eating in public, writing in public, or using a public toilet. For some it includes most social situations.

Some social anxiety is common in the teenage years and social phobia usually starts during this time.

Social phobia, if untreated, can last for years with varying levels of severity. People with social phobia often develop other problems. These can include agoraphobia, alcohol or other drug abuse, and depression.

Agoraphobia
Agoraphobia is a more complicated phobia. Most people with agoraphobia also have panic attacks - sudden severe attacks of anxiety during which people fear that something dreadful is going to affect their physical or mental health. They fear having these attacks and avoid places where they might have them - such as shops and public places, being in cars or other forms of transport. They also fear being away from safety or help in case they collapse.

They feel safest at home or in the company of someone they trust. Agoraphobia tends to vary from day to day and people with it do not panic every time they go to the supermarket or into some feared situation. Agoraphobia is different from most specific phobias where anxiety happens every time you meet the feared object or situation.

Agoraphobia is usually the most severe of the phobias. People with agoraphobia may have anxiety (often, as mentioned, including panic attacks) or depression at other times and they may sleep poorly. Agoraphobia affects one or two people in 100 at some time in their life. It usually starts between the ages of 16 and 35.

Most phobias do not change much from day to day or year to year. Agoraphobia does change and this can be confusing. One day you might be quite calm and confident - the next you might have a bad panic and be unable to go out. This can be very discouraging, especially if it happens when you are generally getting better. Just remember that bad days can happen even when you are recovering.

People with agoraphobia can have bad patches lasting for a few months or longer, and other times when they are less troubled by the phobia. Untreated agoraphobia can be a problem that affects you throughout your life. It may become so severe that you are housebound and become depressed or suicidal.

Causes of phobias

Often there is no obvious cause for a phobia. Phobias do run in families, especially blood, injury and injection phobia and agoraphobia. Some specific phobias start after a frightening experience like being attacked by a dog, but most do not. Most people with spider phobia have not been bitten by spiders.

Agoraphobia and social phobia are more common in people who are anxious or nervous by nature. Some people with social phobia are generally shy, but some are not and only have problems in certain social situations. Specific phobias happen just as often in people who are not otherwise anxious.

Panic attacks are one of the main causes of agoraphobia. Panic attacks can also become linked in the mind to specific situations or objects and can give rise to specific phobias.

Some psychologists believe phobias have a hidden or unconscious cause. The thing that you fear represents or symbolises something else in your life. This may make sense to a few people, but usually there does not seem to be any deeper meaning to phobias.

People with phobias may believe they developed problems because of stress or things that have gone wrong in their lives. Other people with phobias cannot so easily find things that have gone wrong in their lives. They may agree with the view that their problem is genetic or biological in origin. A lot of people with phobias believe it is a combination of these things.

Sometimes people think their problem is a punishment for their moral or spiritual failure. It's important to remember it is not your fault you have a mental health problem.

How phobias are maintained

It is important to remember that, more than anything, avoidance keeps phobias going. If you always avoid something you do not become more confident - you never learn that the intensity of your fear is far greater than the actual threat you face. In fact, you learn that avoidance makes you feel okay and this makes you more likely to use it as a strategy in the future.

This is fine if your life is not greatly affected by the phobia. But if you avoid social situations you will never gain confidence with people and your life can become very restricted.

Panic attacks also tend to make agoraphobia continue. Anything which keeps you anxious will make it harder to recover from agoraphobia or social phobia. This might be living with someone who is unpleasant to you or who threatens to leave, or being under threat of redundancy at work. Coffee and soft drinks containing caffeine make panic more likely and worsen agoraphobia.

See also: Phobias - living with; phobias - treatment

Support groups

See the support organisations (which include helplines) under Further information and support below.

Original material provided by the Mental Health Foundation of New Zealand, 2002. Edited by everybody, May 2005.