What are phobias and how are they treated?

Phobias (or phobic anxiety disorders) differ from other disorders of the psychoemotional sphere in that their symptoms arise, and moreover, are provoked by certain circumstances.

In everyday life, a person tries with all their might to avoid factors that cause fear, but if in the future it is planned to face them, they experience the so-called "apprehension anxiety." But at the same time, the disease "responds" well to treatment.

Short information about phobias

Causes of phobia

The exact cause of phobias is not fully known. Many experts believe that such a mental disorder in an adult is a consequence of various severe childhood fears. Usually, by adolescence, they fade on their own, without the intervention of a psychotherapist, but in some cases they persist, sometimes taking on a bizarre shape. It is assumed that the cause of anxiety at an early age does not disappear as they grow older, but is "replaced" by another object.

Certain forms of pathology occur already in adulthood as a result of strong stress factors (for example, fear of horses after falling and being injured, etc.).

Phobic disorder of a social type (fear of public attention, criticism) develops with a special mindset and character. The disease manifests itself in adolescence (at the end of puberty), when guys and girls actively make new friends and attach great importance to how others perceive them.

Doctors do not exclude that the cause of the disease is also damage to the central nervous system - certain areas in the brain that "control" the development and maintenance of anxiety.

Phobia: symptoms, main forms of the disease

The clinical manifestations of the disease primarily depend on its type.

There are several types of phobias:

- Simple. The patient develops an uncontrollable and clearly inadequate fear at the sight of a certain object, animal (insect), before any situation (flight, rise to a height, change in weather, etc.). Because of the strongest sense of anxiety, a person diligently avoids such "irritants". Some live in almost constant stress, often limiting themselves (for example, in travel, tourism, entertainment), without consulting a specialist.

- Social phobias. A person is afraid of situations when other people are watching them because of fears of discussions behind their back, criticism, ridicule. They try to avoid public places (restaurants, cinemas, entertainment venues), eschews various meetings, conferences, lectures. This has an extremely negative effect on the patient's quality of life, since fear often pushes people to use alcohol and drugs.
- Agoraphobia. A patient suffering from this form of the disorder experiences great anxiety when they are out of the house, among the crowd, in places that they cannot quickly and independently leave. Agoraphobia is much more often accompanied by anxiety and depressive disorders, depersonalization.
- Hypochondriacal phobias is fear of an existing concomitant pathology or fear of possible diseases. As a rule, they are afraid of oncology, infections (tuberculosis, tick-borne encephalitis, viral diseases, etc.). The patient is constantly undergoing tests, examinations, goes to various specialists, but even a negative result relieves them of fear only for a short time. The patient is so focused on their health that a banal slight deterioration in well-being, which many simply do not notice, can cause a panic attack. They can develop hypertension and other disorders simply because of being so focused on the mildest symptoms and live in constant stress.

Typical signs of phobias

The most common manifestation of a severe illness is an anxiety attack, for which the following symptoms are typical:

- Heartbeat;
- Tightness, feeling of heaviness in the chest;
- Feeling of suffocation and lack of air;
- Sweating;
- Dizziness;
- Distinct fear of death or impending serious illness (heart attack or stroke, insanity, loss of consciousness, etc.);
- Numbness in the body;
- Convulsions (rarely).

Clinical manifestations increase rapidly; in general, an attack usually lasts about 30 minutes, less often - several hours.

According to the mechanism of manifestation, panic attacks are divided into:

- Spontaneous, developing unpredictably;
- Attributive, arising under the influence of certain circumstances or situations.

Without proper treatment, episodes of panic attack and fear can develop into a chronic disorder. At the same time, in the intervals between attacks, an anxious and restless mood remains - the patient subconsciously expects and experiences fear of certain objects all the time.

Treatment of fears and phobia

There is no universal method of how to get rid of fears and phobias. The tactics of therapy are selected individually, taking into account the severity of symptoms, the frequency of episodes of panic excesses. Not least is the extent to which the illness affects daily life.

Since even the most modern medicines can cause side reactions, in uncomplicated course of fears and phobias, it is preferred treat them with psychotherapy. Behavioral methods of psychological influence are widely practiced. For instance, it could be the exposure technique in which an alarming situation for the patient is artificially simulated and the patient is taught how to cope with panic attacks. This approach to treatment gives good results, including the correction of behavior avoidance of provocative circumstances.

In severe cases, especially if a person also suffers of a depressive disorder arisen on the basis of phobia and anxiety disorder, drug treatment is used along with psychotherapy.

Drug treatment for phobias includes:

- Antidepressants (for instance, Anafranil, a strict indication for their appointment is the presence of a depressive component in the picture of a phobia);
- Anxiolytics;
- MAO inhibitors.

With the right medication, panic episodes stop after 2–4 weeks. But the improvement in well-being is not a reason to stop treatment. The prescribed medications should be taken for another 6-12 months. During this period, the doctor monitors the patient's condition, and, depending on the dynamics of changes, determines how to treat the phobic disorder further. In the overwhelming majority of cases, it is possible to achieve a positive result and a stable remission.

Phobias in children

Almost all children experience fear and anxiety. It is normal to develop fear in extreme, life-threatening situations. But in some children, fears develop into phobic states: pathological fear of water, darkness, etc. may occur. Often, anxiety phobic disorders occur in adolescents. As a rule, these are social phobias. Children are afraid of disapproval or criticism from peers, teachers.

Phobic fears in children are different from ordinary ones. They are more intense and emotionally charged. Fear can arise not only at the moment when the child is confronted with its cause, it can be constantly present in the form of obsessive reflections on this topic. The child is afraid of the circumstances in which they may be afraid. They constantly think and talk about fears, avoid situations when they may face them. For example, a child can refuses to go outside, does not go to the water, refuses to travel, leaves the lights on, or never remains alone in a room.

Causes of phobias in children

The basis for the formation of phobias is the specific character traits of the child: increased sensitivity, vulnerability, suspiciousness. Such children tend to focus excessively on their experiences and reflect on the event for a long time. They are distinguished by their rich imagination and often have extraordinary creative abilities. For the prevention of panic attacks, it is important to consult a specialist when the child has just had fears. Children often hide their fears from adults, so it is important not to disregard behavioral features and increased anxiety.

Phobias can lead to neurotic conditions and panic disorders in adulthood. In children, phobias can develop into tics, frequent blinking, twitching. Phobias can disrupt sleep patterns and quality. The child cannot fall sleep for a long time, often wakes up at night. They have nightmares, the characters of which are objects of fear. In the morning, the child feels tired and is sleepy during the daytime.
Children with phobic disorders may develop somatic symptoms: abdominal pain, one-time loose stools, fever without respiratory manifestations. In such cases, we recommend contacting a pediatrician to exclude somatic pathology.

Diagnosis and treatment of childhood phobias

The first consultation is carried out by a psychiatrist to rule out more serious mental disorders. First, the doctor talks to the parents, then to the child. In some cases, the consultation takes place in a game format. Then, together with the psychotherapist, a correction plan is drawn up. Sometimes an examination by a neuropsychologist is required. It allows you to understand the characteristics of a child's development.

In some cases, drug therapy may be needed. Psychotherapy techniques aim to reduce the symptoms of pathological fear. With the help of psychotherapy, the child learns to respond correctly to the object of anxiety. In psychotherapy sessions, the patient masters the methods of relaxation and muscle tension relief. The child learns what are the options for resolving conflict situations. Biofeedback therapy is often recommended to children with phobias as a supplement or as an alternative to pharmacotherapy.

Recommendations for parents of an anxious child

Play more sports, attend developmental classes. During the day, it is important to distribute the intensity of the classes: developmental classes should alternate with sports sections with minimization of vigorous activity in the afternoon. Reading books, sculpting, drawing are well suited for the evening. Experts recommend swimming for anxious children, especially in the evening. Relaxing baths or contrast showers have a positive effect.

If the child is afraid of change, afraid of something new, for example, moving, changing kindergarten/school, it is necessary to prepare the child in advance. For example, if the child has to sleep separately from the parents, you can together choose toys that would be in the room so that the child is comfortable. If parents do not know how to prepare a child, they can always come to a psychotherapist and discuss any questions with a specialist.

Post by: John De Vries, clinical pshychiatrist, Amsterdam, Netherlands