What is a phobia?

  The patient, male, 21 years old, a second-year student of a university, from the remote countryside, grew up withdrawn and introverted, weak and low self-esteem, like to be quiet and do not like to move, rarely interact with others, and not good at talking. For many years, he often had an unspeakable disease – fear of meeting girls. Whenever he suddenly saw or approached a female classmate, a feeling of unexplained terror immediately arose in his heart. At the same time, the back of his head was accompanied by paroxysmal headaches. Sometimes, even the sight of girls’ brightly colored clothes or long hair would give him the same painful feeling. For several years, this strange disease made him very painful and mentally burdensome, and because it was inconvenient to tell others, he had to bear the love in silence. In order to get rid of its pain, he had several times to the big hospital outside the school to seek treatment at his own expense, also went to a specialist hospital, took a lot of tranquilizing, sedative and other drugs, but nothing worked.  Later, when he gradually realized that he might belong to a psychological problem, he put aside all his worries and went into the counseling center. Through detailed consultation and careful analysis, the psychologist concluded that the student’s illness belonged to social fear, a symptom of phobia. Through more than six months of psychotherapy and counseling, satisfactory results were achieved. The occurrence of fear gradually changed from more to less, and from stronger to weaker. By the end of the semester, the social fear was largely eliminated and the headache disappeared completely. The student reported that his relationship with other students was quite cordial, his interaction with girls tended to be normal, his mental outlook was greatly improved, his former painful and uneasy face appeared to smile, and there was joy in his academic life.  So what exactly is a phobia? In addition to the general symptoms of neurosis, its main characteristic is the fear of a particular object or environment, knowing that this object or environment is harmless and need not be afraid, but can not overcome, and can not control their anxiety. Due to the different objects of fear, they can be divided into: fear of animals, fear of the square, fear of darkness, social fear, fear of bare faces, fear of blood, fear of impurity, fear of heights, fear of exams, fear of flying, fear of vomiting, fear of hepatitis, fear of cancer, fear of venereal disease, fear of sexual intercourse, fear of suffocation, etc., with social fear being the most common. Social fears often begin in adolescence and center around the fear of being scrutinized in a small group (as opposed to a crowd), leading to avoidance of social situations.  Unlike other phobias, the prevalence of social phobia is nearly equal in men and women. It can manifest in isolation (i.e., limited to eating in public, speaking publicly, or encountering the opposite sex) or can be generalized, involving almost any situation outside of the family circle. Fear of vomiting in public can be a significant symptom. Direct eye contact may be particularly stressful. Social fear is usually accompanied by low self-esteem and fear of criticism. Complaints of blushing, shaking hands, nausea or urgency to urinate, or headache may be present. First episodes often occur in public places without cause. Subsequent episodes of anxiety in similar places are followed by progressively worse episodes and increased avoidance reactions. The etiology of social phobia is unknown. One plausible explanation is that the onset of fear symptoms is due to a combination of conditioned reflexes and abnormal cognition. Social phobia is treated with a combination of waking, cognitive, desensitization, and anxiolytic therapy. This combined treatment has a lower relapse rate than exposure alone.