Is it just fear or an actual phobia?

DEAR DOCTOR K:

I have a terrible fear of heights, dogs and public speaking. My sister calls them “phobias” and says I should seek help. How do I know if my fears are normal, or if I need treatment?

DEAR READER:

We all have things we worry about or are afraid of. And with most of them, we’re right to be fearful. But in people with a phobia, the fear is persistent, excessive and unrealistic. As many as one in 10 people suffer from phobias at some time during their lives.

How can you distinguish a justifiable fear from a phobia? In a phobia:

  • There are fears that are irrational, given the reality of the situation. For example, anyone may be afraid of an unrestrained, menacing dog. But most people do not run away from a calm, quiet animal on a leash. People with dog phobias avoid all dogs.
  • There is avoidance of triggers. People with phobias may go to great lengths to avoid the things that trigger their phobia. For example, they may walk up 10 flights of stairs to avoid using an elevator.
  • There are anxiety-related physical symptoms. These can include tremors, palpitations, sweating, shortness of breath, dizziness and nausea.

Below is a chart that lists many different phobias. They range from fear of snakes to fear of heights and public places.

Why do people get phobias? A vulnerability to getting phobias can run in families. A child of a parent with a specific type of phobia is more likely to have that same phobia than another child. That could be due to genetic factors or to non-genetic factors. Studies indicate that both are involved, but that non-genetic factors are more important. For example, if a parent has a fear of heights, a child may be more likely to develop the same phobia if the child witnesses the parent being terrified when near the top of a tall building.

Phobias are a type of anxiety disorder. A mental health professional is best qualified to diagnose them. Tell him or her about any experience or trauma that may have set off the phobia. For example, maybe a dog attack led to your fear of dogs. Discuss how you react — your thoughts, feelings and physical symptoms — when you are confronted with the thing you fear. Also, describe what you do to avoid fearful situations. How does the phobia affect your daily life, including your job and personal relationships?

Specific phobias are the most common. This is a fear of particular animals (dogs), people (clowns), environments (thunderstorms) or situations (riding in airplanes, getting into elevators).

A combination of medication and “talk therapy” can help. For short-term treatment of phobias, your doctor may prescribe an anti-anxiety medication.

The most commonly used talk therapy is cognitive behavioral therapy (CBT), especially a technique called desensitization therapy or exposure therapy. Exposure therapy involves gradually increasing your exposure to the thing you fear. This is done at your own pace, under controlled circumstances. As you are exposed to the thing you fear, you master your fear through anxiety-reducing strategies.

Phobias can greatly interfere with a person’s life. But with proper treatment, they can be conquered.

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