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Trapped by Fear: The Dynamics and Treatment of Phobias

Shira Yehudit Djlilmand

Spiders and snakes, planes and people, elevators and enclosed spaces. What’s the connection? These are just some of the things that cause such intense fear in some people that the fear becomes a phobia. But what exactly is a phobia — and can it be cured?

Wednesday, November 24, 2010

Every time I sit in a crowded bus, with people standing up all around me, squashing me so that I can’t see or move, I can feel the panic rising within me. I want to scream and push my way outside into the fresh air so I can breathe, but I force myself to sit quietly. I manage to control the panic but it’s there, lurking inside, threatening to burst out. I have the same feeling every time I can’t remove my wedding ring, or a button on my coat gets stuck and I can’t take it off. Like my mother before me, I suffer from claustrophobia, a fear of enclosed spaces.

Or do I? What exactly is a phobia, and how does it differ from a severe fear?

What Is a Phobia?

To obtain some clarity, Family First turned to the prominent Orthodox psychologist Rabbi Dr. Yisrael Levitz, an expert on the treatment of phobias. Dr. Levitz is the founding director of the Family Institute of Neve Yerushalayim and a clinical psychologist with over thirty-five years of clinical practice within the religious community. More relevantly, Dr. Levitz was one of the pioneers in the treatment of phobias. Dr. Levitz opened the first phobia clinics in New York in the 1970s, originally to treat people suffering from a fear of flying, and then broadening out into phobias in general.

Dr. Levitz explains that a phobia is diagnosed by looking at the extent to which it affects a person’s life. The Diagnostic and Statistical Manual of Mental Disorders (DSM IV), which defines mental disorders, states that to be considered a phobia, a fear must “significantly interfere with the sufferer’s daily life.” For example, for a city-dweller, a fear of snakes may not become a phobia, as he may never have to face a snake, whereas for a country farmer, the same fear may be a severe problem requiring treatment.

Another way to differentiate between a phobia and a fear is to assess the rationality of the fear.

“There’s an irrational component to phobia, as contrasted with fear of something objectively dangerous,” Dr Levitz explains. “Look, if you’re in a room with a hungry lion and you’re afraid, that’s good!”

If we compare this with being afraid to get in an elevator because we might die from lack of air, we have to look at how realistic that fear is. Phobias are based on the fear of something dangerous happening, but, as Dr. Levitz points out, usually the statistical probability of that something happening is very, very low. For example, planes do crash — but how often?

There is, however, sometimes a gray area between phobia and fear. Often the diagnosis may depend on the context. Dr. Levitz gives us the all-too-real example of people in Israel who avoid traveling in buses or eating in restaurants, or if they do, they seek out the “safest” place to sit. It might sound irrational, but in the wake of frequent terror attacks, such behavior might actually make sense.

A phobia can be described as a classic avoidance disorder, whereby the sufferer will do almost anything to avoid coming into contact with the feared object. The very avoidance then reinforces the phobia, and thus the sufferer becomes even more anxious about the object, creating a vicious circle of fear.

Finally, a phobia can also be diagnosed according to the symptoms displayed. Common symptoms of a phobic reaction are panic attacks, dizziness, rapid heartbeat, trembling or shaking, and “an intense desire to flee the situation.” Some of these symptoms may be present in the face of a regular fear, but again, such symptoms would be understandable if faced with that hungry lion, but not if faced with an elevator or a harmless spider.

 

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