The classification of phobic disorders has being reviewed since the 19th century. Therefore, the investigation of modern classification is essential for further scientific purpose. The paper explores the historical perspective and defines two major classes of phobic disorders which are divided into subtypes. It also describes major symptoms and provides the causes of phobic disorder occurrence. In addition, main methods of treatment are given in order to provide the complete analysis. The ACP Journal Club and EBM Reviews were accessed and searched for the articles on the issues under investigation. The obtained data were analyzed and systematized in coherent arguments. As a result, it has been found that all human beings suffer from one or few phobic disorders which manifest themselves over the lifespan. The majority of disorders begin in early childhood and adolescence because of fears acquired in various situations. However, all of these disorders can eventually be treated by means of appropriate techniques such as behavior therapy, age regression technique, or medication.
Keywords: age regression technique, agoraphobia, behavior therapy, hypnosis, illness, phobia, internal stimuli, external stimuli, medication, obsessive phobia, phobic disorder, social phobia, specific phobia
The term ‘phobia’ originates from the Greek word ‘phobos’ meaning terror and panic fear. In Greek mythology, Phobos was the twin brother of Deimos. They were the sons of Aphrodite and Ares. The brothers accompanied their father in wars and were known as “terrible gods.” Phobic disorder is considered to be an irrational fear that results in a conscious avoidance of the feared situation, activity, or subject. Phobic anxiety does not differ significantly from spontaneous or non-phobic anxiety since both are characterized by psychophysiological responses. They can surmount a person with unpleasant sensations of helplessness and weakness. Phobia includes two components: “phobic anxiety” and “phobic avoidance.” The inherent component of the phobic personality is the desire or need to escape the anxiety-provoking situation. Phobia may induce very strong feeling of panic that is accompanied by a sense that death or madness are imminent. The secondary feature of phobic disorder is a fear of fear itself. Therefore, the patient no longer feels in control their own body or impulses.
In early psychoanalytic writings, phobic disorder was considered to be predominant through the prism of a threat from instinctual tension. Freud believed that some phobias, for instance, zoophobia was considered to be vestigial traces of the inherent preparedness to face real danger which was strongly developed in animals. These phobic disorders are common in childhood but may be treated if they are symptoms of “anxiety hysteria.” Freud defined phobia as a central symptom of “anxiety hysteria.” However, he also claimed that phobic symptoms might be found in various psychotic and neurotic states (Morgan, 2003).
Phobia managed to achieve a separate diagnostic label only in 1952. At a later date, subdivision of phobic disorders appeared. Phobic disorders were conveniently divided into Class I and Class II. The first division is a phobia of stimuli external, and the second one is a phobia of stimuli internal to the patient. Class I is the commonest phobia seen by psychiatrists. It is divided into three types: agoraphobia, social phobia, and specific phobias. Class II includes illness phobias and obsessive phobias.
According to the American Psychiatric Association, social phobia is a strong fear of interpersonal situation in which the embarrassment can occur. Nowadays this disorder is called social anxiety disorder. It is the most common group of mental illness in the United States. Agoraphobia is the fear of being alone in public places from which a rapid exit would be difficult in the course of some situations. Specific phobia is more frequent in comparison with agoraphobia or social phobia. It is divided into the following major subtypes: natural environment type (fear of water, height), animal type (fear of spiders, snakes, dogs), situational type (fear of elevators, planes, enclosed spaces), blood injury type (fear of blood) and other types (fear of loud sounds, etc.) (Smoller, 2007).
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Phobias of External Stimuli
The animal phobia is a clear cut disorder of specific phobia type. The fear of animals is also defined as zoophobia. As usual, children suffer from this phobia because of the frightening situations they are faced with. For instance, a child has being bitten or has seen a dog attacking a person on the street or in a movie. Animal phobia usually develops in early childhood. It more frequently occurs in women. Fewer patients who suffer from zoophobia seek treatment in comparison to those who have agoraphobia or social fears. This may be due to the fact that the phobic disorder does not disturb person’s life to the extent that other phobias do.
Agoraphobic syndrome is the commonest and the most distressing type of phobic disorders. Women are more prone to agoraphobia. Those who suffer from it demonstrate fear of being in a situation when they cannot escape or get help in case of a panic attack. Patients with this phobia fear public places, shopping, travelling and closed spaces. Stressful life events are the major factors that may precipitate the agoraphobia progression.
Social phobia encompasses fears of drinking, eating, blushing, speaking, or even writing in the presence of other people. This phobic disorder frequently occurs both in men and women. Patients with social phobia experience excessive fear of being judged negatively in social situations. Social phobia belongs to disorders with onset usually occurring in childhood.
Phobias of Internal Stimuli
Illness phobia is an intense fear. A person is focused on specific disturbances, such as heart disease, venereal disease, cancer, and death. The phobia resembles the endless obsessive thoughts of possibility to suffer from any diseases. Obsessive phobia is the fear for own feelings that come to consciousness contrary to the patient’s will. For instance, obsession phobia of killing a child makes a person hide any knives to avoid the temptation. Other examples of such fears are fears of making obscene gestures, or fears of contamination that results in obsessive hand washing. Obsessive phobia can start at any age in both sexes (Bruce, Coles, & Heimberg, 2012).
Symptoms and Causes of Occurrence
Multiple mechanisms contribute to the formation of fear and anxiety. Clinical investigations have discovered that phobia may be a minor complaint in a lot of disorders. It can be a part of depressive illness or a feature of schizophrenia, diffuse anxiety states, and obsessive neuroses. In this case, the management of phobic disorder depends on the treatment of the major condition in which the phobia occurs. Phobia is also distinguished as a patient’s dominant symptom and is called a phobic disorder or a state.
Phobic disorder interferes with person’s ability to study, work, and socialize. People who suffer from this disorder are overwhelmed by their anxiety. Approximately 10 percent of Americans has more than one clinically significant phobia. The average age for the phobia development is 15-20 years of age. A great number of fears develop in childhood and disappear before adulthood. However, if phobic disorder persists into adulthood, it will not disappear without treatment. Major symptoms of the phobia encompass the feeling of panic, horror, dread, rapid heart beating, trembling, shortness of breath, overwhelming desire to abandon the situation, chills or hot flashes, fear of losing control, sweating, abdominal distress, and even fear of dying.
Some physiologists claim that the development of phobic disorders is triggered by a genetic predisposition together with social and environmental causes. Others believe that neurotransmitter-receptor plays a significant part in the social phobia development. It has been proven that twins might suffer from the same type of phobia even if they were separated soon after birth.
Marting Seligan, the American physiologist, associated a small electric shock to certain pictures. He found that two to four shocks were enough in order to establish a phobia to pictures of snakes or spiders. Meanwhile, the pictures of flowers took larger series of shocks. Seligan explained that some fears where essential for the survival of the humanity thousands of years ago. Therefore, the fears lie inside person’s brain and wait awakening at any time (Arlette, Romy, Stephan, Ivailo, Wolfgang, & Frauke, 2007).
Behavior therapy is one of the most successful treatments of phobic disorders. Patients meet a therapist and confront the feared situation in a carefully planned way in order to learn how to control the reactions of fear. The behaviorists believe that the phobic fear is the acquired reflex that can be disposed by exposing a person to the non-dangerous stimulus time after time. This treatment cannot occur naturally, that is why behavior therapy involves exposure to the phobic stimulus in a safe and controlled way. The patients must be immersed in the fear reflex until it fades away. By this medium, they can see that none of the feared consequences actually come to pass.
Hypnosis can also help patients get rid of phobic disorders. This method helps relax, slow down heart rate, and control breathing by means of this method. As a result, phobia sufferers can deal with a problem in a rational and calm manner. More severe cases are cured by the age regression technique that guides the patients back in time. It also helps them reassess the situation that initially triggered the fear.
Medications are mostly used to overcome panic attacks in case of social phobia and agoraphobia. Xanax and Valium are anti-anxiety drugs approved for the treatment of anxiety disorders. Beta-blockers such as Inderal and Tenormin control high blood pressure and some heart problems that help cope with anxiety during public speaking. Serotonin specific reuptake inhibitors such as Prozac, Paxil, and Zoloft also belong to the list of effective antiphobic medications. Practitioners often prescribe these drugs due to fewer side effects and a very low addiction potential (Bruce, Coles, & Heimberg, 2012).
To sum up, phobic states are a set of interrelated disorders with overlapping features. Phobias may occur in particular situations, at certain ages, and together with psychiatric symptoms. Phobic disorders must be clearly differentiated from phobic symptoms. A new classification of phobic disorders was proposed based on modern investigations. Two categories Class I and Class II of phobic disorders have a different clinical presentation, sex distribution, age of onset, and response to treatment.