Resources

Phobias
KE Y T E RM S PERIODICALS
Appold, Karen. ‘‘An optimistic outlook: advances in phle-
Finger stick—A technique for collecting a very botomy promise improvement.’’ Journal of Continuing
small amount of blood from the fingertip area. Education Topics & Issues. April 2010: 62–66.
Hemochromatosis—A genetic disorder known as
iron overload disease. Untreated hemochromatosis Paula Anne Ford-Martin
may cause osteoporosis, arthritis, cirrhosis, heart
disease, or diabetes.
Thrombocytosis—A vascular condition character-
ized by high blood platelet counts.
Tourniquet—Any device that is used to compress a Phobias
blood vessel to stop bleeding or as part of collecting Definition
a blood sample. Phlebotomists usually use an elas-
tic band as a tourniquet. A phobia is an intense but unrealistic fear that can
interfere with the ability to socialize, work, or go
Venesection—Another name for phlebotomy.
about everyday life, brought on by an object, event,
or situation.

their hematocrit checked with a finger stick test prior Demographics

to donation.
Phobias occur in all races, with social phobia
being the most common type of phobia and agorapho-
Aftercare bia being the least common. Women are more likely to
suffer from a phobia than men at a ratio of about two
After blood is drawn and the needle is removed, to one. Simple and social phobias appear earlier in life
pressure is placed on the puncture site with a cotton (at a median age of 15 and 16) than agoraphobia
ball to stop bleeding, and a bandage is applied. It is not (which appears at a median age of 29).
uncommon for a patient to feel dizzy or nauseated
during or after phlebotomy. The patient may be Description
encouraged to rest for a short period once the proce-
Just about everyone is afraid of something such as
dure is completed. Patients are also instructed to drink
an upcoming job interview or being alone outside after
plenty of fluids and eat regularly over the next 24
dark, but about 18% of all Americans are tormented
hours to replace lost blood volume. Patients who
by irrational fears that interfere with their daily lives.
experience swelling of the puncture site or continued
They are not ‘‘crazy’’—they know their fear is unrea-
bleeding after phlebotomy should get medical help sonable, but they cannot control the fear. These peo-
at once. ple have phobias.
Phobias belong to a large group of mental problems
Risks known as anxiety disorders that include obsessive-
compulsive disorder (OCD), panic disorder, and post-
Most patients will have a small bruise or mild
traumatic stress disorder (PTSD). Phobias themselves
soreness at the puncture site for several days. Thera- can be divided into three types:
peutic phlebotomy may cause thrombocytosis and
chronic iron deficiency (anemia) in some patients. As  specific phobias (formerly called ‘‘simple phobias’’)
with any invasive procedure, infection is also a risk.  social phobia
This risk can be minimized by the use of prepackaged  agoraphobia
sterilized equipment and careful attention to proper
technique. Specific phobias
As its name suggests, a specific phobia is the fear
Normal results of a particular situation or object, including anything
from airplane travel to dental visits. Found in one out
Normal results include obtaining the needed of every 10 Americans, specific phobias seem to run in
amount of blood with the minimum of discomfort to families and are roughly twice as likely to appear in
the patient. females. If the person rarely encounters the feared

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 object, the phobia does not cause much harm. How- unique chemical reactions in the brain that cause them
Phobias

ever, if the feared object or situation is common, it can to respond much more strongly to stress. These people
seriously disrupt everyday life. Common examples of also may be especially sensitive to caffeine, which trig-
specific phobias, which can begin at any age, include gers certain brain chemical responses.
fear of snakes, flying, dogs, escalators, elevators, high
While experts believe the tendency to develop pho-
places, or open spaces.
bias runs in families and may be hereditary, a specific
stressful event usually triggers the development of a
Social phobia
specific phobia or agoraphobia. For example, someone
People with social phobia have deep fears of being predisposed to develop phobias who experiences severe
watched or judged by others and being embarrassed in turbulence during a flight might go on to develop a
public. This may extend to a general fear of social phobia about flying. What scientists do not understand
situations or be more specific or circumscribed, such is why some people who experience a frightening or
as a fear of giving speeches or of performing (stage stressful event develop a phobia and others do not.
fright). More rarely, people with social phobia may
Social phobia typically appears in childhood or ado-
have trouble using a public restroom, eating in a res-
lescence, sometimes following an upsetting or humiliating
taurant, or signing their name in front of others.
experience. Certain vulnerable children who have had
Social phobia is not the same as shyness. Shy unpleasant social experiences (e.g., being rejected) or
people may feel uncomfortable with others, but they who have poor social skills may develop social phobias.
do not experience severe anxiety, do not worry exces- The condition also may be related to low self-esteem,
sively about social situations beforehand, and do not unassertive personality, and feelings of inferiority.
avoid events that make them feel self-conscious. On
A person with agoraphobia may have a panic
the other hand, people with social phobia may not be
attack at any time, for no apparent reason. While the
shy; they may feel perfectly comfortable with people
attack may last only a minute or so, the person remem-
except in specific situations. Social phobias may be
bers the feelings of panic so strongly that the possibility
only mildly irritating, or they may significantly inter-
of another attack becomes terrifying. For this reason,
fere with daily life. It is not unusual for people with
people with agoraphobia avoid places where they might
social phobia to turn down job offers or avoid rela-
not be able to escape if a panic attack occurs. As the fear
tionships because of their fears.
of an attack escalates, the person’s world narrows.
Agoraphobia While the specific trigger may differ, the symp-
toms of different phobias are remarkably similar.
Agoraphobia is the intense fear of feeling trapped These include feelings of terror and impending
and having a panic attack in a public place. This type doom, rapid heartbeat (tachycardia) and rapid breath-
of phobia usually begins between ages 15 and 35, and ing, sweaty palms, and other features of a panic attack.
affects three times as many women as men, or about Individuals may experience severe anxiety symptoms
3% of the population. in anticipating a phobic trigger. For example, some-
An episode of spontaneous panic is usually the one who is afraid to fly may begin having episodes of
initial trigger for the development of agoraphobia. pounding heart and sweating palms at the mere
After an initial panic attack, the person becomes thought of getting on a plane in two weeks.
afraid of experiencing a second one. Individuals
‘‘fear the fear,’’ and worry incessantly about when
Diagnosis
and where the next attack may occur. As they begin
to avoid the places or situations in which the panic A mental health professional can diagnose pho-
attack occurred, their fear generalizes. Eventually the bias after a detailed interview and discussion of both
person completely avoids public places. In severe mental and physical symptoms. Social phobia is often
cases, people with agoraphobia can no longer leave associated with other anxiety disorders, depression, or
their homes for fear of experiencing a panic attack. substance abuse.

Causes and symptoms Treatment

Experts do not really know why phobias develop, People who have a specific phobia that is easy to
although research suggests the tendency to develop avoid (e.g. fear of snakes) and that does not interfere
phobias may be a complex interaction between heredity much with their lives may not need to get help. When
and environment. Some hypersensitive people have phobias do interfere with a person’s daily life, a

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 Phobias
KEY TERM S
Agoraphobia—An intense fear of being trapped in a in the brain. MAOs can be used to treat social
crowded, open, or public space where it may be phobia.
hard to escape, combined with the dread of having Selective serotonin reuptake inhibitors (SSRIs)—A
a panic attack. class of antidepressants that work by blocking the
Benzodiazepine—A class of drugs that have a hyp- reabsorption of serotonin in the brain, raising the
notic and sedative action, used mainly as tranquil- levels of serotonin. SSRIs include Prozac, Zoloft,
izers to control symptoms of anxiety. and Paxil.
Beta blockers—A group of drugs that are usually Serotonin—5-Hydroxytryptamine; a substance that
prescribed to treat heart conditions, but that also occurs throughout the body with numerous effects
are used to reduce the physical symptoms of including neurotransmission in the brain. Inad-
anxiety and phobias, such as sweating and equate amounts of serotonin are implicated in
palpitations. some forms of depression, obsessive-compulsive dis-
MAO-B inhibitors—Inhibitors of the enzyme mono- order, and anxiety disorders.
amine oxidase B. MAO-B helps break down dopa- Social phobia—Fear of being judged or ridiculed by
mine; inhibiting it prolongs the action of dopamine others; fear of being embarrassed in public.

combination of psychotherapy and medication can be can be effective in reducing phobias. Drug therapy is
quite effective in reducing the phobia to manageable individualized based on the age of the patient, severity
levels. of the phobia, co-existing physical and/or mental dis-
orders, and history of drug or alcohol addition.
Psychotherapy
Several drugs are used to treat specific phobias
Cognitive-behavioral therapy adds a cognitive and social phobia by controlling symptoms and help-
approach to more traditional behavioral therapy. It ing to prevent panic attacks. Treating agoraphobia is
teaches individuals how to change their thoughts, more difficult than treating other phobias because
behavior, and attitudes, while providing techniques there are often so many fears involved, such as open
to lessen anxiety, such as deep breathing, muscle relax- spaces, traffic, elevators, and escalators.
ation, and refocusing. One cognitive-behavioral Drugs often used to treat phobias include anti-
approach is desensitization (also known as exposure anxiety drugs such as buspirone (BuSpar) and benzo-
therapy), in which people gradually are exposed to the diazepines such as such as alprazolam (Xanax), lor-
frightening object or event until they become used to it azepam (Ativan), clonazepam (Klonopin), and
and their physical symptoms decrease. For example, diazepam (Valium). Antihypertensive beta-blockers
someone who is afraid of snakes might first be shown a (drugs that lower blood pressure), such as propranolol
photo of a snake. Once the person can look at a photo (Inderal), atenolol (Tenormin), and nadolol (Cor-
without anxiety, he or she might then be shown a video gard), appear to work well in the treatment of circum-
of a snake. Each step is repeated until the physical scribed social phobia when anxiety gets in the way of
symptoms of fear, such as pounding heart and sweat- performance, such as public speaking. These drugs
ing palms, disappear. Eventually, the person might reduce overstimulation, thereby controlling the phys-
reach the point where he or she can touch a live ical symptoms of anxiety.
snake. Three-fourths of patients are significantly
improved with this type of treatment. In addition, some antidepressants may be effective
when used together with cognitive-behavioral therapy.
Another more dramatic cognitive-behavioral These include venlafaxine (Effexor), imipramine (Tofra-
approach is called flooding. It exposes the person nil), desipramine (Norpramin), nortriptyline (Pamelor),
immediately to the feared object or situation. The per- duloxetine (Cymbalta), clomipramine (Anafranil), cita-
son remains in the situation until the anxiety lessens. lopram (Celexa), escitalopram (Lexapro), fluoxetine
(Prozac), paroxetine (Paxil), sertraline (Zoloft) and flu-
Drugs
voxamine (Luvox). The monoamine oxidase inhibitor
Medication can block the feelings of panic and (MAO inhibitor) phenelzine (Nardil) may be used when
when combined with cognitive-behavioral therapy, treatment with antidepressants fails or is not tolerated.

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 Home remedies ORGANIZATIONS
Phosphorus imbalance

American Psychiatric Association, 1000 Wilson Boulevard,

In all types of phobias, symptoms may be eased by Suite 1825, Arlington, VA, 22209-3901, (703)907-7300,
lifestyle changes, such as: apa@psych.org, http://www.psych.org.
 eliminating caffeine Anxiety Disorders Association of America, 8730 Georgia
Ave., Suite 600, Silver Spring, MD, 20910, (240)
 reducing or eliminating alcohol use 485-1001, (240) 485-1035, information@adaa.org,
 eating a healthy diet http://www.adaa.org.
National Anxiety Foundation, 3135 Custer Dr., Lexington,
 getting plenty of exercise KY, 40517, 606-272-7166, http://www.lexington-on-
 reducing stress line.com/naf.html.
National Institute of Mental Health, 6001 Executive
Boulevard, Room 8184, MSC 9663, Bethesda, MD,
Prognosis 20892-9663, (301) 443-4513. TTY (301) 443-8431, (866)
615-6464 TTY (866) 415-8051 , (301) 443-4279,
Phobias are among the most treatable mental nimhinfo@ nimh.gov, http://www.nih.nih.gov.
health problems. Depending on the severity of the
condition and the type of phobia, most properly Carol A. Turkington
treated individuals can go on to lead normal lives. Rebecca J. Frey, PhD
Research suggests that once a person overcomes the Tish Davidson, AM
phobia, the problem may not return for many years, if
at all. Phospholipidosis see Pulmonary alveolar
Although phobias are highly treatable, only about proteinosis
20% of specific phobias will go away without treat-
ment, and agoraphobia will get worse with time if
untreated. Social phobias tend to be chronic and are
not likely go away without treatment. Moreover,
untreated phobias can lead to other problems, includ-
ing depression, alcoholism, and feelings of shame and Phosphorus imbalance
low self-esteem. Unfortunately, only about 25% of Definition
people with phobias seek help to deal with their
condition. Phosphorus imbalance refers to conditions in
which the element phosphorus is present in the body
at too high a level (hyperphosphatemia) or too low a
Prevention level (hypophosphatemia).
There is no known way to prevent the development
of phobias. Medication and cognitive-behavioral ther-
Description
apy may help prevent the recurrence of symptoms once Almost all of the phosphorus in the body occurs
they have been diagnosed. as phosphate (phosphorus combined with four oxygen
atoms), and most of the body’s phosphate (85%) is
Resources located in the skeletal system, where it combines with
BOOKS
calcium to give bones their hardness. The remaining
amount (15%) exists in the cells of the body, where it
Elliott, Charles H. and Smith, Laura L. Overcoming Anxiety
plays an important role in the formation of key nucleic
for Dummies. New York, NY : Wiley Pub., 2003.
acids, such as DNA, and in the process by which the
Liebgold, Howard. Freedom From Fear. New York, NY :
body turns food into energy (metabolism). The body
Citadel Press, 2004.
regulates phosphate levels in the blood through the
Rachman, Stanley and de Silva, Padmal. Panic Disorder. 3rd
controlled release of parathyroid hormone (PTH)
ed. Oxford; New York : Oxford University Press, 2009.
from the parathyroid gland and calcitonin from the
OTHER thyroid gland. PTH keeps phosphate levels from
Medline Plus. Phobias. January 21, 2010. http://www. becoming too high by stimulating the excretion of
nlm.nih.gov/medlineplus/phobias.html phosphate in urine and causing the release of calcium
Richards, Thomas A., PhD. Anxiety Network Homepage. from bones (phosphate blood levels are inversely pro-
Undated [accessed February 3, 2010]. http://www. portional to calcium blood levels). Calcitonin keeps
anxietynetwork.com phosphate blood levels in check by moving phosphates

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