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Fear or phobia: The science of being afraid

The only thing to fear is fear itself – except that sometimes it can seem like other things are a lot scarier…

"Oh no, here comes my dentist"

Republished with permission from Greatist.com

IT’S NOT UNCOMMON to become a little unglued in anticipation of events or situations we find stressful or overwhelming. (Who hasn’t tossed and turned the night before a long flight?) For many, these feelings of apprehension or unease are manageable and temporary, subsiding perhaps with stern self-talk or a little deep breathing. But for people with phobias, this unease takes the form of a persistent and consuming anxiety, which can turn into overwhelming panic.

So what’s the difference between an everyday fear and a diagnosable phobia, and how can we use this information to assess our own anxieties? Greatist digs into the science of feeling afraid.

Who’s afraid of what? The phobia breakdown

Most people can relate to feeling anxious or fearful every so often (hello, long needle about to draw blood). But clinically diagnosable phobias are not as common. In a given year, approximately 15 per cent of the adult population will experience a phobia (in the US, at least).  A type of anxiety disorder, phobias are strong, irrational fears of an object or situation that poses no actual threat. Generally speaking, people with phobias are intellectually aware that they’re not in real danger, but are still unable to control their fear.

Phobias exist in three different forms: Specific (think heights, flying, dogs, and anything else related to a certain object or situation), social (like Social Anxiety Disorder, or the fear of being humiliated in public or around others), and agoraphobia (the fear of being in a place or situation from which it would be difficult or impossible to escape). Specific and social phobias occur in about 8 per cent and 7 per cent of adults in America, respectively, while agoraphobia occurs in only 0.8 per cent of the adult population.

Because everyday anxiety is par for the course for a lot of people, perhaps the line between phobia and fears can seem vague — after all, many of us may swallow hard as our elevator ascends to the top of a skyscraper, draw back momentarily upon seeing a big dog, or feel self-conscious in social situations. So how can we know if our fears are actually phobias that beg intervention, clinical or otherwise?

Signs and symptoms of a phobia

Phobias share a few key characteristics that clearly distinguish them from everyday fear. In short, phobic people are preoccupied with the possibility that they will encounter the object of their fear — they dread it, and expend significant time and energy to make sure they avoid any circumstances that might put them in contact with the focus of their fear.

If they do run into the object of their fear, they endure the situation with epic levels of distress: nausea, sweating, shortness of breath, elevated heart rate or blood pressure, trembling, even a sense of impending doom or death (as in a panic attack). More generally, says Greatist expert Dr Paul Zak, if a fear impacts the quality of a person’s life, it’s probably a phobia.

Given how psychologically torturous it is to face one’s phobia, avoiding these situations often becomes a project of daily life, ruling decisions when it comes to relationships, jobs, travel and transportation, recreation, and so on. Agoraphobic individuals, for example, often shape their lives around avoiding any spaces from which it would be difficult to escape. Those with social phobia may be fearful of socialising in general or of specific social situations — such as eating and drinking, using public bathrooms, or speaking in front of groups — to the point where they avoid social situations entirely.

Why we’re afraid (and what to do about it)

Even though these fears can be incredibly specific, the cause of a given phobia isn’t always clear. Still, says Greatist expert Dr Michael Mantell, all phobias share a root in catastrophic thinking (i.e., imagining in one’s mind that horrible things will occur) as well as the demand that whatever is imagined should never occur. Phobias may emerge in childhood or pop up unexpectedly in adolescence or adulthood, with no obvious instigating factor. In some cases, they may be a result of a traumatic event (such as a dog bite or uncommonly turbulent flight); they can also arise as a result of witnessing a parent’s own phobia play itself out. Some research has also connected phobias to genetics and brain chemistry.

Interestingly, phobias may also be related to gender. Women are more likely than men to suffer from all three kinds of phobias, possibly owing to how sex hormones affect brain chemistry. It’s also worth noting that women are more likely than men to be mentally and physically abused, putting them at increased risk for anxiety disorders in general.

Upon diagnosis, phobia patients have several treatment options, which typically include a combination of medication and some kind of psychotherapy. Cognitive-behavioral therapy is a common option for specific phobias and can include exposure therapy that incrementally desensitises the patient to the object of their fear. Agoraphobia is often treated with a combination of anti-depressants or anti-anxiety medication and cognitive-behavioral therapy. Likewise, social phobias are often treated with anti-anxiety medication, talk therapy, cognitive-behavioral therapy, or some combination thereof.

According to Mantell, most phobias can be cured within several weeks or months, even without medication (which may carry side effects). An experienced psychologist will likely teach patients to question the evidence for their frightening thoughts, analyse unhelpful beliefs, and develop strategies for challenging negative thinking.

All that we have to fear is fear

Because the line between phobias and everyday fears and anxiety is actually a pretty stark one, knowing what makes a fear truly phobic can help people clarify their own fears or better understand behavior they’ve observed in a friend or family member. If the above descriptions of phobia resonate, visiting a doctor who can make a clinical diagnosis could lead to some relief. At the very least, no one needs to fear that they’re the only who sometimes feels afraid.

Got any tips for overcoming your fears? Let us know in the comments.

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