Phobias

Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of ​​enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

More about the experts All content is checked by medical journalists.

Phobias are inappropriately strong fears of certain situations or objects. Be it the fear of flying, the dentist, of spiders or in general when dealing with other people: The irrational fears affect the thoughts, feelings and behavior of the people concerned. Read here, among other things, how phobias arise, how they affect and how they can be treated.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F40

Phobias: description

In principle, fear is a natural reaction to danger. To a healthy degree, fear ensures our survival by shying away from threat. In contrast to healthy fear, fear is pathologically exaggerated in a phobia and affects the life of those affected.

What is a phobia?

People with phobias are afraid of situations or objects that objectively do not pose a threat, or the fear of those affected is inappropriately great. Exposing oneself to feared situations is almost unbearable for fearful patients. If possible, try to avoid them altogether.

As a result, some of those affected withdraw further and further and are thus severely restricted in their freedom of action. Although they know that the level of their fear is irrational, they cannot control it.

Phobias create a high level of suffering. Fear is not only associated with threatening thoughts, but also with physical symptoms such as tremors, sweating or palpitations. If the phobia is severe, some people fear they will even die from the physical effects.

Many anxiety patients initially suspect an organic cause of their symptoms and run from one doctor to another. For some, it takes years before the correct diagnosis is made and appropriate help can be offered.

There are different types of phobias that can appear both alone and in combination. Experts differentiate between the following three forms of phobic disorders, social phobia, agoraphobia and specific phobias:

Social phobia

People with social phobia are very afraid of embarrassing themselves in front of others or of being rejected by them. They therefore avoid social contacts and situations and withdraw. You can read more about this in the article on social phobia.

Agoraphobia

People with agoraphobia are very afraid of situations from which they cannot escape in an emergency or where it is difficult to help them with a panic attack. They therefore avoid public places, crowds or going to the cinema, among other things. You can read more about this in the article Agoraphobia.

Specific phobia

Unlike people who have a social phobia or agoraphobia, people with specific phobias fear a very specific situation or object.

The list of phobias is long. In principle, people can develop a phobia with regard to any situation and any object. Experts distinguish four types of specific phobias:

• Animal type (e.g. fear of snakes,)
• Environment type (e.g. fear of heights)
• Type of blood injection injury (e.g. fainting from the sight of blood)
• Situational type (e.g. fear of flying)
• Other type (e.g. fear of vomiting)

A common fear from the phobias list is the fear of animals (zoophobia), such as the fear of dogs (cynophobia), of cats (ailurophobia), of spiders (arachnophobia) or the fear of snakes (ophidiophobia). The fear of confined spaces is also widespread (fear of space or claustrophobia). People with claustrophobia fear being locked in rooms. But there are also rather unusual phobias, such as fear of vomiting (emetophobia) or fear of bacteria (mysophobia).

Some objects and situations can be avoided by those affected. Those who do not have to fly for work can simply switch to other modes of transport. But not everything can be avoided at all times. A visit to the dentist is also sometimes necessary. Avoidance can be very stressful, and in many cases the fear results in severe impairments in everyday life. Serious consequences arise when people no longer dare to go to the doctor for fear of needles (trypahophobia) or sharp objects (aichmophobia), for example. Then at the latest it is high time to seek help.

While the fear of animals is usually understandable for other people, people with more unusual phobias have a hard time because the social environment often reacts with incomprehension. It is important for both those affected and their loved ones to recognize anxiety as a condition that needs treatment.

Phobias rarely occur alone

In many cases, those affected suffer from other psychological complaints in addition to the phobic disorder. About 60 percent of anxiety patients also have depression. The risk of becoming dependent on medication, drugs or alcohol is also significantly higher.

How many people suffer from phobias?

Anxiety disorders, which include phobias, are the most common mental disorders. The likelihood of developing an anxiety disorder is between 14 and 29 percent. Specific phobia is the most common disorder among anxiety disorders. Around ten percent of the population suffer from the specific phobia. Women are affected about twice as often as men.

Dental fear

Fear of the teeth is also one of the specific phobias. Those affected are so afraid of going to the dentist that they cannot be treated even if they have dental problems. You can read more about this in the article fear of dentists.

Phobias: symptoms

The main symptom of a phobia is always a strong and exaggerated fear of certain situations or objects. These are increasingly avoided by those affected. Such avoidance behavior, in turn, increases fear. In addition, there are other psychological symptoms, but above all severe physical symptoms such as palpitations or breathing difficulties, which can put those affected in fear of death.

For the diagnosis of a specific phobia, for example, according to the ICD-10 classification of mental disorders, the following symptoms must apply:

People either have a definite fear of a certain object or situation or avoid such objects and situations. However, it is not an agoraphobia or a social phobia.

Since the onset of the disorder, at least two physical symptoms have occurred in the dreaded situations. There must be at least one of the symptoms from the area of ​​vegetative symptoms such as palpitations, sweating, tremors or dry mouth.

Other possible symptoms from the abdomen and chest area are:

• Difficulty breathing
• Anxiety
• Chest pain or discomfort
• Nausea and discomfort in the abdominal region

Typical psychological symptoms are:

• Feelings of dizziness, insecurity, weakness, or lightheadedness
• the feeling that the objects are unreal or that you are far away and not really there (derealization and depersonalization)
• the fear of losing control, fear of going crazy or freaking out
• the fear of dying

In addition to the symptoms mentioned, those affected often suffer from hot flashes or chills as well as numbness or tingling sensations. Those affected are emotionally stressed by the symptoms and the consequences. However, they know the fear is exaggerated.

Phobias: causes and risk factors

For our ancestors, fear played an important role in survival. Dangerous animals and darkness were a real threat. These fears have been passed down through the generations. Road traffic poses a much greater danger for us nowadays, but animal phobias are much more common. Experts attribute the development of a phobia to an interplay of learning experiences, biological and psychosocial factors.

Phobias: learned fear

At the beginning of a phobia there is a learning process. A neutral object or situation is rated negatively because of a bad experience. Experts refer to this process as conditioning.

For example, fear of the dentist can arise if the patient has had a very unpleasant experience at the dentist. The person concerned links the pain during the treatment with the smells and noises at the dentist. Fear of the dentist and the treatment are the result. Because the negative feelings that arose during the treatment reappear the next time you visit the dentist or just think about them. Physical symptoms such as strong palpitations or sweating are then interpreted by those affected as confirmation that they are in danger.

Phobias: avoidance

Many situations create discomfort in almost everyone without developing a phobia. For example, most people associate a dental treatment with a bad feeling or are even afraid of it. It is only a morbid fear if the person concerned avoids visiting the dentist in the future out of fear.

Avoidance increases fear more and more - a vicious circle. People with what is known as dental phobia are so scared that they can no longer even go near a dentist's office. Such avoidance behavior is a strategy that all people with phobias use.

Phobias: learning from the model

Many phobias, especially animal phobias, arise in childhood. For an animal phobia to develop, the child does not even have to have had bad experiences with an animal. They learn fearful behaviors through the example of adults. The technical term for this is “learning on the model”.

When assessing danger, children trust their parents. If a child observes the mother becoming frightened at the sight of a dog, they may take over that fear without knowing why. A specific phobia can also arise indirectly in adulthood, for example through media reports. But why doesn't everyone who has bad experiences develop a phobia?

Phobias: Biological Roots of Fear

Some people are more prone to phobias than others. Biological factors probably have an influence on this susceptibility (vulnerability). Family and twin research suggests that anxiety is partly genetic.

An imbalance of the messenger substances serotonin, noradrenaline, dopamine and gamma-aminobutyric acid (GABA) also affects anxiety. Physiological peculiarities can also promote phobias. People who suffer from low blood pressure, for example, get dizzy more quickly in stressful situations, which can frighten those affected.

These biological factors favor an anxiety disorder, but upbringing and environmental influences are the decisive triggers.

Phobias: Psychosocial Factors

Experts assume that the parenting style has an influence on the development of phobias. There seems to be a connection between anxiety disorders in children and the controlling and less sensitive behavior of the parents. Children who do not have a secure bond with their parents are at risk of developing an anxiety disorder later on.

Temperament also plays an important role.Anxious people are more prone to phobias than others. They quickly become frightened because they judge harmless situations as dangerous and their thoughts and attention are focused on possible negative consequences.

A tendency towards anxiety can already be recognized in childhood, when children are very scared, find it difficult to calm down and generally tend to withdraw. Experts summarize these properties under the term "behavioral inhibition".

Phobias: Investigations and Diagnosis

If you suspect an anxiety disorder, you should first consult your family doctor, who can refer you to a psychotherapist if necessary. The doctor will ask you about your physical complaints and anxiety symptoms.

He will also do a physical exam to rule out other illnesses. This usually consists of a blood sample, an examination of the heart using an electrocardiogram (EKG) and an examination of the thyroid using ultrasound and blood tests. Magnetic resonance imaging (MRI) can rule out pathological changes in the brain as the cause of the fears.

The therapist is responsible for an accurate diagnosis of the mental disorder and the appropriate treatment. It is important to check for other mental disorders such as depression. These must also be treated to restore mental health.

To diagnose phobias, the therapist uses clinical questionnaires as a guide, which inquire about the most important aspects of the symptoms. The doctor may ask the following questions to help diagnose the specific phobia:

• Are there certain objects or situations that you are very afraid of (for example altitude, spiders, blood or other)?
• What physical signs do you feel when you think about or come into contact with these objects or situations (for example, palpitations, sweating or dry mouth)?
• Do you feel that your fear is excessive?
• Is your fear limited to one object or a situation?

If parents suspect a phobia in their child, the therapist will investigate whether the fears are age-appropriate or whether treatment is necessary. Some fears that children show are part of the normal course of development.

Phobias: treatment

Anxiety disorders are usually treated with the help of psychotherapy and medication. For the treatment of the specific phobia, experts recommend only psychotherapy, as there is no evidence of the effectiveness of drugs. The method of choice is exposure therapy, which is carried out as part of cognitive behavioral therapy.

Outpatient treatment is often sufficient for the treatment of specific phobias. If there are no other mental disorders, a few therapy sessions can be enough to overcome the phobias.

Phobias: confrontation with fear

The idea of ​​exposure therapy is that by confronting the patient with his or her fears, the unreal fears can be put aside. Together with the therapist, the person concerned should seek out precisely those situations in therapy that they have avoided due to the phobia.

Initially, the patient will experience great anxiety and strong physical symptoms - but these negative sensations will eventually subside if he can endure them. So the patient has a new experience. He learns that fear disappears again, that he can endure and control it. The old fear pattern is overwritten and the fear is at least reduced to a tolerable level.

It is important that the patient dares to encounter the object of his fear at some point on his own. Only in this way can he experience that he can cope with the fears without help and regains confidence in himself.

For some, the confrontation means walking into a park with dogs, others have to bring themselves to re-enter an elevator. For situations that are not so easily accessible in everyday life, there is now often virtual reality exposure therapy. The patients put on VR (virtual reality) glasses and see a seemingly real world in which they can move.

This method is often used for fear of flying and fear of heights. The patients experience a flight including take-off and landing or virtually climb a very tall building. For many sufferers, the fear diminishes after just a few sessions. Because a change in behavior also causes a change in thinking.

Phobias: restructuring of thoughts

Cognitive behavioral therapy also includes questioning previous cognitive assessments. People with phobias overestimate the danger. Harmless situations become a great threat in the mind. The therapist helps the person affected by asking specific questions to replace negative thoughts with realistic interpretations.

Phobias: relapse prevention

The person concerned should also visit the dreaded situations regularly after the end of therapy. Even if strong fears suddenly reappear, there is no reason to despair. Relapses can happen again and again. It is important not to panic about this, but to remember the strategies you have learned. If the fear increases, those affected should see a therapist again. Seeking help is a sign of strength. Those who face their fears keep control over the fear.

Special treatment for blood injection injury phobia

For patients with a blood phobia, there is a special technique that was developed by the Swedish psychologist Lars-Göran Öst. It's called applied relaxation. Because those affected with a blood injection injury phobia differ from other anxiety patients in that they often feel nauseous or even pass out in connection with appropriate medical examinations.

Öst's special method is for patients to tense their muscles in their arms, legs and chest for 15 to 20 seconds. After a short relaxation break, this tension is repeated. Many patients can use the contraction technique to reduce symptoms, such as sweating and discomfort from exposure to blood or injections, and prevent fainting.

Phobias: disease course and prognosis

Phobias can develop at any time in life after scary situations. For example, fear of flying, if a person fears falling during a turbulent flight. Most phobias appear in childhood and adolescence.

Specific phobias often develop around the age of seven. When started early, the specific fear may fade over time. Phobias that are still present in adulthood or only appear afterwards are usually chronic.

Among the phobias, the specific phobia has the best prognosis. The treatment of specific phobias by means of exposure therapy has a good chance of success even after a few therapy sessions. However, many of those affected do not seek help. If there are other anxiety disorders as well as depression or an addiction problem, longer therapy is often necessary.

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