Phobias

There are three major types of phobias: specific phobias, social phobias, and agoraphobia. Specific phobias are those triggered by fear of a specific object, such as snakes or spiders. Claustrophobia (fear of enclosed spaces), acrophobia (fear of heights), and fear of flying or driving also fall into this category. About 8 percent of American adults experience one or more specific phobias in any given year. Typically developing in childhood, many specific phobias disappear by adulthood. Those that last into adulthood usually require treatment.

Social phobia describes persistent anxiety in social situations, based on fear of embarrassment or ridicule. People with a social phobia become preoccupied with concern that other people will notice their anxious symptoms—such as blushing, sweating, or trembling—or that their mind will go blank when speaking to someone else. Like stage fright, social phobia causes intense fear when the person is aware that other people can observe him or her doing even simple things, such as eating a meal in a restaurant or putting on a coat. A more general form of the disorder provokes fear during most interactions with other people. People with a social phobia often avoid socializing and even can have difficulty attending school or keeping a job. Performance anxiety and fear of public speaking also fall into this category of phobias. Social phobia affects men and women in equal numbers and usually develops in childhood or adolescence. It has been linked to shyness and tends to run in families.

Agoraphobia, a term that literally means "fear of the open marketplace," refers to fear of being in public places, such as streets, shopping malls, theaters, airplanes, and other places where people gather. People with agoraphobia fear that they will not be able to escape from a given place or that no one will be available to help them in such circumstances. People with agoraphobia often do not venture out of their homes unless accompanied by someone else. Agoraphobia is the most serious type of phobia because in the most extreme cases,

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Concerns affected people refuse to leave their homes at all. The disorder most often develops from the constant worry, preoccupation, and avoidance that occurs following a series of panic attacks (see below). Agoraphobia occurs twice as often in women as in men.

Many doctors use desensitization techniques to treat phobias. Desensitization involves gradually exposing a person to the trigger (object or situation that he or she fears) in an attempt to teach the person to react without fear. Medication and psychotherapy also are typically used to treat phobias.

Panic Disorder

Panic attacks are brief and very intense episodes of a high level of anxiety that often occur with no apparent cause. A panic attack can produce sweating, shortness of breath, rapid heart rate, chest pain, numbness or tingling, trembling, and nausea or stomach pains. Most affected people also report feeling that they are losing control, "going crazy," or dying. An attack typically starts suddenly and builds to its maximum intensity in 10 to 15 minutes, rarely lasting more than 30 minutes. The experience provokes a strong urge to flee and often causes the person to seek help at a hospital emergency department. After the person experiences one or more panic attacks, he or she begins to anticipate more of them and may begin to avoid activities or situations, such as riding in an elevator, that seem to trigger them. Anxiety caused by merely thinking of the possibility of another attack can cause the person to become reclusive. Extreme cases of panic disorder can lead to agoraphobia (fear of being in public places).

Panic disorder is about twice as common in women as in men. Typically the disorder first appears between late adolescence and middle age. Panic attacks do not always indicate an underlying mental illness; up to 10 percent of people experience an isolated panic attack each year. A panic disorder can occur when other mental disorders, such as social phobia (see previous page), generalized anxiety disorder (see previous page), or depression (see page 345), also are present. Doctors can confirm a diagnosis of panic disorder when the person has experienced at least two panic attacks and develops persistent concern about having additional attacks.

Obsessive-Compulsive Disorder

Obsessions are recurrent, intrusive thoughts, impulses, or images that the affected person perceives as being inappropriate, grotesque, or forbidden. These thoughts seem unlike the person's usual thoughts and can cause anxiety and distress. The obsessions also seem uncontrollable, and the person becomes afraid that he or she will lose control and act upon them. Common themes of obsessions include contamination with germs, worry that the person has unknowingly inflicted harm upon someone else, or loss of control over violent or sexual impulses.

Compulsions, on the other hand, are repetitive behaviors or patterns of 353

thought that reduce the anxiety that accompanies an obsession or that "prevent" Mental some dreaded event from occurring. Compulsions can take the form of repeated, Dis°rders ritualistic patterns of hand washing, checking, counting, or praying. For example, the person may count to ten 30 times or may count backward. He or she may recite a certain prayer or passages from the Bible in a specific sequence. Compulsive rituals can consume long periods of time. The presence of both obsessions and compulsions constitutes obsessive-compulsive disorder.

Obsessive-compulsive disorder affects about 2^2 percent of Americans and is equally common among men and women. It typically begins in adolescence or young adulthood in males. As with generalized anxiety disorder (see page 351), symptoms tend to worsen during stressful periods. There is strong evidence that the disorder runs in families.

Posttraumatic Stress Disorder

Posttraumatic stress disorder refers to the anxiety and disturbances in behavior that develop after experiencing an extreme trauma, such as witnessing a murder, experiencing torture, being in a serious accident, or participating in military combat. A critical feature of posttraumatic stress disorder is the psychological symptom of dissociation, a perceived detachment of the mind from the person's emotional state or even from the body. Dissociation is also characterized by a dreamlike or unreal perception of the world and may be accompanied by poor memory of the traumatic event. Other symptoms of posttraumatic stress disorder include general anxiety, a heightened sense of arousal, avoidance of situations that elicit memories of the trauma, and intrusive recollections of the event in flashbacks, dreams, or recurrent thoughts. Symptoms of the disorder may be immediate or delayed, beginning 6 months or more after the traumatic event.

A person with posttraumatic stress disorder experiences decreased self-esteem and a loss of long-held beliefs about people or society. He or she begins to feel hopeless and permanently damaged by the traumatic experience and begins to have difficulty with personal relationships. Substance abuse often develops as the person attempts to relieve such feelings by using alcohol, marijuana, or sedatives.

Posttraumatic stress disorder is most common among women who are rape victims. Women are twice as likely to have the disorder as men. The disorder is also common in concentration-camp survivors and Vietnam War veterans. About half of all people with posttraumatic stress disorder recover within 6 months. For the others, the disorder typically persists for years and may dominate their lives.

Treatment of Anxiety Disorders Anxiety disorders are usually treated with some form of counseling or psychotherapy (see page 347), often combined with drug treatment. Doctors now use more focused, time-limited forms of therapy

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Concerns that teach the affected person how to cope with the symptoms of anxiety rather than exploring unconscious conflicts. A critical element of such therapy is gradual but increasing exposure to the object or situation that causes the anxiety in order to stop the affected person from avoiding anxiety-inducing situations.

Medications that doctors typically prescribe to treat anxiety disorders are those that readjust imbalances in neurotransmitters (chemicals that carry messages between brain cells). Such medications include benzodiazepines, antide-pressants (such as paroxetine or fluoxetine), and an antianxiety medication called buspirone. Benzodiazepines such as clonazepam, diazepam, and lorazepam have antianxiety and sedative effects but can be habit-forming. Buspirone is useful for treating generalized anxiety disorder and, unlike the benzodiazepines, is not addictive.

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