Tuesday, March 17, 2009

Phobias: Just One More Thing To Deal With

Hello Friends:

It is not uncommon for phobias of all kinds to be accompanied by (comorbid with) other stress and trauma related disorders, including depression. So if you end up with one, your odds are good that you’ll be dealing with another.

Because dealing with just one disorder is too easy … or something.

Phobias are at least one sort of diagnosis that gets a lot of press. Everyone knows someone who is afraid of something, so having a phobia doesn't have to make a person feel 'abnormal' anymore. My own little survey was hardly scientific, but once again I will extrapolate from no data to broad and sweeping conclusions. Three brave folks completed the poll with the following results:

Phobias! Which of the following make you freak? Pick all that apply.

(1) Spiders/Insects

(1) Needles/Blood

(1) Talking to people

(2) High or small spaces

(0) Leaving the house

(0) Nope – No phobias

This does support the idea that phobias are reasonably commonplace. Of course, many people are uncomfortable with spiders or needles, but if you find yourself panicked around them and avoiding them to the point that you would prefer to inhibit a major life activity, then you probably have a phobia.
And naturally phobias come in several different flavors, with different triggers and treatments. Again, because it would be too easy, otherwise.

Specific Phobias - Also called 'simple' phobias, which none of them really are. These are the sorts of fears most people think about when they imagine phobias. And they are, in turn, also split into categories.

- Natural Environment Phobias - Triggered by objects or events in nature such as fear of storms, fear of lightning, fear of water, fear of the dark, fear of heights, and fear of flowers. Yes, flowers. It happens (anthrophobia). I've recently started developing both a fear of storms and a fear of snow - I think it's related to a general fear of being trapped, but whatever it is it is getting really irritating.

- Animal/Insect Phobias
- All the classics are here; fear of mice, fear of cats/dogs, fear of spiders, fear of snakes, and -heh- fear of bats (chiroptophobia). I am phobic about spiders - terrified of them with no reason needed or given. Of course I wrote about being afraid of bats, but it's not the same. I find spiders disgusting and loathesome. I'm just afraid of bats, and squirrels and dogs and most other furry things because of my OCD fear of rabies. Makes perfect sense ...

- Situational Phobias
- Triggered, as one might expect, by specific situations, like fear of flying, fear of elevators, fear of small spaces, fear of dentists, fear of driving, fear of tunnels, and on and on. Holy cow do I have a fear of flying. Bad bad fear that has never gotten better, even though I fly at least a half a dozen times a year, sometimes as much as once a month. The only thing that works is drugs - Ativan, actually. I'm still terrified, but in a sort of fogged out way. I've even fallen asleep on planes when I've had enough of the stuff, and that's a gift I only fantasized about before the meds.

- Blood/Injection/Injury Phobias - This is something of a more loose association of fears, but they all include issues like fear of blood, fear of being harmed, fear of needles, fear of medical procedures and such. I am terrified of needles. Again, just looking at them makes me sweat. I have both a standard phobia here, as well as an OCD phobia. And then you can add on the traumatic reactions related to violation and contamination. Needles = bad, and there's no getting around it.

Social Anxiety/Social Phobia - This category is split into two subdivisions.

- Generalized Social Anxiety - This is anxiety generated in any sort of social or 'performance' situation. Basically needing to be around people or talk in almost any way can scare a person with this fear. Yep. And I'm even an extrovert. I've got this one pretty bad.

- Specific Social Phobias - For people with specific social phobias, they are fine in almost any situation, except for something in particular; examples are fear of public speaking, fear of eating or drinking in front of people, using public restrooms, making phone calls, or answering a question in class.

Agoraphobia - Has it's own separate category. People used to think this was a fear of wide open spaces, but more likely it is a conditioned pattern of avoidance to situations where the person feels they might lose control or have a panic attack and be unable to get help. It is not entirely clear if agoraphobia, which usually ends up trapping people in their homes, is a kind of offshoot of Generalized Anxiety Disorder. Some people think that panic attacks are an extreme expression of GAD. And so having many panic attacks, leading to Agoraphobia, could mean that Agoraphobia is really bad GAD. Heh. I buy into that particular idea, myself, although my Agoraphobia isn't really Agoraphobia at all. I thought it was GAD related, but it seems to be severe generalized social anxiety, instead. I'm so afraid of having to deal with people, and afraid of their expectations, that I end up unable to leave the house, unable answer the phone, or even read my email, let alone respond to it.

And then, apparently, there are phobias that don't really fit into any category. Fear of illness and disease is tricky. It can sometimes be a type of injury phobia, but can also be an OCD related issue. Hypochondria in the classic sense is listed as a somatoform disorder; a type of disorder where people feel real pain, but the causes are most likely due to psychological factors. It is a severe bummer to have that disorder, since it is the one where people say "It's all in your head, so just get over it." But the pain is quite real, and needs to be dealt with. Many anxiety disorders have physical symptoms that can make a person feel physically very ill. Panic attacks routinely have people calling the ambulance thinking they are having heart failure. In any case, fear of illnesses and experiences of physical symptoms without cause is a very complex issue.

Oh yeah, as for the pic at the top:

Fear of stairs and steep slopes – Bathmophobia
Fear of climbing or falling down stairs – Climacophobia

And so what's the difference? Apparently Bathmophobia is a specific phobia, your basic fear and loathing of stairs. Climacophobia is a kind of social phobia, related to a fear of doing something embarrassing or humiliating when trying to climb stairs, or by accidentally falling down them.

When I started this I was thinking I'd just do a one-post job on phobias. Now I see it is going to provide fodder for a long, long time to come.

Your Hostess With Neuroses

Image is "look downstairs into stairwell whirl" by quapan on flickr via Creative Commons


The Tenacious Writer said...

Thank you for such a thorough and intelligent review of phobias! Very informative.

I told a doctor once that I was sensitive to drugs. She said that when someone was sensitive to one thing, then they were sensitive to a lot of things. Kind of like phobias. Never just one.

I wonder why there are so many phobias that center around fear of embarrassment. Is that a socialized fear? Something inherited or taught? Why do we have a free society in which so many people are afraid of being around other people?
Just wondering.

Destress Yourself said...

Excellent post, Hostess with Neuroses.

I wonder, is there a fear of menstruation? Silly huh? But, I was thinking about this before I read your post and I have a simple phobia over it.

It is funny to me but true.


The Blue Morpho said...

Hey there Destress Yourself! Thanks for reading and commenting.

I did a little research on fear of menstruation - menophobia - and it is very interesting. Apparently, like the fear of stairs, one can be phobic about menstruation for a host of reasons. For example, some people have a social phobia around menstruation; they are afraid that others can tell they are menstruating or that a leak might give them away. Some people have an anxiety or trauma reaction that is more related to the fact that their body is doing something completely out of their control. A related trauma centers on those who have had very painful periods, and so develop panic/phobias for that reason.

Apparently some phobias about menstruation are tied to eating disorders either as cause or effect. Starving yourself will stop your periods. Young women who are already very uncomfortable with their bodies may find the onset of menstruation threatening, and this can contribute to any existing or developing eating disorders.

And of course, any past abuse or boundary violation in that part of the body can be the trigger for or a serious complication of existing menophobia.

One of the most interesting things I found was that menophobia as a fear of blood was not common among women - but it is among men! Men who have a fear of menstruation seem to either fear it for the blood-phobia reason, or fear it as something they can't really understand or control. It can be a focus issue for men who are already very uncomfortable with woman for one reason or another.

I imagine you don't have the blood phobia yourself, since your profile says you were an EMT. That's a job I could never manage! Again, thanks for reading and continued good fortune with your career in Destressing people. Cheers!

The Blue Morpho said...

Hello Tenacious - Thanks for reading and posting another comment. I did some research into the nature of the fear of embarrassment since I was intrigued by your questions of if this is socialized, inherited, taught or what, and why people should be afraid of being around other people.

What I found mostly remains in the research realm of hypothesis and conjecture, but holds up with other observations. Embarrassment is a higher order social reaction that is adaptive in promoting the survival of the self and of groups. Embarrassment is an emotion that redirects behavior to whatever is considered 'normal' by the social group the person is in. Those who learn from embarrassing incidents are more likely to find mates and thus reproduce, and more likely to function better as a part of their group and thus increase their own chances for survival (as well as for the survival of the group as a whole).

Embarrassment is a higher order function because you can't get embarrassed if you have no concept of social rules or expected behavior. But since it is tied to survival as well as obtaining a mate, it has tremendous power. So it is not surprising in that context that a fear of being embarrassed should develop in people who are predisposed (either by nature or nurture, either or both can be in play).

Our advanced minds are both the problem and the solution. As society gets more complex, with confusing and conflicting rules, constant changes, and increasing expectations of the individual, more and more people are likely to respond with social anxiety and fear of embarrassment. Fortunately we have the higher thinking to allow cognitive therapy to be effective in this case, so that we can learn to say 'to heck with your expectations for me, I'm doing it my way' and then find both a group and a mate that believe those things too!

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