Definition

Phobic anxiety disorder, commonly known as phobia, is an excessive and irrational fear of certain situations or objects that are not dangerous. As a result, individuals with a phobia tend to avoid certain objects or situations. Unlike the fear that arises before a presentation or taking an exam, specific phobias develop over a long period and can cause intense physical and psychological reactions. This can interfere with daily activities at work, school, or in social settings.

Phobias are divided into three large groups, including:

• Agoraphobia, namely fear of open spaces, crowds, and situations where it is difficult for a person to find a safe place.
• Specific phobia, namely irrational fear of certain objects
• Social phobia, namely irrational fear of certain social situations.

The estimated prevalence of agoraphobia ranges from 2% to 6%. Specific phobias are experienced by around 5% to 10% of the population in the United States. The prevalence of social phobia is around 3% to 13%. Children commonly experience phobias of animals, the environment, or needles, whereas situational phobias are more common in adults.

Causes

The pathogenesis of phobias is related to the following factors:

• Biological factors. Someone with a phobia produces more epinephrine and norepinephrine than normal people, so they are more sensitive to certain situations.
• Genetic factors. Agoraphobia is often associated with panic disorder, but agoraphobia can also occur without panic disorder. Several studies have found that there is an increased risk of panic disorder if there is a first-degree relative who experiences panic disorder. Specific phobias generally occur in one family, and the risk of social phobia occurring increases if the first degree of the family has social phobia.
• Psychosocial factors. Traumatic events in childhood, such as parental separation or domestic violence, can lead to behavioral inhibition towards unfamiliar things, which in the long term can develop into a phobia.

Risk factor

Factors that can increase the risk of a phobia include:

• Having panic disorder or another phobia increases your risk of experiencing agoraphobia
• Have experienced a traumatic event, such as domestic violence, divorce, or accident
• Having a family with a phobia
• Has a sensitive and shy temperament
• Social phobia generally starts as a teenager when they are asked to meet new people, give a speech in front of many people, or make a presentation

Symptoms

Symptoms of agoraphobia include:

• afraid to leave the house alone
• afraid when in a crowd or waiting in line
• afraid of closed locations, such as movie theaters, elevators, or small stores
• afraid of being in locations that are too exposed, such as parking lots, bridges, or malls
• afraid to use public transportation, such as buses, planes, or trains

Symptoms of specific phobias include:

• Intense fear, anxiety, and panic when exposed to or thinking about the feared thing
• Feeling the fear, but not being able to control it
• Fear and anxiety increase as the object approaches
• Do anything to distance yourself from the object
• Difficulty functioning normally due to this fear
• Physical reactions such as sweating, palpitations, shortness of breath, and difficulty breathing
• Nausea, vomiting, or fainting when looking at an object
• In children the symptoms shown are tantrums, crying, fear of leaving their parents

Someone with a specific phobia experiences the symptoms above when exposed to something that makes them afraid, such as:

• Certain situations, such as being in an airplane, elevator
• Natural events, such as lightning and heights
• Animals, such as insects, dogs, or spiders
• Blood, needles, or wounds
• Other things, like choking, vomiting, loud noises, or clowns

Diagnosis

A psychiatrist diagnoses patients based on their main complaints and symptoms. Laboratory tests cannot confirm the diagnosis, which relies on the Diagnostic and Statistical Manual, Fifth Edition (DSM-V).

Agoraphobia

• Apparent fear or anxiety about two (or more) of the following five situations :
  • Use public transportation
  • Being in an open space
  • Being in a closed room
  • Standing in a line or crowding people
  • Being outside the house alone
• Individuals feel afraid or avoid the situation because they think it is difficult to escape
• Fear and anxiety are out of proportion to actual danger

Specific phobia

• Marked fear or anxiety about specific objects or situations
• Exposure to a phobic object or situation almost always provokes immediate anxiety\
• The phobic object or situation is actively avoided
• Fear or avoidance persists for more than 6 months

Social phobia

• Fear or anxiety about one or more social situations in which the individual is faced with the possibility of being judged by others
• Individuals feel afraid that they will act by showing symptoms of anxiety that will be evaluated negatively
• Social situations almost always cause fear or anxiety

It is necessary to have a professional conduct this assessment.

Management

In general, phobia therapy includes:

• Psychological therapy
  • Cognitive behavioral therapy includes various approaches, such as desensitization therapy, exposure, imaginal exposure, and others. This therapy is said to be the most effective type of therapy for overcoming phobias. Exposure therapy is considered effective, especially for specific phobias and agoraphobia.
  • Psychotherapy
  • Other therapies, such as hypnotherapy, supportive psychotherapy, and family therapy

• Drugs
  •  The drugs commonly used are serotonin selective reuptake inhibitor (SSRI) antidepressants and beta blockers, especially for social phobia. Sedatives may be used before exposure to a phobic stimulus, such as public speaking. Consult this treatment method with your doctor.

Complications

Agoraphobia is a condition that can affect your daily life. In severe cases, it can prevent you from leaving your home. Without proper treatment, agoraphobia can negatively impact your relationships with family, friends, work, school, and other routine activities. If left untreated, it can lead to depression, substance abuse, and other mental health issues such as anxiety and personality disorders.

Even though some people may think that specific phobias are unrealistic or not serious, they can greatly affect the life of the person experiencing them. These phobias can lead to social isolation, which can hurt academic and professional outcomes. Additionally, they may contribute to mood disorders, drug abuse, and even suicidal thoughts or attempts.

Social phobia can result in a lack of confidence, negative self-talk, hypersensitivity to criticism, poor social skills, isolation, low academic and professional achievement, substance abuse, and suicidal thoughts or attempts. 

Prevention

It is still uncertain how to prevent the development of phobias. However, early detection can help get the right treatment before the condition worsens. You can seek advice from a psychiatrist to overcome fear and anxiety related to certain things.

When to see a doctor?

If you experience excessive fear that interferes with your daily life, consult with a psychiatrist for fast treatment and to help you overcome your fear of leaving the house, certain animals, conditions, or social situations.