Impact of Phobias

Abstract
Phobias are a kind of anxiety disorder that can make an individual to experience extreme irrational fear regarding a situation, object, or living creature. Phobias should not be confused with normal fears since phobias are linked to a particular situation or object and they are persistent for 6 or more months. In this paper, we will describe what a phobia is and offer the differentiation of phobias from normal fear. We will then provide the diagnosis criteria for phobias as indicated in the DSM-5 manual. The 4Ds will be analyzed as they relate to phobia and the models of abnormality will be discussed. Treatment, history, culture, and prognosis will form the later part of the paper.
Description
According to Sutherland, Middleton, Ornstein, Lawson, and Vickers (2016) a phobia is defined as a type of anxiety disorder that makes an individual experience extreme irrational fear about a living creature, situation, place, or object. Phobias are more pronounced than fears and they will develop when an individual has an exaggerated or unrealistic sense of danger regarding a situation or object. An individual who experiences a phobia will often shape his or her life to avoid what they consider to be dangerous. According to the individual, the imagined threat is far greater than any actual threat that is posed by their cause of terror. In certain situations, a phobia can result in a restriction on the day-to-day life of the individual (Halldorsdottir & Ollendick, 2016). When faced with the source of their phobia, an individual will experience intense distress and this can prevent them from functioning normally. Sometimes a phobia can lead to panic attacks. It is estimated that in the United States about 17 million people have phobias. A phobia is more serious than a simple fear sensation. While most people are aware that their phobia is irrational most of them are not able to control the fear reaction they experience when faced by their phobia. The mere thought of the phobia is enough to prompt the individual to become anxious or panicky, which is referred to as anticipatory anxiety.
The worst part about phobias is that even when the situation does not regularly happen in the individual's life, they may find that they spend a considerable amount of time worrying about it appearing or trying to figure out how to avoid it. The American Psychology Association (APA) has recognized three types of phobias namely specific phobia, social phobia or social anxiety, and agoraphobia. Specific phobia is an intense irrational fear for a particular trigger. Specific phobia is referred to as simple phobias since they can be linked to a cause that is identifiable and might not occur frequently in the individual's everyday life like fear of snakes. Social phobia is the profound fear of public humiliation and being judged or being singled out by others in a social situation. An individual with social phobia will be terrified about the idea for a large social gathering. This should not be confused with shyness. Agoraphobia is the fear of situations that would be difficult for an individual to escape if they were to experience extreme panic like being in a lift. In most cases, people commonly misunderstand it as fear of open spaces but it can also apply for fear of being confined in a small space such as being in a lift or public transport. People who have agoraphobia have an increased risk of suffering a panic disorder. Social anxiety and agoraphobia are referred to as complex phobias since their triggers are not easily recognizable. People who suffer from complex phobias find it hard to avoid the triggers.
DSM-5 Application
The DSM-5 diagnostic criteria for phobias are:
· Having a marked fear about a specific object or situation.
· The phobic situation or object almost always provokes immediate fear.
· The phobic situation is avoided or endured with intense fear.
· The fear one experiences are out of proportion to the actual danger posed by the specific situation.
· The anxiety, fear, or avoidance is persistent and typically lasts 6 months or more.
· The anxiety, fear, or avoidance causes clinically significant distress or impairment in occupational, social, or other vital areas of functioning.
· The disturbance cannot be better explained by symptoms of another mental disorder.
The DSM-5 is used to diagnose psychiatric illnesses. To properly use the DSM-5 manual one should be well trained in how to use the manual to ensure that they offer their clients an adequate diagnosis. When making a diagnosis the clinician should ensure that they respect the client. Clinicians are supposed to be nonjudgmental in their diagnosis and using the DSM-5 manual can result in the clinician being judgmental (Sutherland et al., 2016). The diagnoses given by the manual seem to be judgmental since the clinician should indicate that a client has a certain ailment. However, under the principle of beneficence, the clinician can be termed as doing good and not be seen to be violating the respect of the client. Providing a diagnosis offers the client an opportunity to get appropriate and effective intervention. In order to make proper use of the manual, the clinician should be well trained and have the requisite minimum qualifications before they use the manual. This will ensure that one does maintain the ethics of their work and diagnosis. The issue arises in that many professionals are not aware that they need to be trained before they can make use of the manual.
Clients need to be involved in the diagnosis process. In most cases when a client is merely given the diagnosis, they are disempowered. This can be avoided by working with the client when conducting the diagnosis. The clinician should educate the client on the diagnostic process, which will allow the client to be a more equal partner in determining the conditions they may be experiencing. Ideally, the clinician will be offering the client information regarding a particular condition, which will include the indicators of the condition and the tools that can be used to assist in determining if the client has the condition (Halldorsdottir & Ollendick, 2016). The two should then work together to determine the condition. In some cases, the client will deny the diagnosis and it is vital that the clinician explores why the client thinks they might not have the condition. There might be cultural issues that are preventing the client from accepting the diagnosis. Therefore, the clinician will have to seek ways to offer treatment while respecting the cultural requirements of the client.
For diagnosis of phobia, the clinician should be able to determine that the phobia is the underlying cause of the issue and not related to another condition. Without proper training, the clinician would not be able to offer the proper diagnosis and he or she might end up diagnosis the client and offering treatment for the wrong condition. Culture does play a significant role in client diagnosis. As has been pointed out being discovered that one has a phobia might be taken wrongly by the client's community or culture. This could result in additional issues for the client. Most people would be unwilling to accept they have a mental problem if they come from a culture that discriminates or looks down on such people. Therefore, even with the proper diagnosis, the clinician should be able to read the non-verbal cues that are raised by the client.
4 Ds - Distress, Deviance, Dysfunction, and Danger
Distress refers to the negative feelings that are experienced by the individual with the phobia. A person might feel deeply troubled and affected by the phobia and this might be affecting their normal functioning (Leitenberg, Agras, Barlow, & Oliveau, 1969). When compared to others, when a person has an irrational fear of something or a situation and this is bringing them too many negative feelings then we can say they are distressed. Phobias create an irrationally negative reaction for the individual and this makes it hard for them to face the phobia. For normal people, there is a tendency to also have fear of something, but this fear does not result in complete avoidance or it does not limit the individual's functioning. However, for a phobia, the individual will be overly troubled and this will result in them being overly stressed about a situation.
Deviance is in reference to the thought, emotions, and behaviors that are unacceptable or uncommon in society. This should not be misconstrued to mean that minority groups are deemed deviant because they have nothing in common with other groups. Phobias can be categorized as deviant in that it is not common for a person to be afraid of a situation that will not cause them the harm they perceive. The fear and anxiety experienced by the individual regarding the situation or object are what is abnormal and this deviates from other people or the group. For instance, the fear of cats can be considered to be a phobia considering that most people love cats and consider them to be gentle animals. A phobia is deviant because it is unacceptable in the culture that one belongs to.
Dysfunction refers to the extent that the phobia has impacted the individual and makes it hard for them to perform normal daily activities like driving a car or getting ready for work (Campos et al., 2018). The phobia has to be problematic enough for it to be considered a diagnosis. The individual might have learned coping mechanisms and they have managed to avoid certain situations and objects. Therefore, it is vital that the clinician is observant enough to determine if there is the avoidance of any sort. A phobia is likely to cause a person to withdraw from certain activities or even withdraw from a group. This would be termed as a dysfunction since the individual is going against the norm and leaving groups due to their irrational fears.
Danger involved dangerous behavior that is directed to the individual or others. In terms of phobia, danger comes about when the individual refuses to acknowledge that they have an irrational fear of a situation or object and this forces them to avoid certain situations or areas. This can result in starvation especially if the person has a phobia for certain vital areas or phobia for leaving the house. The fear of germs can lead one to overly clean their body and this will result in the removal of the protective layer of their skin. This will limit their barrier to environmental influences causing them harm. Therefore, there is a danger to self in this situation as the individual is unaware of the consequences of their over scrubbing.
Models of Abnormality That Explain the Etiology
Behavioral and cognitive models of abnormality are the two models that explain the etiology of phobias. The behavioral model assumes that all behavior is learned be it good or bad behavior. Learning occurs by the individual's interaction with their environment (Sheerin, Kozak, Hale, Ramesh, & Spates, 2016). Therefore, when it comes to phobias one is not born with phobia but rather, they learn to fear the situation or object that causes the phobia. The abnormal behavior becomes a psychological condition that the individual has learned in response to a particular set of environmental stimuli. In most cases, the fear will stem from a negative incident a person either experienced or they witnessed. For example, a person might have a phobia for dogs and their response is fear due to the experience they had of a dog almost biting them or being chased by a dog. The good this about this model is that it indicates that whatever has been learned can be unlearned. It is believed that it is possible to modify the environmental conditions to treat the psychological condition effectively (Rardin, 1969). Behaviorists believe that no matter the phobia that a person has experienced it is possible for the individual to overcome the phobia (Probst et al., 2019). This is because the individual has learnt to always associate a certain situation or object with a negative aspect.
The cognitive model of abnormality assumes that a person's thoughts are responsible for their behavior. This means that the phobia a person has is due to the thought they have regarding the situation or object. This model indicates that it is not the experiences one has had that lead them to have the phobia. It is the thoughts they hold about those experiences that determine their behavior. With faulty or irrational thought a person is not able to function normally and this will cause problems in their life. The deeply held thoughts determine how a person reacts to life situations. These thoughts will prevent the individual from overcoming their fears and the phobia will persist. Having unhealthy cognitions about a situation like being in an elevator is the leading cause of elevator phobia (Leitenberg et al., 1969). While the individual might not have been in a situation where they got stuck in an elevator you find that a person has a genuine fear of being stuck in an elevator. This phobia is based on the individual's own thoughts and since they have been continuously replaying these thoughts over and over, they have formulated a real phobia based only on their thoughts.
The cognitive model best explains the etiology of phobia. This is because most phobias stem from the thoughts and learnings that individuals have had in their lives. The fear of animals comes from thoughts that have been ingrained in individuals regarding how dangerous animals are. Campos et al. (2018) posit that in most cases, people will have a phobia of snakes and this comes from the thoughts they hold on how dangerous and poisonous snakes are. The person might not have experienced a snake attack in their lives and they have an abnormal fear of snakes. The fear might cause the individual to avoid walking or going to areas where they believe snakes can be found especially forests or jungles.
Treatments
For most people who have a phobia treatment is not necessary. All they have to do is to avoid the object or situation that causes their irrational fear in order to control their problem. Most people who have phobias are always aware of their disorder and this does assist in diagnosis. In extreme cases, it might not always be possible to avoid certain phobias like fear of flying (Rardin, 1969). In such a case, the individual will have to undergo professional treatment. Phobias are curable but there is no single treatment that is guaranteed to work for all phobias. A combination of treatments is recommended for most individuals. The main forms of treatment are medication and psychotherapy. Cognitive-behavioral therapy (CBT) is a type of counseling that can assist an individual to manage their problems by altering the individual's thoughts and behavior (Goetter et al., 2018). CBT teaches the individual different ways of understanding and reacting to their phobia or source of the phobia. This will make coping much easier. The aim of CBT is to teach the individual how to control their thoughts and feelings (Hirsch, 2018). The irrational thoughts that one holds are the reason why the individual is having the phobia in the first place. Therefore, there is a need to alter these irrational thoughts and train the individual to have different rational thoughts in place of the negative ones. With this strategy, the individual will learn how to cope with their phobia and with time they will overcome their irrational thoughts. Another strategy used in CBT is to gradually expose the individual to their phobia. This is aimed at assisting the individual to feel less anxious about their phobia. This is referred to as exposure or desensitization therapy. Exposure therapy is effective in that it gradually increases the individual's level of exposure to their phobia. This allows the individual to gain control over their fear. As one continues with treatment, they will find they begin to feel less anxious about their fear.
Medication is mostly prescribed on a short-term basis because it is not usually recommended for treating phobias. The aim of the medication is to treat the effects of phobia like anxiety. The medications used are Beta-blockers, antidepressants, and tranquilizers (Erceg-Hurn & McEvoy, 2018). Beta-blockers can assist to reduce the physical signs of anxiety. Antidepressants like serotonin reuptake inhibitors are prescribed to people with phobias to affect their serotonin levels in the brain and this leads to better moods. Tranquilizers assist in reducing anxiety symptoms.
The most effective treatment method is CBT. This method allows the individual to overcome their fear in a controlled manner and directed by a psychiatrist. CBT teaches the individual new thoughts and coping mechanisms that allow the individual to reduce their anxiety when faced with their phobia. This treatment methodology is effective and leads to long-lasting results and cases of remission are few (Carleton et al., 2014). Using the exposure therapy, the individual is able to face their fear in a controlled environment guided by a professional. This will give the individual an opportunity to gradually overcome their fear and with time they will no longer hold the negative thoughts they had in the past.
Historical and Cultural Contexts
Historically phobias were not considered to be an illness but rather phobias were bundled under other diagnoses. When a person had some bizarre behavior, no one considered referring them to a physician. They were placed under the jurisdiction of the clergy or judiciary. Phobias were not well defined and people did not understand them as we currently do. This made it hard for people to explain or even fathom the idea of someone fearing something that others do not consider frightening. While people experienced irrational fear, it was assumed that the phobia stemmed from something else. Mental illness was still in its infancy and not many physicians had properly understood how to treat mental patients. Therefore, the people were left to themselves to attempt to find cures and remedies for their phobias. Coping was the norm and others would make fun of those who had irrational fears. It was common for someone to play pranks on a person who had a certain fear. The usage of the term phobia was coined and attempts were made to link the conditions. However, it was not possible to correctly distinguish between the different kinds of phobia as we do today. Most physicians found it strange that a person will have symptoms associated with mental illness and only for a short time or a specific situation. Their understanding was limited due to a lack of or enough information and research on the condition.
Culture plays a vital role in developing phobias. It has been proven that a young child can be taught to fear a white rabbit or any fury white animal. This fear will be demonstrated in terms of phobia by the child. If certain things or objects are feared by a community it is likely that all members of the community will have the same irrational fear. For example, in the early 20th century, the disease polio had been seen by many Americans as one that can lead to paralysis and this resulted in most of them having an irrational fear of the disease. Even after being immunized people still held on to the fear. In certain cultures, people will have a combined fear of something and the children born of these communities will also internalize the same fear. Based on the example we used of a child being taught or conditioned to fear certain objects it is the same with the community. Culture influences beliefs that are held by an individual and it can have a devastating impact on what a person fears (Carleton et al., 2014). While it might be natural and rational to have a certain fear while being within the group, when one leaves the group and expresses the same phobia, people will be judgmental and recognize the irrational behavior.
Prognosis
It has been shown that most phobias will develop in late childhood and they might continue through adult life. If the individual does not seek treatment then they will continue to have the phobia. In cases where the phobic stimulus is easy to avoid most people will live their entire life avoiding the situation or object (Hirsch, 2018; Samson, Proyer, Ceschi, Pedrini, & Ruch, 2011). However, if the phobia is not easy to avoid, then the individual is likely to seek professional assistance to resolve the phobia. The prognosis with therapy has been found to be quite excellent for most types of phobias. The poor outcomes of therapy are mostly associated with poor compliance, understanding, or poor compliance or treatment procedures. There have been cases where interpersonal factors have interfered with treatment results. When there is a presence of more than one specific phobia it is associated with early age onset. Children and adolescents who have more than one type of phobic stimulus have been found to have higher rates of psychiatric comorbidity.
Specific phobias that develop during childhood generally attenuate over time but some might persist into adulthood. On the other hand, specific phobias that manifest in adolescents and adults will persist and only about 21% of these cases will resolve without intervention. It is possible to extinguish a fear using natural environmental contingencies. This means that the individual does not undergo any treatment and they manage to eliminate their fear with time. While this is one of the rare cases, there are situations that might force one to face their fear and this might assist to resolve the phobia. An individual with a specific phobia that one is not able to avoid will be forced to seek professional assistance. This is the only way the individual will be able to lead a normal life. Learning to eliminate the irrational thoughts and behavior is vital if one is to lead a normal and fruitful life.
Complex phobias have the same prognosis as specific phobias. However, it has been noted by Samson et al. (2011) that some complex phobias like agoraphobia have a less promising prognosis. The condition is most resistant to behavioral therapy and psychotherapy. This means that a person can undergo treatment and still continue having the same phobia. While the cases are few, the instances where treatment has failed have been noted and one should be prepared for a negative outcome. Patients suffering from a phobia are also at an increased risk of future anxiety disorders. There are some phobias that will get better with age and others will get worse with age. A phobia like the fear of heights will get worse with age. There are numerous reasons that lead to an increase in the phobia like having defendants who would suffer if one is no longer there for them.
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