What is social phobia?
Social phobia is, in its essence, an extreme fear of social interactions. It can be experienced as being scared of riding the elevator at work, going on a date, eating in public, or presenting at a work conference. The patient expects the worst possible outcome.
The life history of such a patient might involve a highly critical or substance-abusing parent who became disinhibited and then attacked the patient when she was a young child. Perhaps these attacks occurred while the child did exciting things.
The patient learned to associate feeling anxious with feeling excited. Social phobia, therefore, creates a kind of a compromise. The patient can keep a critical parent alive in her mind by keeping herself inhibited from progressing in life.
While she recreates and remembers these painful times, she also keeps the hopes alive of rising in life (the elevator), sharing intimacy with close friends over a meal (the date or eating in public), or exhibiting her natural talents (the conference presentation), hopes about which all children regularly talk and fantasize.
What is a specific phobia?
Generally speaking, phobia means fear. A specific phobia can be anything from a fear of the number 13 to a fear of needles to a fear of snakes to a fear of heights. Many of the same principles that apply to one phobia apply to another.
A couple of the most common phobias serve as examples to illustrate these ideas. For example, the passenger with a flying phobia experiences absolute horror at the idea of being trapped on an airplane. This fear can handicap one’s ability to take business trips by airplane or can cause one to prohibit family members from flying. A flying phobia may have many roots, but often it involves a basic difficulty trusting the world or trusting others with one’s safety.
In a more psychological approach, simply exploring what comes to the patient’s mind around flying and inquiring about sexual desires and/or fears that the patient potentially struggled with at the time of the flying phobia’s onset can provide symptom relief.
If a woman can connect her conscious fear of the plane’s crashing with an unconscious fear of being punished for wishing to be sexual on the trip on which the phobia commenced, then the conscious symptom can disappear. Others might experience a genuine fear of success, or of climbing to new heights in their lives.
A man might have panic attacks on the plane in conjunction with the feeling of permanently leaving home, marrying, or taking an exciting trip. This sensed loss of control can have sexual associations, in that the man can feel that the excitement of going higher is linked (often unconsciously) with sexual aspirations.
If this man can connect his conscious fear of blowing up while on the plane with his feelings of his sexual or financial potency (and his fears of sexual or financial success), then flying on business trips might immediately feel less threatening. Other strategies, such as medication or behavioral treatments, can provide immediate symptom management.
In claustrophobia (literally, fear of the claustrum, or mother’s womb), one becomes overwhelmingly fearful of being trapped in a closed space and being unable to get out. This fear can link to fantasies of being trapped on a bridge or in a tunnel. However, fears of going on a date, being stuck in a movie theater, riding in a car without being the driver, or receiving treatment in a hospital or clinic setting often elicit panic attacks or anxious reactions.
These psychological claustrophobias might recreate an experience from earlier in life when the patient felt overwhelmed and sensed that she could not get out of a trapped situation or away from a certain person, such as from her mother or family, or from an abusive relationship. Again, in almost any case, these extremely common phobias are treatable.
What is a panic attack?
A panic attack occurs usually as a seemingly out-ofthe-blue sensation that transforms into an overwhelming, crippling, emotional tidal wave of nervousness. Panic attacks have both mental and physical symptoms. Mental symptoms include a fear of doom, worry that something horrible will happen, an overwhelming sense of dread, or an immediate sense of pending death.
Physical symptoms include chest pain, chest tightness, numbness, tingling, nausea, sweating, or a feeling of nearly passing out. The panic attack, if experienced regularly in the same situation or with a consistent frequency, can progress to what is known as panic disorder.
The circumstances surrounding the panic attack can take on a life of their own, thereby becoming hallmark triggers for further attacks. So, if someone has a panic attack driving on the highway in the car, he may come to fear driving on the highway in association with the panic attack.
He may then believe that the highway itself or the situation of driving caused the panic attack, rather than whatever underlying anxiety he experienced or was experiencing at the time. A panic attack serves as the body’s responding to the mind’s inability to handle an overwhelming feeling.
With close psychotherapeutic investigation, we usually discover that the panic attack only appeared to occur out of the blue, while a clear, identified stressor, which, up until that point, had been largely unknown to the patient emerges.
Close exploration of the circumstances and the feelings surrounding a panic attack help identify the root of the patient’s suffering. In its worst-case scenario, panic disorder will lead to agoraphobia, or a “fear of open spaces.”
This designation means that the patient might become reclusive or stay at home to avoid any situation in which she fears the unforgettable misery of panic attack may recur.