HOME HEALTH CARE MANAGEMENT & PRACTICE / August 2004

Psychosocial Perspectives

Phobias
Marshelle Thobaben, RNC, MS, APMHNP, FNP

hobias are a type of anxiety disorder. Clients who are phobic experience a persistent irrational fear of an object or a situation, anxiety when they come into contact with it, and a strong desire to avoid it. Common phobias are listed in Table 1. The list is not inclusive, but it includes some of the more common phobias. The cause of phobias is still largely unknown. Clients usually do not seek treatment until their phobia interferes with their ability to function. With proper treatment, the vast majority of clients can completely overcome their fears and be symptom free. The phobic disorders in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.), Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) are categorized into three types: agoraphobia, specific phobia (formerly simple phobia), and social phobia.

bridge, and traveling in a bus, train, or automobile (American Psychiatric Association, 2000). Clients often restrict their travel or require the presence of a companion to go outside their homes, which interferes with their social or occupational functioning and causes marked distress (American Psychiatric Association, 2000). Clients experiencing agoraphobia, especially when it is accompanied by a panic disorder, are usually treated with selective serotonin reuptake inhibitors (SSRIs) and psychotherapy (Mayo Foundation for Medical Education & Research [MFMER], 2003). The prognosis is variable with those more severely impaired suffering from the disorder throughout their lives.

AGORAPHOBIA
Agoraphobia is anxiety about being alone or being in public places or situations from which escape might be difficult (or embarrassing) or help may not be available (American Psychiatric Association, 2000). Most people develop agoraphobia after first suffering from one or more spontaneous panic attacks that include feelings of intense, overwhelming terror accompanied by symptoms such as sweating, shortness of breath, or faintness. The attacks seem to occur randomly and without warning thereby making it impossible for clients to predict what situation will trigger such a reaction. They typically involve characteristic clusters of situations that include fear of being outside the home alone, being in a crowd or standing in a line, being on a

SPECIFIC PHOBIA (FORMERLY SIMPLE PHOBIA)

Specific phobias are common and affect approximately 10% of the U.S. population. For the specific phobias subtypes, refer to Table 2. Clients experiencing specific phobias have an intense fear of specific things that pose little or no actual danger (e.g., seeing blood, heights; American Psychiatric Association, 2000). They experience mild anxiety to panic when confronted with the prospect of facing a fearful situation. They feel their only recourse is one of avoidance. For example, a client may say, Im scared to death of blood, and I will never get my blood drawn again. The phobia may be incapacitating if the situation is frequently encountered and not easily avoided. It may
Key Words: phobia; anxiety; agoraphobia; social phobia

Home Health Care Management & Practice / August 2004 / Volume 16, Number 5, 414-416 DOI: 10.1177/1084822304264655 2004 Sage Publications

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TABLE 1 Names of Common Phobias Type Acrophobia Aquaphobia Claustrophobia Glassophobia Hemaphobia Hydrophobia Microphobia Pharmacophobia Zoophobia Description of Fear Heights Water Closed spaces Speaking in public or trying to speak Blood Water Germs Drugs Animals

TABLE 2 Diagnostic and Statistical Manual of Mental Disorders (4th ed.), Text Revision Specific Phobias Subtypes Specific Phobias Subtypes Animal Natural environment Blood-injection-injury Situational Other Examples Animals or insects Storms, heights, water Seeing blood, an injury, receiving an injection, invasive medical procedures Public transportation, tunnels, bridges, flying, enclosed places Fear of choking, vomiting, contracting an illness

cause minimal impairment if rarely encountered and easily avoided. Clients are generally responsive to psychotherapy and do not need to be treated with medications (MFMER, 2003).

SOURCE: Adapted from the American Psychiatric Association (2000).

SOCIAL PHOBIA
Social phobia is an overwhelming or persistent fear of social or performance situations in which individuals may be exposed to scrutiny by others or that may be humiliating or embarrassing (American Psychiatric Association, 2000, p. 456). The most common social phobia is a fear of public speaking. In addition to intense anxiety, social phobia often causes clients to experience physical symptoms such as blushing, profuse sweating, tremors, difficulty talking, gastrointestinal discomfort, and muscle tension. Even though clients recognize that their fear is excessive or unreasonable, they either avoid the fearful social situations or endure them with intense anxiety or distress. Social phobia is so disabling that it can interfere with clients normal routines, occupational functioning, or social activities and relationships. It is usually treated with antidepressants or beta blockers along with psychotherapy (MFMER, 2003).

TREATMENT
Research supported by the National Institute of Mental Health (NIMH) has indicated that psychotherapy and medications are the two most effective treatments available to help clients with phobias. Antidepressants, and sometimes benzodiazepines, are prescribed to help reduce the amount of anxiety that

phobic clients experience (NIMH, 2003). The most commonly used antidepressants are SSRIs, which include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft) (NIMH, 2003; U.S. Department of Health & Human Services, 2002). Benzodiazepines are cautiously prescribed because they can be addictive. They include lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), and chlordiazepoxide (Librium) (NIMH, 2003; U.S. Department of Health & Human Services, 2002). Psychotherapy used with phobic clients includes cognitive-behavioral therapy (CBT). A type of CBT called systematic desensitization or exposure therapy involves gradual exposure to a phobic object or situation aimed at decreasing the fear and increasing the ability to function in the presence of a phobic stimulus (NIMH, 2003; U.S. Department of Health & Human Services, 2002). Additionally, anxiety management training such as progressive muscle relaxation and autogenic relaxation (using imagery to relax) are relaxation techniques taught to clients to help reduce their anxiety (NIMH, 2003; U.S. Department of Health & Human Services, 2002). REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Mayo Foundation for Medical Education & Research. (2003). Phobias. Retrieved February 15, 2004, from www.mayoclinic.com/invoke.cfm?id= DS00272

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HOME HEALTH CARE MANAGEMENT & PRACTICE / August 2004 State University (HSU), Arcata, California. She has published more than 100 articles on psychosocial issues affecting client care and health professionals in leading nursing journals and textbooks. She has been nationally recognized for her work on elder abuse prevention and psychiatric home health nursing. She has been honored by HSU as a scholar of the year for her outstanding research.

National Institute of Mental Health. (2003). Facts about social phobia. Retrieved February 15, 2004, from www.nimh.nih.gov/anxiety/phobiafacts.cfm U.S. Department Of Health & Human Services, Office on Womens Health. (2002). Phobia. Retrieved February 15, 2004, from www.4woman.gov/faq/ phobia.htm

Marshelle Thobaben, RNC, MS, APMHNP, FNP, is the department chair of and a professor in the Department of Nursing, Humboldt