Defined as a persistent and irrational fear of a specific object, activity, or situation, a phobia results in a compelling desire to avoid the perceived hazard. The patient recognizes that his fear is out of proportion to any actual danger, but he can’t control it or explain it away. Three types of phobias exist: agoraphobia, the fear of being alone or of open space; social, the fear of embarrassing oneself in public; and specific, the fear of a single, specific object, such as animals or heights.
A social phobia typically begins in late childhood or early adolescence; a specific phobia usually begins in childhood. Most phobic patients have no family history of psychiatric illness, including phobias.
Agoraphobia and social phobia tend to be chronic, but new treatments are improving the prognosis. A specific phobia usually resolves spontaneously as the child matures.
A phobia develops when anxiety about an object or a situation compels the patient to avoid it. The precise cause of most phobias is unknown. Psychoanalytic theory holds that the phobia is actually repression and displacement of an internal conflict. Behavior theorists view phobia as a stimulus-response reflex, avoiding a situation or object that causes anxiety.
Ten percent of Americans suffer from a phobic disorder. In fact, phobias are the most common psychiatric disorders in women and the second most common in men. More men than women experience social phobias, whereas agoraphobia and specific phobias are more common in women.
The phobic patient typically reports signs of severe anxiety when confronted with the feared object or situation. A patient with agoraphobia, for example, may complain of dizziness, a sensation of falling, a feeling of unreality (depersonalization), loss of bladder or bowel control, vomiting, or cardiac distress when he leaves home or crosses a bridge. Similarly, a patient who fears flying may report that he begins to sweat, his heart pounds, and he feels panicky and short of breath when he’s on an airplane.
A patient who routinely avoids the object of his phobia may report a loss of self-esteem and feelings of weakness, cowardice, or ineffectiveness. If he hasn’t mastered the phobia, he may also exhibit signs of mild depression.
For characteristic findings in this condition, see Diagnosing phobias, pages 460 and 461.
The effectiveness of treatment depends on the severity of the patient’s phobia. Because phobic behavior may never be completely cured, the goal of treatment is to help the patient function effectively.
Antianxiety medications, tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors may help relieve symptoms in patients with agoraphobia or social phobias.
Systematic desensitization, a type of behavioral therapy, may be more effective than drugs, especially if it includes encouragement, instruction, and suggestion.
In some cities, phobia clinics and group therapy are available. People who have recovered from phobias can usually help other phobic patients.
❑ Provide for the patient’s safety and comfort, and monitor fluid and food intake, as needed. Certain phobias may inhibit food or fluid intake, disturb hygiene, and disrupt the patient’s ability to rest.
❑ No matter how illogical the patient’s phobia seems, avoid the urge to trivialize his fears. Remember that this behavior represents an essential coping mechanism.
❑ Ask the patient how he normally copes with the fear. When he’s able to face the fear, encourage him to verbalize and explore his personal strengths and resources with you.
❑ Don’t let the patient withdraw completely. If an agoraphobic patient is being treated as an outpatient, suggest small steps to overcome his fears such as planning a brief shopping trip with a supportive family member or friend.
❑ In social phobias, the patient fears criticism. Encourage him to interact with others and provide continuous support and positive reinforcement.
❑ Support participation in psychotherapy, including desensitization therapy. However, don’t force insight. Challenging the patient may aggravate his anxiety or lead to panic attacks.
❑ Teach the patient specific relaxation techniques, such as listening to music and meditating.
❑ Suggest ways to channel the patient’s energy and relieve stress (such as running and creative activities).
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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