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Fear, Anxiety, and Phobias

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Fear

Fear (or fright) is a normal emotional reaction to a threat or a potential danger that may involve our mind or body. Sense of fear is a built in mechanism to respond and react to a situation that might pose a physical, psychological or emotional threat of injury. The response or reaction may be an immediate one or it may prepare you to deal with it in a timely and appropriate manner. It is normal to feel some degree of worry or uneasiness about certain unforeseen situations, anything beyond this triggers a fight or flight reaction preparing the body mentally and physically to fight off the danger. This reaction is manifested in the form of increase in the heart rate, increase in blood pressure, sweating, increase in respiration, tremor of hands, shaking of legs and knees etc. Once the danger is eliminated, fear goes away and the body functions gradually return to normal.

There are different types of fear:

  • Fear may be a reaction (like a startle reaction) to a brief moment when you are confronted with something unknown or unfamiliar that you did not expect.
  • Sense of fear can be a thrilling and exciting experience like a ride on a roller-coaster or bungee jumping.
  • There may be fear of embarassment, rejection or failing (social fears)
  • There may be fear of heights, animals (like dogs, snakes), insects (personal fears)
  • Fear of public speaking (stage fright)
  • Fear of war or violence (global fears).

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Anxiety

Anxiety is very similar to fear but with one very important difference. The feeling of anxiety may result from the anticipation of future danger although nothing bad could be happening there and then. Anxiety can be mild or intense, depending on the person's perception, past experiences and body's inbuilt responses to stressful and frightening situations. Some degree of anxiety may actually be positive as it motivates us to keep on top of things and perform to the best of our ability. Anxiety also helps the body to prime for a more intense and taxing situation.

What are anxiety disorders? Are they common?

Everybody knows what it's like to feel anxious - the butterflies in your stomach before a first date, the tension you feel when your boss is angry, the way your heart pounds if you're in danger. Anxiety isn't always a bad thing. It can help you cope with life's everyday stress. It makes you study harder for that exam, keeps you on your toes when you're making a speech, and helps you stay focused when looking for a job or asking for a raise.

But if you have an anxiety disorder, this normally helpful emotion can do just the opposite. It can keep you from coping and can disrupt your daily life. Anxiety disorders aren't just a case of "nerves." They are serious illnesses that can grow worse when not treated. They are thought to be related to the biological makeup and life experiences of a person, and often run in families. Every year, more than 19 million American adults suffer from anxiety disorders. There are treatments for these disorders that can help people lead full and healthy lives. And, research is being done to find new ways to help people with anxiety disorders.

What are the different types of anxiety disorders and what are their symptoms?

There are five types of anxiety disorders, each with different symptoms. They include:

  • Generalized anxiety disorder (GAD) - constant and exaggerated (more than normal) worry and tension about everyday life events and decisions that lasts for at least six months. A person fears the worst, even though there may be little reason to expect so. Physical symptoms can also happen, such as fatigue, trembling, muscle tension, headache, or nausea.

  • Obsessive-compulsive disorder (OCD) - repeated, unwanted thoughts (obsessions) or ritual behaviors (compulsions) that a person feels they can't control or stop. A person can sometimes feel an urgent need to perform a ritual behavior, such as always washing hands three times because three is a "good luck" number and one isn't.

  • Panic disorder - feelings of extreme fear and dread that strike with no warning and for no reason. These feelings can happen over and over again. A person can have physical symptoms, such as chest pain, heart palpitations (heart beating fast or skipping beats), shortness of breath, dizziness, stomach problems, feeling disoriented or not "real," and have a fear of dying.

  • Phobias - includes social phobia, an extreme fear of being embarrassed, judged, or made fun of in social or work situations and specific phobia, an extreme fear of an object or situation that poses little or no danger. People with phobias often avoid certain situations (like public speaking or parties) or objects (like elevators). Phobias can affect a person's career, relationships, and daily life activities.

  • Post-traumatic stress disorder (PTSD) - involves how a person reacts to a very frightening or stressful event, such as being tortured or put in a prison camp during a war, seeing another person being hurt or killed, or raped. With PTSD, a person can keep re-living the event with nightmares and flashbacks. They can feel numb, depressed, angry, irritable, and jumpy. Family members of victims can also develop PTSD.

How are anxiety disorders treated?

Anxiety disorders are among the most common of all the mental disorders. Many people misunderstand these disorders and think people should be able to overcome the symptoms by sheer willpower. But, the symptoms can't be willed or wished away. There are treatments, developed through research, that work well for these disorders.

Anxiety disorders are treated in two ways - with medication and with certain types of psychotherapy (sometimes called "talk therapy"). Sometimes only one treatment is used or both treatments are combined. If you have an anxiety disorder, talk with your doctor about what will work best for you. If you do choose psychotherapy, make sure the therapist is able to provide you with medication, if needed.

A number of drugs used for treating depression, called antidepressants, have been found to help with anxiety disorders as well. Monoamine oxidase inhibitors (MAOIs) are used, along with the newer selective serotonin reuptake inhibitors (SSRIs). Other medicines include anti-anxiety drugs called benzodiazepines and beta-blockers.

Treatment with psychotherapy includes cognitive-behavioral therapy (CBT) and behavioral therapy. In CBT, the goal is to change how a person thinks about, and then reacts to, a situation that makes them anxious or fearful. In behavioral therapy, the focus is on changing how a person reacts to a situation. CBT or behavioral therapy most often lasts for 12 weeks. It can be group or individual therapy. Some studies have shown that the benefits of CBT or behavioral therapy last longer than do those of medications for people with panic disorder, OCD, PTSD, and social phobia.

Keep in mind that it can be a challenge to find the right treatment for an anxiety disorder. But, if one treatment doesn't work, the odds are good that another one will. Your doctor and therapist will work together to help you find the best approach. New treatments are being developed through ongoing research. So, don't give up hope. If you have recovered from an anxiety disorder and it comes back at a later date, don't think that you've failed. You can be treated again. And, the skills you learned dealing with the disorder the first time can help you in coping with it again.

What should I do if I think I may have an anxiety disorder?

If you think you may have symptoms of anxiety, a visit to your doctor is the best place to start. Your doctor will perform a careful exam to figure out whether your symptoms are really due to an anxiety disorder, which disorder you have, and if there are any other problems present. Be aware that all anxiety disorders are not treated the same.

The next step your doctor may suggest is a visit with a mental health professional. This includes psychiatrists, psychologists, social workers, and counselors. It is best to look for a professional who has special training in cognitive-behavioral and/or behavioral therapy. Try to find someone who is open to the use of medications, should they be needed. And if they are not a medical doctor, be sure they work with one so medication can be prescribed. Keep in mind that when you start taking medicine, it may not start working right away. You need to give your body a few weeks to get used to the medicine. Then, you and your doctor can decide if it's working.

You can get free information about anxiety disorders from the National Institute of Mental Health. Call toll free 1-88-88-ANXIETY.

It's very important that you feel comfortable with your treatment. If this is not the case, seek help elsewhere. If you've been taking medication, don't stop it all of a sudden. These drugs need to be tapered off slowly, under the care of your doctor. Talk with your doctor about how to stop the medication you're taking.

What can I do to help myself if I have an anxiety disorder?

Many people find it helps to join a support group because they can share their problems and successes with others who are going through the same thing. While it doesn't take the place of mental health care, talking with trusted friends or a member of your faith community can also be very helpful. Family members can play an important role in a person's treatment by offering support. Learning how to manage stress will help you to stay calm and focused. Research suggests that aerobic exercise (like jogging, bicycling and swimming) may be of value as well. Other studies have found that caffeine, illegal drugs, and some over-the-counter cold medicines can worsen the symptoms of these disorders. Check with your doctor or pharmacist before taking any over-the-counter medicines.

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Phobia

A phobia is an unreasonable fear of a situation that is out of proportion to the actual danger. Phobias lead the person to avoid situations that they are afraid of. Phobia can be described as an extreme and intense cause of distress and it affects a person's normal daily activities as they tend to avoid that or object or situations that make them feel uncomfortable.

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For More Information

National Institute of Mental Health

Anxiety Disorders Association of America

National Mental Health Consumers' Self-Help Clearinghouse

National Anxiety Foundation

National Mental Health Association

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Fear & Phobia