Fears and Phobias

Fear is a normal emotion, experienced when a person senses danger. Fear includes physical, mental, and behavioral (bee-HAY-vyor-al) reactions. Certain childhood fears are common and normal.

A phobia is an intense, persistent fear of a particular object or situation. Phobias can be narrowly focused or more general in nature. A broad spectrum of phobias has been reported. Social phobia is an intense, persistent fear of being painfully embarrassed in a social setting. Agoraphobia is fear of being in any situation that might provoke a panic attack * or from which escape might be difficult.

Whenever 15-year-old Hannah entered a building with more than two stories, she checked to see if the building had stairs. Hannah was intensely afraid of riding in elevators. Her friends teased her, and she readily admitted that her fears were “silly.” But when an elevator door closed, Hannah began to sweat and her heart started to beat faster. “It's like I'm trapped,” she told her friends. “As if I'll never, ever escape.” It's likely that Hannah is experiencing claustrophobia, or fear of enclosed or tight spaces.

Fear is the emotion that people feel when they sense that they are in danger. It is a protective emotion, which signals danger and helps a person to prepare for and cope with it. Fear includes physical, mental, and behavioral * reactions.

The physical reaction to fear is called the “fight or flight” response. Fight or flight is an involuntary response, a response that a person cannot control consciously but that is controlled by the body's nervous system * . It is the body's way of preparing either to run from danger or to fight. The heart beats faster, and the blood pressure and breathing rate increase. Oxygen-rich blood rushes to the large muscles of the body, which are tensing to prepare to fight. The pupils of the eyes grow larger to help the eyes scan for danger. Epinephrine * , also called adrenaline * , is released to prepare the body for quick action. Sweat is produced to cool the body.

Mentally, fear triggers thoughts about the danger or threat that the person senses. These thoughts may size up the danger, anticipate what might happen, or imagine ways to avoid harm. Behaviorally, the person may startle or jump and then run, freeze, or get ready to fight.

Fear and anxiety (ang-ZY-e-tee) are similar emotions but with an important difference. Fear is the emotion that people feel when a danger is actually present, whereas anxiety is the fear connected with worrying about danger that might happen.

Certain fears are common and normal during childhood. In fact, all children have fears at times during their lives. Because so much of the world is new to children, they may fear certain things until they understand them better or are better able to cope. Fear serves a protective purpose, keeping children appropriately cautious while they learn about what is safe and what is dangerous.

Fears of animals, loud noises, or being in water are common in very young children, who are still learning to understand the information their senses are gathering. Babies as young as eight months old may fear strangers. This is a sign that the baby is able to recognize his parents and to tell them apart from strangers.

Young children often fear imaginary creatures such as monsters, ghosts, and witches. Because imagination is developing at a rapid pace but the young child has not yet developed the ability to tell the difference between what is real and what is make-believe, these imaginary things can seem dangerous. Children tend to outgrow fears of imaginary creatures as soon as they are able to understand the difference between what is real and what is pretend.

Older children are more likely to fear real-life things such as burglars, being hurt or lost, or natural disasters such as earthquakes and extreme weather like hurricanes. These children may need reassurance and support from parents while they learn to cope with worry and fear and gain confidence in dealing with life's challenges.

Fearful parents tend to have fearful children. Without realizing it, parents may teach children to be too fearful or cautious of certain things, not so much by what they say but by how they act. If a mother always crosses the street to avoid dogs and gets a little pale when a dog is nearby, chances are the child will learn to be afraid of dogs. Research has found that fears or worries can run in families, and it may be that certain fear reactions are inherited.

Fears can be “unlearned.” If the fearful child watches another child calmly approach and pat a dog, she is learning that petting a dog can be safe and pleasant. By watching and then learning to go toward the dog slowly herself, with the right adult support, she can learn to overcome her fear of dogs. When leaving home, even to go to school, is too scary or when people avoid important activities because of fearfulness, professional help may be needed to help “unlearn” fears.

Most childhood fears pass with time, maturing, and support from caring adults. Childhood fears do not get better by teasing, threatening, or forcing the child to meet the feared object or situation. Such remedies are likely to produce shame and lower self-esteem, and they may even worsen fear. The protective emotion of fear is not outgrown. People feel fear throughout life whenever they sense danger.

Sometimes a normal childhood fear can become intense or last well beyond the age when a child usually outgrows it. If this happens, or if fears cause so much distress that they interfere with everyday life, professional help may be needed to help get over fears.

Cognitive-behavioral therapy * is often helpful. It may involve teaching coping skills, supporting the child's gradual approach to the feared situation, and coaching parents to provide needed reinforcement and support.

A phobia (FO-bee-a) is an intense fear of a specific thing, such as dogs or spiders or riding in elevators. Phobias are the most commonly observed of the anxiety disorders. With a phobia, the fear a person feels is out of proportion to the real danger. The person with a phobia is very worried about the possibility of seeing the feared object or experiencing the feared situation. People with phobias may go to great lengths to avoid any situation that might bring them face to face with the object of their fear. Because of all the worry and avoidance, a phobia can interfere with a person's everyday life.

Estimates from the U.S. National Institute of Mental Health are that between 5 to 12 percent, or about 6 million, Americans report phobias. Different phobias tend to develop in different age groups. For example, younger children have phobias associated with animals and weather-related events such as storms. Teenagers tend to develop height phobias (acrophobia) and phobias related to enclosed spaces (claustrophobia).

At some point in their lives, people find themselves in a social situation that makes them uncomfortable. But phobias involve more than social discomfort and can take several forms. For individuals with a social phobia, the exposure to a particular event provokes such enormous anxiety that it can trigger a panic attack. A person with a social phobia will do almost anything to avoid similar social situations.

Social phobias are often associated with persistent fears of humiliation or embarrassment. These occur commonly in situations such as walking into a classroom or even leaving one's home. Individuals may feel as if everyone is looking at them. This phobia often persists. It may intensify to the point that when affected people venture into social situations, they spend all of their time alone, attempting to avoid other people.

When exposed to the trigger for a specific phobia, individuals may experience elevated levels of anxiety, including a panic attack. People with specific fears, such as Hannah with her fear of elevators, may know that their fear might be seen as “silly” or “irrational,” by others, but the fear still produces significant distress for them. Sometimes, particularly with children, affected individuals may not understand that their fears are excessive or unwarranted.

Traumatic events often contribute to the development of specific phobias. Social phobias often begin in the mid-teens, with the average onset between the ages of 15 and 20 years. Some social phobias begin in childhood, but they can start at any age. Phobias may begin when two unrelated events are associated in someone's mind. Research has shown that social phobias may have a hereditary component.

The most common variety of phobia involves social situations. Social phobia is a persistent fear of humiliation or embarrassment in social settings. Closely related to social phobia is agoraphobia (literally “fear of the marketplace”), which is a fear of being in locations or situations from which escape might be difficult or embarrassing. People suffering from agoraphobia believe that they may suddenly develop a panic attack. To cope, people with agoraphobia avoid crowds or situations they find threatening. When they cannot do so, they are often filled with anxiety.

People with agoraphobia may limit themselves to being in places they think of as safe. Any movement beyond this safety zone leads to mounting worry and nervousness. They may worry about whether they could escape quickly from a certain place if they should begin to have a panic attack there. People with agoraphobia often avoid being on busy streets or in crowded classes or stores for fear that they might feel trapped if they start to have a panic attack. Gradually, fewer and fewer places feel “safe.” Some people reach the point where they are too frightened to leave their homes. Others still go out, but doing so causes great distress, and they may insist that family members or friends go with them. Such self-imposed limits can make it difficult for people to get on with their lives at school and work.

Other specific phobias, such as arachnophobia (fear of spiders), acrophobia (fear of heights), or hydrophobia (fear of water), can cause people to avoid specific situations in which they might confront what frightens them.

Several prescription medications are used to treat social phobias. People with specific phobias may also benefit from psychotherapy *

* panic attack is a period of intense fear or discomfort with a feeling of doom and a desire to escape. The person may shake, sweat, be short of breath, and experience chest pain.

* behavioral means related to the way a person acts.

* nervous system is a network of specialized tissue made of nerve cells, or neurons, that processes messages to and from different parts of the human body

* adrenaline (a-DREN-a-lin), also called epinephrine (ep-e-NEFrin), is a hormone, or chemical messenger, that is released in response to fear, anger, panic, and other emotions. It readies the body to respond to threat by increasing heart rate, breathing rate, and blood flow to the arms and legs. These and other effects prepare the body to run away or fight.

* epinephrine (eh-pih-NEH-frin) is a chemical substance produced by the body that can also be given as a medication to constrict, or narrow, small blood vessels, stimulate the heart, and cause other effects, such as helping to open narrowed airways in conditions like asthma and croup.

* cognitive-behavioral therapy (KOG-nih-tiv beHAY-vyuh-rul THAIR-uh-pee) is treatment that helps people identify negative ways of thinking and behaving and change them to more positive approaches.

* psychotherapy (sy-ko-THER-apea) is the treatment of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.

* psychotherapy (sy-ko-THER-apea) is the treatment of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.