Phobias and what can be done about them

By Candace Murphy
Knight Ridder Newspapers

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Garden-variety fears are one thing. Phobias are another.

Let's say Dorothy was in Oz today, trying to get back to Kansas. If she had a phobia, she might not have gone more than a few steps down the Yellow Brick Road for fear of encountering a bridge. That hot-air balloon? Forget it. Of course, she might never have gone on her fantasy journey in the first place if she'd had agoraphobia, a fear of crowded public places.

Phobias, the most extreme manifestations of fear, come in three varieties: agoraphobia (irrational anxiety about being in a place where escape is difficult or embarrassing); social phobia (irrational anxiety about performing or being in social situations); and specific phobias (spiders, germs, clowns — anxiety provoked by a specific object).

"Many people have fears, but not necessarily phobias. So the question is, is it a phobia? Or is it just a personal distaste?" says Hildy Agustin, a clinical psychologist in California.

To be a phobia, a fear must interfere with daily routine, occupation or social life. If it does, it should be identified and treated.

Facts, figures, resources • The National Institute of Mental Health estimates that 5.1 percent to 12.5 percent of Americans suffer from phobias. • Phobias are estimated to be the most common psychiatric illness among women of any age, and the second-most common among men over age 25. • Phobia warning signs: The anxiety from a fear begins to interfere with daily life (interrupts sleep patterns, causes physical symptoms, interferes with work, social or general daily activity). • Cognitive behavioral therapy, overseen by a professional therapist, is the most successful method of treatment. • Medications and antianxiety drugs are not successful in curing phobias, though they can get sufferers to a point where they may start behavioral work. • Alternative therapies include meditation and aromatherapy. Therapists say sufferers whose treatment is unsupervised should find activities that relieve anxiety and introduce calm, such as meditation, listening to calming music or smelling scents that invoke a feeling of peace. • Informational site: American Psychological Association (www.apa.org)

"Phobias aren't like a common cold," says California psychologist Barbara Kirsch. "They get worse. You don't eventually get rid of them on your own."

Before treatment, though, what is most important is to identify the phobia. Here is a sampling:

• Cynophobia — Fear of dogs. "A simplistic way of describing many phobias is something that has happened to you," says Kirsch. "You see a dog, the dog bites you, you cultivate a fear of dogs."

Key to conquering cynophobia? "Unlearn what you've learned," says Kirsch. And in the meantime, give a wide berth to unleashed dogs that make you uncomfortable.

• Aviophobia — Fear of flying. Like it or not, it's tough to live a modern life and not fly. At the Fear of Flying Clinic in San Mateo, Calif., (www.fofc.com), flying pros provide information about flying, airports and safety features. After that, behavioral therapist Paula Zimmerman steps in to help the still-fearful.

"No one is saying you shouldn't have fears, but maybe the fears are displaced," Zimmerman says. "Now that you know what planes and flying are all about, you should ... start to feel differently because you are thinking differently."

• Mysophobia — Fear of germs or dirt. Health-discussion forums teem with mysophobes' recommendations for using public bathrooms. (Turn on water. Rinse and soap hands. With water still running, press towel dispenser lever to release paper. Wash again as lever may have been dirty. Tear paper off and dry hands. Use same paper as protective shield to turn water off. Use paper again to open door to restroom. Lather sanitizer gel on hands.)

• Arachnophobia — Fear of spiders. A classic phobia. Many sufferers, though, misdiagnose their fear as a phobia simply because they'd rather have someone else kill the offending stimulus. Still, it can help to identify and work with this fear.

• Agoraphobia — Generally interpreted as a fear of public, crowded spaces (and a fear of being unable to escape the situation), this is "the most common and the most debilitating phobia," says Karen Elpers, a certified hypnotherapist in the Bay Area. "It can actually cripple someone, and really affect their life."

Help from a professional is almost always a must. After all, it's difficult to have a life if you're afraid to take a step outside.

• Claustrophobia — Like agoraphobia, claustrophobia stems from a fear of being unable to escape, only in this case from a confining space. In treatment, therapists often point to Harry Houdini, who made a living out of escaping from a variety of nightmarish claustrophobic situations. Houdini was a claustrophobe. It was situations that he couldn't control that caused the phobia. Seems magic was his cathartic outlet.

• Gephyrophobia — Fear of bridges. In the San Francisco Bay Area, this fear spiked after the Loma Prieta earthquake of 1989.

"If you saw [a section of] the Bay Bridge collapse, that's a clear example of how a phobia might develop," says Agustin. "The bridge becomes connected to a fear response."

Others suffer from gephyrophobia without firsthand experience, though, and it's something that therapists have difficulty explaining except to say that a bridge puts one in a vulnerable position.

• Hobophobia — Fear of bums or beggars. This phobia has gotten worse as cities have grown, while jobs and housing have shriveled. Therapists point out that though it may be politically incorrect, this is a phobia that can largely be avoided — just skirt areas where panhandlers hang out.

• Coulrophobia — Fear of clowns. Possibly the most maligned phobia. But therapists say it's no surprise — clowns can be downright scary.

"That bright makeup ... the clothes ... it can be terrifying for small children," Agustin says. "I could see that fear blossoming into a phobia."

Therapists urge parents to explain to their children before encountering a clown what the entertainer is all about.

• Fear of terrorists. "During certain periods the world goes through, there's an increase in specific fears," Elpers says. "Like now ... there is a fear of terrorists, but it doesn't have a name. Within the year, they'll have a name for that."

Copyright © 2004 The Seattle Times Company