Phobias

Defined as a persistent and irrational fear of a specific object, activity, or situation, a phobia results in a compelling desire to avoid the perceived hazard. The patient recognizes that his fear is out of proportion to any actual danger, but he can't control it or explain it away.

Three types of phobias exist: agoraphobia, the fear of being alone or of open space; social, the fear of embarrassing oneself in public; and specific, the fear of a single, specific object, such as animals or heights.

Seven percent of all Americans suffer from a phobic disorder. In fact, phobias are the most common psychiatric disorders in women and the second most common in men. More men than women experience social phobias, whereas agoraphobia and specific phobias are more common in women.

A social phobia typically begins in late childhood or early adolescence; a specific phobia usually begins in childhood. Most phobic patients have no family history of psychiatric illness, including phobias.

Both agoraphobia and social phobia tend to be chronic, but new treatments are improving the prognosis. A specific phobia usually resolves spontaneously as the child matures.

Causes

Much is still unknown about what causes phobias. However, there may be a strong correlation between your phobias and the phobias of your parents. Children may learn phobias by observing a family member's phobic reaction to an object or a situation. An example of a common learned phobia may be the fear of snakes.

Signs and symptoms

The phobic patient typically reports signs of severe anxiety when confronted with the feared object or situation. A patient with agoraphobia, for example, may complain of dizziness, a sensation of falling, a feeling of unreality (depersonalization), loss of bladder or bowel control, vomiting, or cardiac distress when he leaves home or crosses a bridge. Similarly, a patient who fears flying may report that he begins to sweat, his heart pounds, and he feels panicky and short of breath when he's on an airplane.

A patient who routinely avoids the object of his phobia may report a loss of self esteem and feelings of weakness, cowardice, or ineffectiveness. If he hasn't mastered the phobia, he also may exhibit signs of mild depression.

Diagnosis

A child psychiatrist or other qualified mental health professional usually diagnoses anxiety disorders in children or adolescents following a comprehensive psychiatric evaluation. Parents who note signs of severe anxiety in their child or teen can help by seeking an evaluation and treatment early. Early treatment can prevent future problems.

Panic disorder, however, may be difficult to diagnose in children and adolescents and may require multiple evaluations and tests in a variety of settings.

Treatment

The effectiveness of treatment depends on the severity of the patient's phobia. Because phobic behavior may never be completely cured, the goal of treatment is to help the patient function effectively.

Anti-anxiety and antidepressant drugs may help relieve symptoms in patients with agoraphobia.

Systematic desensitization, a behavioral therapy, may be more effective than drugs, especially if it includes encouragement, instruction, and suggestion.

In some cities, phobia clinics and group therapy are available. People who have recovered from phobias can often help other phobic patients.

Prevention

Preventive measures to reduce the incidence of phobias in adolescents are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the adolescent's normal growth and development, and improve the quality of life experienced by children or adolescents with anxiety disorders.