HOME HEALTH CARE MANAGEMENT & PRACTICE / August 2004

Psychosocial Perspectives

Phobias

Marshelle Thobaben, RNC, MS, APMHNP, FNP

Phobias are a type of anxiety disorder. Clientswho are phobic experience a persistent irratio-nal fear of an object or a situation, anxiety when

they come into contact with it, and a strong desire toavoid it. Common phobias are listed in Table 1. The listis not inclusive, but it includes some of the more com-mon phobias. The cause of phobias is still largelyunknown. Clients usually do not seek treatment untiltheir phobia interferes with their ability to function.With proper treatment, the vast majority of clients cancompletely overcome their fears and be symptom free.

The phobic disorders in the Diagnostic and Statisti-cal Manual of Mental Disorders (4th ed.), Text Revi-sion (DSM-IV-TR; American Psychiatric Association,2000) are categorized into three types: agoraphobia,specific phobia (formerly simple phobia), and socialphobia.

AGORAPHOBIA

Agoraphobia is anxiety about being alone or beingin public places or situations from which escape mightbe difficult (or embarrassing) or help may not be avail-able (American Psychiatric Association, 2000). Mostpeople develop agoraphobia after first suffering fromone or more spontaneous panic attacks that includefeelings of intense, overwhelming terror accompaniedby symptoms such as sweating, shortness of breath, orfaintness. The attacks seem to occur randomly andwithout warning thereby making it impossible for cli-ents to predict what situation will trigger such a reac-tion. They typically involve characteristic clusters ofsituations that include fear of being outside the homealone, being in a crowd or standing in a line, being on a

bridge, and traveling in a bus, train, or automobile(American Psychiatric Association, 2000). Clientsoften restrict their travel or require the presence of acompanion to go outside their homes, which interfereswith their social or occupational functioning andcauses marked distress (American Psychiatric Associa-tion, 2000).

Clients experiencing agoraphobia, especially whenit is accompanied by a panic disorder, are usuallytreated with selective serotonin reuptake inhibitors(SSRIs) and psychotherapy (Mayo Foundation forMedical Education & Research [MFMER], 2003). Theprognosis is variable with those more severely im-paired suffering from the disorder throughout theirlives.

SPECIFIC PHOBIA(FORMERLY SIMPLE PHOBIA)

Specific phobias are common and affect approxi-mately 10% of the U.S. population. For the specificphobias subtypes, refer to Table 2. Clients experienc-ing specific phobias have an intense fear of specificthings that pose little or no actual danger (e.g., seeingblood, heights; American Psychiatric Association,2000). They experience mild anxiety to panic whenconfronted with the prospect of facing a fearful situa-tion. They feel their only recourse is one of avoidance.For example, a client may say, “I’m scared to death ofblood, and I will never get my blood drawn again.” Thephobia may be incapacitating if the situation is fre-quently encountered and not easily avoided. It may

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

Key Words: phobia; anxiety; agoraphobia; social phobia

cause minimal impairment if rarely encountered andeasily avoided. Clients are generally responsive to psy-chotherapy and do not need to be treated with medica-tions (MFMER, 2003).

SOCIAL PHOBIA

Social phobia is an overwhelming or persistent fearof social or performance situations in which individ-uals may be exposed to scrutiny by others or that maybe humiliating or embarrassing (American PsychiatricAssociation, 2000, p. 456). The most common socialphobia is a fear of public speaking.

In addition to intense anxiety, social phobia oftencauses clients to experience physical symptoms such asblushing, profuse sweating, tremors, difficulty talking,gastrointestinal discomfort, and muscle tension. Eventhough clients recognize that their fear is excessive orunreasonable, they either avoid the fearful social situa-tions or endure them with intense anxiety or distress.Social phobia is so disabling that it can interfere withclients’ normal routines, occupational functioning, orsocial activities and relationships. It is usually treatedwith antidepressants or beta blockers along withpsychotherapy (MFMER, 2003).

TREATMENT

Research supported by the National Institute ofMental Health (NIMH) has indicated that psychother-apy and medications are the two most effective treat-ments available to help clients with phobias. Antide-pressants, and sometimes benzodiazepines, areprescribed to help reduce the amount of anxiety that

phobic clients experience (NIMH, 2003). The mostcommonly used antidepressants are SSRIs, whichinclude citalopram (Celexa), escitalopram (Lexapro),fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine(Paxil), and sertraline (Zoloft) (NIMH, 2003; U.S. De-partment of Health & Human Services, 2002). Ben-zodiazepines are cautiously prescribed because theycan be addictive. They include lorazepam (Ativan),diazepam (Valium), alprazolam (Xanax), and chlordi-azepoxide (Librium) (NIMH, 2003; U.S. Departmentof Health & Human Services, 2002).

Psychotherapy used with phobic clients includescognitive-behavioral therapy (CBT). A type of CBTcalled systematic desensitization or exposure therapyinvolves gradual exposure to a phobic object or situa-tion aimed at decreasing the fear and increasing theability to function in the presence of a phobic stimulus(NIMH, 2003; U.S. Department of Health & HumanServices, 2002). Additionally, anxiety managementtraining such as progressive muscle relaxation andautogenic relaxation (using imagery to relax) are relax-ation techniques taught to clients to help reduce theiranxiety (NIMH, 2003; U.S. Department of Health &Human Services, 2002).

REFERENCESAmerican Psychiatric Association. (2000). Diagnostic and statistical man-ual 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

Thobaben / PSYCHOSOCIAL PERSPECTIVES 415

TABLE 1Names of Common Phobias

Type Description of Fear

Acrophobia HeightsAquaphobia WaterClaustrophobia Closed spacesGlassophobia Speaking in public or trying to speakHemaphobia BloodHydrophobia WaterMicrophobia GermsPharmacophobia DrugsZoophobia Animals

TABLE 2Diagnostic and Statistical Manual of Mental Disorders

(4th ed.), Text Revision Specific Phobias Subtypes

Specific Phobias Subtypes Examples

Animal Animals or insectsNatural environment Storms, heights, waterBlood-injection-injury Seeing blood, an injury,

receiving an injection,invasive medical procedures

Situational Public transportation, tunnels,bridges, flying, enclosedplaces

Other Fear of choking, vomiting,contracting an illness

SOURCE: Adapted from the American Psychiatric Associa-tion (2000).

National Institute of Mental Health. (2003). Facts about social phobia. Re-trieved February 15, 2004, from www.nimh.nih.gov/anxiety/phobiafacts.cfm

U.S. Department Of Health & Human Services, Office on Women’s Health.(2002). Phobia. Retrieved February 15, 2004, from www.4woman.gov/faq/phobia.htm

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

State University (HSU), Arcata, California. She has published morethan 100 articles on psychosocial issues affecting client care andhealth professionals in leading nursing journals and textbooks. Shehas been nationally recognized for her work on elder abuse preven-tion and psychiatric home health nursing. She has been honored byHSU as a scholar of the year for her outstanding research.

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