The world is full of specific phobias, but they are usually not bothersome because most people are able to avoid confrontations with the feared object or situation.
Specific phobia
If you are afraid of heights, you would not work as a window cleaner in front of a high-rise apartment building. People who are afraid of snakes do not travel through the forest and heath. If you suffer from claustrophobia, avoid crowded elevators and do not ride with someone else if you have to crawl into the back of a small car.
People with a phobia of bridges plan their journey in such a way that they can cross the river without too much trouble. In each of these situations the person concerned has reached a balance that is at least acceptable to him. The advantages of avoidance behavior (including the reduction in anxiety) seem to outweigh the disadvantages (restrictions in daily life or travel options).
One usually seeks treatment for one’s specific phobia after a change in life circumstances disrupts the equilibrium and avoidance becomes unfeasible or unsustainable. A person with a fear of heights is transferred from a ground-floor office space in a suburb to the top floor of an office tower in the city. A family with a playful Irish wolfhound comes to live next to someone with a dog phobia. A person who is afraid of injections is diagnosed with cancer, so he has to undergo chemotherapy. Someone with a snake phobia should move to Arizona.
The response to a phobic stimulus is both predictable and immediate when exposure to the feared object or situation cannot avoid intense fear and the desire to run away immediately. You remain fully aware that your reaction is out of proportion to any real danger, but this insight is of no help at all when your worst fears come true.
The mechanisms underlying the specific phobia are interesting and vary widely. In some people the phobia is no more than a king-sized version of innate, ethically responsible fears that are necessary for adequate adaptation. Natural selection has allowed those animals to survive that were equipped from birth with the instinct to avoid dangerous situations. A baby chimpanzee will react with fear to even an image of a snake, even if it has never had contact with snakes in its life. A baby or small dog will avoid falling from a height even if they have never fallen from something before.
Our instincts help us fear those things that, by definition, posed the most danger to our ancestors in the world of the past million years. This explains why people are naturally much more afraid of animals, the dark, being alone, suffocation, drowning, heights and thunderstorms than they are of the more modern (now considerably more fatal) risks of fast cars, busy intersections, electrical sockets, firearms, unsafe sex and drugs . It also explains why animals that have adapted so perfectly to the dangers of the natural environment are so easy to kill. Our genes have not yet had time to keep up with the rapidly changing dangers of the modern world.
This type of innate phobia usually emerges early in childhood and persists throughout life. Although they do not have to be learned, fear can be heightened by actual experiences.
Phobias can also be learned through exposure to the painful consequences of a confrontation with a dangerous object or situation. What probably begins as adaptive avoidance intended to prevent further collisions of this kind is taken to the extreme, in an extreme and over-simplified generalization. Experiencing a car accident can lead to a complete withdrawal from public transport; an insignificant light bite from a German Shepherd puppy leads to frenzied fear for all dogs; and being stuck in a crowded elevator once leads to an enormous disgust for all confined spaces.
Some phobias develop through the less direct path of example. This is most often seen in children of parents who themselves suffer or have suffered from serious phobias. A twenty-five-year-old woman was so afraid of dogs that she didn’t want to live or even walk in residential areas for fear of ever encountering a stray dog. Although she had never touched any kind of animal in her life, she came to terms with her fear in a very logical way; her mother shuddered at the thought of ever even seeing a dog walking across the street.
Likewise, many people are afraid of water because their parents are so terrified of drowning. Phobias can also spread through the media. Many people with a morbid fear of flying have never been on an airplane or been in close relationship with a plane crash survivor. However, the vivid reports of plane crashes that appear widely in the newspapers and on television are enough to further reinforce an irrational fear of flying.
People who are not at risk can develop an AIDS phobia because of the well-intentioned warning messages that come to your ears all day long on the radio. Unpleasant exposure to what one is so terribly afraid of is usually only part of the story in the development of specific phobias. Not everyone who is bitten by a dog develops a dog phobia. Certain people are particularly prone to developing phobias, especially those who are very sensitive to stimuli and those who are naturally shy, inhibited, fearful and do not like to take risks.
The diagnostic manual divides the specific phobias into four different categories. The animal type includes phobias of dogs, cats, snakes, spiders, insects or rodents. The nature type includes phobias of thunder, storms, heights or water. These phobias, developed over the course of evolution, usually begin in childhood, are most likely ingrained and usually do not need to be triggered by a special traumatic experience.
The blood injection injury type is found in people who cannot see blood or are phobic about any medical or dental procedure. This phobia is a particularly remarkable phenomenon. Seeing blood, getting an injection or seeing an animal run to death can make you light-headed and even faint due to a sudden drop in pulse rate and blood pressure. This is the exact opposite of the increases in heart rate and blood pressure seen in all other types of phobias. As always, nature is devilishly clever. All the other phobias imitate a fight or flight response with activation of the cardiovascular system. Here we see an exaggeration of an opposite but equally tailored physiological response: a reduction in blood pressure, which reduces blood loss after an injury.
Most phobias of the situational type (not daring to drive, being alone or traveling on public transport) begin in early adulthood and are more likely to be a learned response to a real traumatic experience, such as a car accident or a crime involving violence. Other fairly common phobias include fear of vomiting, choking, or contracting a disease such as AIDS.
Diagnosis according to DSM IV:
- You feel an unreasonable and excessive fear of a certain object or situation.
- When exposed to the feared stimulus, you react immediately and predictably with great anxiety or a panic attack.
- You recognize that you are much more afraid of the object or situation than is justified.
- You do your best to avoid this stimulus – otherwise you simply endure the confrontation stiff with fear and dread.
- Your fear or avoidance of the object or situation significantly disrupts or limits your life.
