Phobias are constant, excessive fears of an object or situation that interfere with one's life and/or cause personal distress. Phobias are among the most common types of psychiatric disorders, with 11% of the population subject to a phobia at some point in their lives, and 5.5% of the population subject to a phobia within a given 30-day period. Many people learn to manage their phobia with minimal difficulties.
For example, a person with a spider phobia might avoid activities such as camping, but otherwise does not notice a disruption in his or her life. However, for phobias that cause noticeable life interference, there are effective treatments that are successful in up to 90% of cases.
How do I know if I have a phobia?
Most people admit they are afraid of certain things, such as snakes, blood, and/or public speaking. It could be said that some fears are useful, as they alert us so that we can prepare for potential danger. Fears of certain objects or situations are considered a phobia when:
- The fear is excessive or unreasonable.
- The person almost always has an anxiety reaction when he or she encounters the feared object or situation.
- The feared object or situation is either avoided or endured with extreme distress.
- The avoidance, anxious apprehension, or distress in the presence of the feared object or situation disrupts one or more aspects of a person's normal routine.
In other words, when a person notices a specific fear getting in the way of routine activities or life satisfaction, then it is possible that he or she is suffering from a phobia. Phobias are typically grouped into one of five categories:
- Animal Type (fears of spiders, snakes, cats, dogs, mice, birds, or other animals)
- Natural Environment Type (fears of being near water, storms, and high places)
- Blood-Injection-Injury Type (fears of seeing blood, medical procedures, and injuries, receiving injections, and having blood drawn)
- Situational Type (fears of driving, flying, and being in enclosed spaces)
- Other Type (fears of vomiting, choking, loud sounds and other fears not belonging to any of the other categories)
What causes phobias?
There are many ways a person can develop a phobia. Some individuals remember a particularly traumatic experience with the feared object or situation. More often than not, however, people report that they have had the phobia as long as they can remember, or that they were always fearful of an object or situation and that it gradually developed into a phobia. Most psychologists believe that a combination of factors explains why phobias develop, including biological vulnerability, such as the tendency to be startled or alarmed, traumatic experiences with feared objects or situations, observations of others reacting fearfully to certain objects or situations, and learning information about the danger of certain objects and situations. These circumstances, in turn, make it likely that phobic individuals will develop problematic ideas about the feared object or situation, such as the amount of danger it poses, the frequency with which they will encounter it, and their ability to cope with it. Interestingly, people are more likely to develop phobias of insects and storms rather than guns or knives. Many researchers believe things like insects and storms posed a threat to our ancestors, and it helped them to survive if they had a moderate level of fear toward them.
How do phobias affect relationships and family life?
At times, phobias can cause disagreements in close relationships, as they can limit the activities that partners and families can do together. Families of children with phobias often create time-consuming rituals to structure the phobic child's environment so that the child either successfully learns to deal with the phobia, or so that the family can avoid a "scene" caused by the phobia. Partners and family members often find themselves trying to strike an unstable balance between showing love and concern toward the phobic individuals, and encouraging them to overcome their fears.
What kinds of treatments are commonly used?
Medications are rarely used to treat phobic individuals (if there are no other psychiatric symptoms). Instead, most clinicians believe that a therapeutic method called "in vivo," or "real life" exposure to the feared object or situation is necessary to reduce fear. Although real life exposure might be uncomfortable for the phobic individual, it is conducted in a way that allows the individual a sense of control and maximizes effectiveness. Real life exposure in a therapy session is typically one to three hours, which is different than the brief moments the phobic individual usually encounters the feared object or situation before escaping. Such prolonged exposure allows plenty of practice with the feared object or situation and the opportunity to learn that the danger he or she perceives is exaggerated. Unlike encounters with feared objects or situations in their everyday lives, in therapy, phobic individuals know what to expect and must give their permission at each step of the exercise. Individuals also work to deal realistically with their exaggerated ideas about the feared object or situation. For example, learning that there will not be a catastrophic consequence to the exposure. Most phobic individuals can be treated successfully using this method in one to five sessions.
Partners and family members can assist with exposure therapy. In some instances, it is helpful for them to attend sessions so that they can learn therapist behaviors that make the exposure exercise effective. Between sessions, they can serve as a coach as phobic individuals practice exposure to feared objects or situations at home. Although the support of partners and family members can help therapy to run smoothly (and may result in relationship improvements), it also is important for the phobic individual to practice exposures alone, so that he or she does not rely on the presence of another person to signal safety.
Post-Traumatic Stress Disorder (PTSD) is a psychiatric diagnosis for people who have endured a highly stressful and frightening experience and who are experiencing distress caused by memories of that experience. It is as if a person is "possessed" by memories of an experience and just cannot let go. Because anxiety is the major sign of PTSD, it is classified as an anxiety disorder. Other anxiety disorders are phobias, panic disorders, and generalized anxiety.
The good news is that it is highly treatable when diagnosed early. The bad news is that it is often missed by examining physicians and mental health professionals, or it is misdiagnosed as some other condition that is more neurobiochemical in nature. But there is no drug cure for PTSD.
What causes PTSD?
Catastrophe/traumatic events are the cause of PTSD. These events are sudden, overwhelming, and often dangerous, either to one’s self or significant others(s), such as a car wreck, natural disaster, dangerous accident, war combat, robbery at gunpoint, or a near drowning; the person affected felt intense fear, helplessness, or horror either at the time or immediately afterwards. Close friends, family members, and professionals helping those who survive such catastrophes can also be affected by trauma. These helpers, because of their empathy and compassion for the person in harm’s way, can be traumatized in the course of providing help.
A catastrophe or traumatic event is a source or cause of stress that most people experience. The stress experienced during or immediately after the traumatic event or catastrophe is traumatic stress. Similarly, the stress that is associated with the traumatic event/catastrophe and that is experienced well afterwards is post-traumatic stress. It is defined as a set of conscious and unconscious behaviors and emotions associated with dealing with the memories of the stressors of the catastrophe.
How can you tell if it’s PTSD?
Most people who have been exposed to a catastrophe experience both traumatic and post-traumatic stress reactions. Most are able to survive and cope well; only a small percentage of people develop PTSD.
Authorities recognize four features that all those with PTSD tend to exhibit at some time during their illness. The person:
- Has been exposed to a traumatic event
- Re-experiences the most traumatic aspects of the event
- Makes efforts to cope with these symptoms by avoiding exposure to reminders
- Is on edge, unable to relax, and unable to think about the event without being obsessed
Is it possible that there can be a delayed reaction to the traumatic event?
Yes. There are three types of PTSD:
- Acute: when the above symptoms last between one and 3 months after the trauma
- Chronic: when the symptoms last for at least 3 months following the trauma.
- Delayed: when symptoms do not show up for at least 6 months after the trauma. This is often found with adult survivors of childhood traumas.
What are other effects of trauma?
When PTSD is detected, other symptoms and characteristics are found too. This is why PTSD is so often misdiagnosed. Among the major sets of symptoms are phobia and general anxiety (especially among former POWs and hostages and natural disaster survivors), substance abuse, depression, psychosomatic complaints, an altered sense of time (especially among children), grief reactions and obsessions with death (especially among those who survived a trauma in which someone could have died), feeling guilty, and increased interpersonal conflicts. For some who have PTSD, these other features go away once the PTSD symptoms are eliminated through treatment.
What kind of help is there for PTSD?
Both drugs and psychotherapy can be helpful. The most effective treatment approaches are called "cognitive-behavioral" because they focus both on the way traumatized persons view the trauma and on their resulting behavior. Exposure therapy includes systematic desensitization (training to relax in the face of frightening reminders of the trauma) and imaginable, in-vivo techniques such as flooding or the process of putting the client back into the trauma psychologically. The most effective treatment for PTSD includes a variety of anxiety management training strategies. Some of these include Rational Emotive Therapy, various kinds of relaxation training, stress inoculation training, cognitive restructuring, breathing retraining, biofeedback, social skills training, and distraction techniques. Innovative therapists are successful in combining various techniques to fit the trauma and the patient’s unique requirements.
Families are the best setting to help those who suffer from this stress disorder. Families know when a member is acting differently than before the traumatic event. A therapist may work with you or your family member with PTSD to remember the trauma and reprocess the information and mourn losses. This also means that you will learn self-soothing techniques and ways to limit the distress during and between sessions. Your therapist will help you disconnect from the trauma so that reminders do not arouse distress. In doing so, the therapist will help you reconnect to life now and in the future without being haunted by the trauma. Sometimes this transition to life without the trauma is harder than expected.
The reconnecting is especially important: once you are desensitized from the burdens caused by the traumatic event, family therapy enables you to turn your attention to the future. You will attempt to learn from the traumatic events and make needed changes in your personal life and relationships, especially love relationships.
What types of drugs might be used in treatment?
For some clients, drug treatment is a useful supplement to effective psychotherapy approaches. Drugs such as imipramine, amitriptyline, phenelzine, fluoxetine, and propranolol may provide temporary symptom relief for general anxiety, depression, insomnia, and related problems.
So there is hope for me and my family?
Family therapy offers an extraordinary and useful resource for helping families survive a major traumatic event. Social scientists have documented the remarkable and consistent patterns of emotional recovery from a wide variety of traumatizing events. There is a large number of treatment approaches available today. It is impossible to prevent traumatic events but family therapy can help promote recovery more quickly, and enable family members to get back to what they do best: love each other.
Obsessive-compulsive disorder (OCD) is a common anxiety disorder that affects about 1 to 2% of the population. As its name implies, the symptoms of OCD involve obsessions that lead to compulsions. Obsessions are recurrent and persistent ideas, thoughts, images, or impulses that may cause a great deal of anxiety or distress. People experiencing these obsessions typically find them to be disturbing and intrusive, and usually recognize that they don't make a lot of sense. In response to obsessions, people with OCD try to get rid of them by way of compulsions-acts that are done over and over again, and often according to certain personal rules. Also called rituals, compulsions are usually aimed at preventing or reducing distress and anxiety, or preventing some feared event or situation.
Obsessions and compulsions can take many forms. A few examples include: drivers who fear that they've hit a person every time they run over a pothole or bump on the road. In response to such an obsession, these persons may resort to compulsions such as retracing their routes to be sure no harm was done, or avoid the particular road altogether in the future. Individuals who fear or are obsessed with germs may wash their hands repeatedly throughout the day after touching any potentially "germy" objects, such as door handles, money, or newspapers. Often, their hands are sore and raw from repeated washing, but they can't seem to stop washing. Others who might be obsessed with order and cleanliness may compulsively arrange items in a particular order, or clean their home floors many times a day. Those who fear burglary, fires, or floods may repeatedly check door locks, stove burners, and taps to ensure that their homes are safe. Over time, such repetitive actions work less and less effectively, and the persons may experience anxiety and often depression in response to the increasing obsessions and compulsions.
Besides causing a great deal of stress, OCD symptoms may take up a lot of time (more than an hour a day for some diagnosed people) and may significantly interfere with a person's work, social life, or relationships. OCD can be a challenging problem but fortunately, very effective treatments for OCD are now available to help individuals and families lead a more satisfying life.
What causes OCD?
There is no single, proven cause for OCD. There is, however, growing evidence that biological factors are a primary contributor to the disorder. Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures communicate with each other by using serotonin, a chemical messenger. It is possible that serotonin plays a significant role in the development or maintenance of OCD. Other psychological, familial, social and cultural factors may contribute to OCD, but it is not clear whether they cause the disorder.
What is the effect of OCD on family members?
Family members often feel confused and frustrated by the symptoms of OCD. They may have difficulty understanding the exaggerated behaviors seen in a person with OCD, and they may think that the person is behaving oddly on purpose or that he/she has simply "lost their mind." Understandably, the family may find it difficult to cope with the behaviors seen in the member with OCD and they may not know how to handle the situation. The family may react negatively to the person, possibly causing a lot of family and marital stress. In order to avoid and/or deal appropriately with family reactions, it is very important for family members to learn about OCD, including its symptoms, causes, and treatment. Families who educate themselves about the disorder can contribute to the successful treatment of the individual with OCD.
What treatments are available for OCD?
There are several types of effective treatments for individuals with OCD and their families. The most common types of treatments are the following:
- Cognitive Behavioral Therapy (CBT)
- This treatment has two parts: behavioral therapy and cognitive therapy. Behavioral therapy involves exposure and response prevention. Exposure is designed to reduce the negative emotions (anxiety and guilt) brought on by obsessions. It is based on the idea that anxiety usually decreases after lengthy contact with something feared. For example, people with obsessions about germs will be advised to stay in contact with "germy" objects, such as money. In order for exposure to be most helpful, it needs to be combined with response prevention (RP). In RP, the person's rituals (or compulsions) are blocked. For example, those who worry a lot about germs will be advised to stay in contact with "germy" objects, but avoid the compulsion to wash their hands excessively. This repeated exposure without rituals assists individuals to understand that coming into contact with certain objects or situations will not lead to the initial fear-in this case, becoming ill from the germs found on common objects.
- CBT's second part is cognitive therapy (CT). It is often combined with behavioral therapy to help reduce the catastrophic thinking and exaggerated sense of responsibility often seen in OCD. In cognitive therapy, the therapist asks the client a series of questions to help him/her identify and evaluate the interpretations and beliefs that lead to typical OCD behavior. Once these beliefs are identified, the therapist will use a variety of strategies to assist the client in challenging the faulty assumptions that are seen in OCD.
- Behavioral Family Treatment
- Whenever possible, it is helpful for family members to participate in the treatment of OCD. Family members and persons with OCD both tend to benefit when the family members participate in psychoeducational groups. These groups educate family members about OCD and provide strategies that the family can use to assist and support the member with OCD.
- Research shows that the use of medication, specifically serotonin reuptake inhibitors (SRIs), is beneficial for the treatment of OCD. Most research shows that medication alone does not get rid of OCD, but it reduces the force of obsessions and urges to engage in rituals (for example, excessive hand washing), thereby allowing the person with OCD to have more control over their thoughts and behaviors.
How can a family therapist help?
Family therapists are trained to assist individuals, couples, and families with a variety of clinical issues, including OCD. A family therapist will carefully assess a person's condition and assist him/her in determining which of the above treatments will be most appropriate and beneficial. A family therapist will also encourage the family to actively participate in the treatment of OCD in a variety of ways, including participation in a psychoeducational group. If medication is necessary, the therapist will refer the client to a physician who can guide the person in determining which medication is the most appropriate to take. Often, the family therapist and physician will work together to coordinate and carry out the treatment of the person with OCD. This will ensure that the person receives the best possible treatment. The information in this brochure was provided by Gail Steketee, Ph.D. and the Obsessive Compulsive Foundation, Inc., www.ocfoundation.org.
It’s the extreme fear of being scrutinized and judged by others in social or performance situations: Social anxiety disorder can wreak havoc on the lives of those who suffer from it. This disorder is not simply shyness that has been inappropriately medicalized: Read about the difference.
Symptoms may be so extreme that they disrupt daily life. People with this disorder, also called social phobia, may have few or no social or romantic relationships, making them feel powerless, alone, or even ashamed.
- About 15 million American adults have social anxiety disorder
- Typical age of onset: 13 years old
- 36 percent of people with social anxiety disorder report symptoms for 10 or more years before seeking help
Although they recognize that the fear is excessive and unreasonable, people with social anxiety disorder feel powerless against their anxiety. They are terrified they will humiliate or embarrass themselves.
The anxiety can interfere significantly with daily routines, occupational performance, or social life, making it difficult to complete school, interview and get a job, and have friendships and romantic relationships.
Social anxiety disorder usually begins in childhood or adolescence, and children are prone to clinging behavior, tantrums, and even mutism.
Case example: Michael was driving home from work one day and was caught in traffic. He suddenly noticed that his heart was beginning to race. He then felt short of breath, and tightness in his chest. When he began to sweat, he became concerned and drove to the nearest emergency room where they could find nothing physically wrong with him. Michael had just experienced his first panic attack. Over the next few weeks, the attacks became worse, and he started to avoid driving altogether.
Panic disorder is a type of anxiety disorder in which the key symptom is the experience of unexpected panic attacks. These panic attacks consist of physical and/or cognitive symptoms such as racing heart, dizziness, blurred vision, fear of death, trembling, sweating, and shortness of breath. As shown in the above example, the experience of panic attacks may lead to the development of avoidance behavior, known as agoraphobia. In Michael's case, he started to avoid driving out of concern that he might have another panic attack, so his agoraphobia was limited to driving. However, it is common for avoidance behavior to occur in multiple situations. Those with panic disorder with agoraphobia may stop or reduce activities such as drinking coffee, sexual encounters, or taking hot showers in an effort to control the sensations that are associated with panic attacks.
Panic disorder with agoraphobia is the most common of the panic-related disorders, although individuals may also report panic disorder without agoraphobia (panic attacks without avoidance behavior) or agoraphobia without a history of panic (avoidance behavior related to one or two sensations of panic, but has never had an actual attack).
The Impact of Panic Disorder on Individuals and Families
The experience of panic can range from mild (where the person will have limited interference in their daily routine) to extremely severe (possibly resulting in being partially or completely housebound). The experience of panic for most panic sufferers is frightening and the avoidance can greatly alter one's lifestyle (e.g., inability to drive to work). As a change in their lifestyle becomes apparent, there is also a change in their personal relationships. Others around the person must take on more of the day-to-day routine and responsibilities (e.g., going to grocery stores or taking the kids to school). This may cause those around the panic sufferer to feel more stress from their increased duties. The additional stress experienced by the family can cause resentment and anger towards the person and then worsen the panic symptoms. At the same time, she or he may begin to show signs of depression as a result of their changed family role. The negativity that comes with depression may then lead the person to believe that they don't have the capability to improve their condition, and consequently increase their dependency, depression, and panic symptoms. If left untreated, this disorder can be consuming.
Knowing When to Seek Help
In general, a person should consider seeking help when the anxiety occurs too frequently, intensely, or is becoming disruptive in daily functioning (e.g., going to fewer parties or social gatherings, going out to stores or movies less than usual). A good rule to follow is to be conservative and consider seeking help from a mental health professional when you notice the following:
- Frequently occurring panic attacks. If you have noticed that the attacks are increasing in either frequency or intensity, it may be a sign that they are becoming more difficult to control. At these times, it is advisable to seek help before the attacks begin to greatly interfere in your life.
- The appearance of avoidance behavior. If you notice a decrease in the amount of time you spend in activities you have typically done in the past, you may want to consider seeking help, especially if the reason for the decrease is related to experiencing panic attacks. The same can be said for activities that may bring on some of the sensations of panic (e.g., coffee). If you are changing your behavior to reduce the number of activities that are associated with panic symptoms, you may be letting the fear of the sensations control your behavior at a subtle level, and should consider seeking help from a qualified mental health professional.
- Dependency. If you notice that you are becoming more dependent on others to accomplish tasks that you would normally do because of the possibility of experiencing a panic attack, you may want to seek help. While this behavior is functional in the short-run, in the long-run dependency may intensify your anxious symptoms.
- Use of safety-signals. Safety-signals are objects or people that you feel comfortable with and signal that you are less likely to experience a panic attack. As such, it is common for individuals with panic to seek safe objects or people. If you notice that you want others (e.g., spouse or partner) to accompany you more during usual activities, then you may want to seek help.
What Treatments are Available?
Treatment for panic disorder with agoraphobia usually involves psychotherapy, medication, or a combination of the two. A qualified family therapist can work with you to determine which treatment will work best for your circumstances. Psychotherapy usually involves some form of behavior therapy. This basic approach consists of in-vivo exposure, which involves repeatedly entering the feared situations, gradually over time. The exposures can be conducted with or without the direct assistance of the therapist. A variation of this approach (cognitive behavioral therapy) involves conducting behavior therapy exposures in combination with helping you manage the troublesome thoughts that often accompany periods of intense anxiety. Cognitive behavioral therapy is a comprehensive treatment designed to influence the negative thinking (e.g., "I might die") that is common with panic disorder. It provides accurate information regarding the nature of panic and teaches specific techniques that allow the patient to correct the catastrophic thoughts that contribute to panic attacks. In this treatment, the patient is also taught to utilize breathing techniques to alleviate some of the physical sensations. This type of therapy has been shown to greatly reduce the return of panic symptoms in the future. Either of these treatments can be conducted individually, or in a couples or group format.
Anti-panic medications may be recommended, including benzodiazepines such as alprazolam, clonazepam, and lorazepam. These medications work well and are generally considered safe, quick acting, and have fewer side effects than other types of medications. While both medications and psychotherapy are effective, some patients have a preference for one type versus another.
Panic can be very distressing, but the good news is that it is treatable, and the treatments outlined here are very successful. The suffering does not have to last for an extended period of time. A qualified family therapist can help you explore your treatment options and recommend a treatment plan that is appropriate for you.
Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about everyday things.
People with the disorder, which is also referred to as GAD, experience exaggerated worry and tension, often expecting the worst, even when there is no apparent reason for concern. They anticipate disaster and are overly concerned about money, health, family, work, or other issues. GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. Learn more symptoms.
Sometimes just the thought of getting through the day produces anxiety. They don’t know how to stop the worry cycle and feel it is beyond their control, even though they usually realize that their anxiety is more intense than the situation warrants.
GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year. Women are twice as likely to be affected.
The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age. Although the exact cause of GAD is unknown, there is evidence that biological factors, family background, and life experiences, particularly stressful ones, play a role.
When their anxiety level is mild, people with GAD can function socially and be gainfully employed. Although they may avoid some situations because they have the disorder, some people can have difficulty carrying out the simplest daily activities when their anxiety is severe.