Claire Ledger was diagnosed with the condition agoraphobia after she had a panic attack while shopping in her local high street.  

Claire, who was 26 at the time, was unable to explain the experience. She initially believed that it may have had something to do with where she was, so she stopped going there and began to shop elsewhere. When she had a similar attack in another location, she stopped going there too.

Within five months, she had stopped going to so many places that she only felt truly safe at home. She left her job as a nurse and spent the next two-and-a-half years indoors. She read, watched TV, surfed the web and cared for her husband, who is in a wheelchair, and never went outside.

“When I had the first attack, I didn’t know what was happening,” says Claire, who lives in Bradford, West Yorkshire. “I was inside a shop and I felt suddenly faint and had to crouch down to avoid collapsing. I was shaking and felt sick.”

She went to her GP, who initially thought she was suffering from stress. Claire had just begun a new job, had recently married and was undergoing IVF (in-vitro fertilisation) treatment.

“Every time I went out after that, I got this feeling again,” she says. “Everywhere it happened, I avoided that place. Instead of thinking it was me, I associated the panic attack with the place. I was such an outgoing person, the idea that it was all in my head never occurred to me.”

She was eventually diagnosed with agoraphobia, a fear of open spaces, which is estimated to affect 30 people in every thousand at any one time in the UK.

“I got to a point where my stomach dropped as soon as I woke up,” she says. “It’s like a feeling of grief and despair. You’re shaking, tired and you don’t really feel there. It’s like you’re watching yourself.

“I tried to get through it but I reached a stage when even the thought of going into my own garden made me panic. It was like coming up against an invisible wall.

“It was hard on my husband. He’s a big sports fan and likes going out to watch live events.”

The couple’s elderly neighbours helped out with getting food and household supplies. “I felt ashamed that someone in their 70s was doing my shopping,” says Claire.

She became determined to get treatment and had a course of cognitive behavioural therapy. She found the treatment helpful, but it didn’t change her thought process. What made the difference was sharing her experience with fellow sufferers, whom she contacted through support groups on the internet.

“You feel like a freak,” she says. “Talking to other people in the same position was what helped me most. We worked on breaking down our boundaries together.”

She became friends with a woman in another town. They made the same trips together in their respective neighbourhoods, slowly increasing the time and length of their journeys.

“We would call each other before leaving the house and we would remain on the phone to each other until we got back in,” says Claire. “Even though she wasn’t there in person, her voice was really reassuring.”

For the next two years, this was how Claire expanded her boundaries. “My husband changed our mobile provider when he saw the monthly bills I was running up,” she says.

Claire has learned to cope with her moods and has now regained enough confidence to go back to work.

“It’s important for people to know that you can recover,” she says. “You may think it’s like a death sentence but the treatments do work. I never thought I’d return to work.

“I still have my down days but I’ve learned to accept that you can’t feel your best every day.”

Most of us find vomit unpleasant, but even the mention of it makes Hilary Fraser panic.

In fact, as this page contains the words vomit, sick and throwing up, she probably won’t be able to read it.

Her condition, known as emetophobia, is one of the 10 most common phobias in the UK, according to Anxiety UK.

Vomiting is a momentary loss of control and a cause of embarrassment for Hilary, 55, who lives in Bournemouth. “If I’m sick, I always need someone with me to reassure me,” she says. “Being sick on my own is my worst nightmare.”

She has a similar but much milder reaction to sneezing or hiccups in public. “If I sneeze more than three times, I go into a panic,” she says. “The sickness itself isn’t so much of a problem. It’s the unexpected loss of control that I can’t deal with. I’m a control freak. I’m comfortable when I’m in control. I don’t like surprises.”

Seeing other people vomit is enough to make her sick. “The sight and smell can make me gag,” she says. “I was out on my own the other day and somebody in a shop said ‘six’ and I misheard it as ‘sick’. I suddenly went bright red and started shaking and sweating. I had a full-blown panic attack.”

Hilary’s phobia began when she was at school. She remembers one year when several pupils had a sickness bug. “People were being sick in front of me,” says Hilary.

The only time she has been able to control her phobia was when her three children were growing up. “My daughter could throw up at the drop of a hat so I kind of became desensitised to it,” she says. “But when they all left home and I was no longer exposed to it, the symptoms returned.”

Hilary has never seriously considered treatment. She believes that nothing is effective. A doctor told her that it was normal to be put off by vomit. “I don’t think people understand how paralysing it can be,” she says.

Her fear of sickness means she avoids public transport and most public lavatories, doesn’t go on holiday and does all of her shopping online.

She’s a full-time carer for her husband, who suffers from the effects of a head injury. “My life is based around the home. I stick to my safe places: my house, my garden and my sister’s place,” she says. “Gardening is a passion. Depending on the weather, I spend two hours a day gardening.”

Her other passion is distance learning and she is very proud of being an Open University graduate. “Distance learning is my window on to the world,” she says.

“I accept that I can’t do some things. I don’t live a life that other people would like but I manage. I’m happy most of the time.”

A phobia can develop during childhood, adolescence or early adulthood.

They’re often linked to a frightening event or stressful situation. However, it’s not always clear why some phobias occur.

Specific or simple phobias

Specific or simple phobias, such as a fear of heights (acrophobia), usually develop during childhood.

Simple phobias can often be linked to an early negative childhood experience. For example, if you’re trapped in a confined space when you’re young, you may develop a fear of enclosed spaces (claustrophobia) when you’re older.

It’s also thought that phobias can sometimes be “learnt” from an early age. For example, if someone in your family has a fear of spiders (arachnophobia), you may also develop the same fear yourself.

Other factors in the family environment, such as having parents who are particularly anxious, may also affect the way you deal with anxiety later in life.

Complex phobias

It’s not known what causes complex phobias, such as agoraphobia and social phobia. However, it’s thought that genetics, brain chemistry and life experiences may all play a part in these types of phobias.

The physical reactions (symptoms) that a person experiences when faced with the object of their fear are real and aren’t simply “in one’s head”.

The body reacts to the threat by releasing the hormone, adrenalin, which causes bodily symptoms, such as sweating, trembling, shortness of breath and a rapid heartbeat (tachycardia).

Simple phobias, such as a fear of heights, aren’t usually formally diagnosed. Most people with a phobia tend to be fully aware of the problem.

Some people live with a phobia for many years by trying to avoid what they are afraid of.

However, you should see your GP if your phobia is interfering with your day-to-day life and preventing you from doing the things you enjoy.

In particular, you should consider seeking help if your phobia:

• is causing intense fear, anxiety and panic
• is making you avoid certain places or situations
• is interfering with your daily routine or causing you significant distress
• has lasted six months or longer

Your GP may refer you to a mental health specialist with expertise in behavioural therapy, such as a psychologist. 

Agoraphobia

Anxiety UK has produced a list of questions to help you determine whether you have agoraphobia. If you answer yes to most of the questions below, it’s likely you have agoraphobia.

During the past six months:

• have you been regularly avoiding situations because you’re scared of having a panic attack?

Do any of the following situations make you feel anxious:

• going outside, away from your home
• standing in long queues
• being in a confined space, such as tunnels, lifts or the London Underground
• being at home alone
• being in large open spaces, such as a park or field
• being in crowded places

Do you avoid being in any of the above situations?

If you answered yes to most of these questions, see your GP. They will be able to make a formal diagnosis of agoraphobia and give you further information and advice.

Social phobia

Anxiety UK has also produced a list of questions to help determine whether you have social phobia. If you answer yes to most of the questions below, it’s likely you have social phobia.

During the past six months:

• have you been worried about embarrassing yourself in front of others?
• have you been worried about what people might think of you?
• have you felt anxious in social situations?

Do you worry about behaving anxiously in any of the following situations:

• public speaking
• eating and drinking in front of other people
• writing in front of other people
• going to parties and other social gatherings

Do you avoid any of the above situations because they make you feel anxious?

If you answered yes to most of these questions, see your GP. They will be able to formally diagnose social phobia and give you further information and advice.

A phobia is an overwhelming and debilitating fear of an object, place, situation, feeling or animal.

Phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger about a situation or object.

If a phobia becomes very severe, a person may organise their life around avoiding the thing that’s causing them anxiety. As well as restricting their day-to-day life, it can also cause them considerable anguish.

Anxiety disorder

A phobia is a type of anxiety disorder. You may not experience any symptoms until you come into contact with the source of your phobia.

However, in some cases, even thinking about the source of a phobia can make a person feel anxious or panicky. This is known as anticipatory anxiety.

Symptoms may include:

• unsteadiness, dizziness and lightheadedness
• nausea
• sweating
• increased heart rate or palpitations
• shortness of breath
• trembling or shaking
• an upset stomach

If you don’t come into contact with the source of your phobia very often, it may not affect your everyday life. However, if you have a complex phobia such as agoraphobia (see below), leading a normal life may be very difficult.

Read more about the symptoms of phobias.

Types of phobia

There are a wide variety of objects or situations that someone could develop a phobia about. However, phobias can be divided into two main categories:

• specific or simple phobias
• complex phobias

The two categories are discussed below.

Specific or simple phobias

Specific or simple phobias centre around a particular object, animal, situation or activity. They often develop during childhood or adolescence and may become less severe as you get older.

Common examples of simple phobias include:

• animal phobias – such as dogs, spiders, snakes or rodents
• environmental phobias – such as heights, deep water and germs
• situational phobias – such as visiting the dentist or flying
• bodily phobias – such as blood, vomit or having injections
• sexual phobias – such as performance anxiety or the fear of getting a sexually transmitted infection 

Complex phobias

Complex phobias tend to be more disabling than simple phobias. They tend to develop during adulthood and are often associated with a deep-rooted fear or anxiety about a particular situation or circumstance.

Two common complex phobias are:

• agoraphobia
• social phobia

Agoraphobia is often thought of as a fear of open spaces, but it’s much more complex than this.

Someone with agoraphobia will feel anxious about being in a place or situation where escaping may be difficult if they have a panic attack.

The anxiety usually results in the person avoiding situations such as:

• being alone
• being in crowded places, such as busy restaurants or supermarkets
• travelling on public transport

Read more about agoraphobia. 

Social phobia, also known as social anxiety disorder, centres around feeling anxious in social situations.

If you have a social phobia, you might be afraid of speaking in front of people for fear of embarrassing yourself and being humiliated in public.

In severe cases, this can become debilitating and may prevent you from carrying out everyday activities, such as eating out or meeting friends.

Read more about social phobia.

What causes phobias?

Phobias do not have a single cause, but there are a number of associated factors. For example:

• a phobia may be associated with a particular incident or trauma
• a phobia may be a learned response that a person develops early in life from a parent or sibling (brother or sister)
• genetics may play a role – there’s evidence to suggest some people are born with a tendency to be more anxious than others

Read more about the causes of phobias.

Diagnosing phobias

Phobias aren’t usually formally diagnosed. Most people with a phobia are fully aware of the problem.

A person will sometimes choose to live with a phobia, taking great care to avoid the object or situation they’re afraid of. However, if you have a phobia, continually trying to avoid what you’re afraid of will make the situation worse.

Therefore, you should seek help from your GP, who may refer you to a specialist with expertise in behavioural therapy, such as a psychologist.

Read more about diagnosing phobias.

Treating phobias

Almost all phobias can be successfully treated and cured.

Simple phobias can be treated through gradual exposure to the object, animal, place or situation that causes fear and anxiety. This is known as desensitisation or self-exposure therapy.

You could try these methods with the help of a professional or as part of a self-help programme.

Treating complex phobias often takes longer and involves talking therapies, such as counselling, psychotherapy and cognitive behavioural therapy (CBT).

Medication isn’t usually used to treat phobias. However, it’s sometimes prescribed to help people cope with the effects of anxiety. Medications that may be used include: 

• antidepressants
• tranquillisers
• beta-blockers

Read more about how phobias are treated.

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: anxiety

 

Each phobia is different and no single self-help programme will work for everyone. You may decide to use your own self-help strategy, or get help from a mental health specialist, such as a psychologist.

A self-help programme could include:

• lifestyle changes
• a course of cognitive behavioural therapy (CBT)
• attending a self-help group
• using exposure therapy (see below) to overcome your fear
• a combination of these

Lifestyle changes

Making some simple adjustments to your lifestyle may help reduce the symptoms of a phobia, such as panic attacks. This could include:

• regular exercise 
• eating healthy, regular meals
• getting enough sleep
• reducing or avoiding caffeine and other stimulants

Exposure therapy (desensitisation)

Exposure therapy (desensitisation) involves gradually increasing the length of time you’re exposed to your phobia.

For example, if you have agoraphobia (a fear of open spaces and public places), you might start by going outside your house for a very short period of time, before gradually increasing the length of time you spend outside and the distance you travel from your house.

Exposure therapy can be a very effective way of enabling you to cope with your anxiety.

Other self-help techniques

Other self-help techniques include:

• relaxation techniques – a series of physical exercises that may help you relax and control your breathing
• visualisation – combines relaxation and breathing techniques with mentally visualising how you will successfully deal with a situation that could cause anxiety
• self-help groups – a useful way of meeting others with similar experiences and sharing ways of coping

Depression Alliance supports a national network of self-help groups across England and has details of groups in your area.

Read more about relaxation tips to relieve stress and dealing with panic attacks.

Computerised CBT

FearFighter is a computer software programme that you can access online. It’s recommended by the National Institute for Health and Care Excellence (NICE) and has been shown to be an effective self-help method for treating panic disorder and phobia.

All phobias, particularly complex phobias such as agoraphobia and social phobia, can limit your daily activities and may cause severe anxiety and depression.

People with phobias often purposely avoid coming into contact with the thing that causes them fear and anxiety. The lengths someone with a phobia will go to to avoid contact can vary considerably.

For example, someone with a fear of spiders (arachnophobia) may not want to touch a spider, whereas someone else with the same phobia may not even want to look at a picture of one.

In some cases, a person can develop a phobia where they become fearful of experiencing anxiety itself because it feels so uncomfortable.

You don’t have to be in the situation you’re fearful of to experience the symptoms of panic. The brain has the capacity to mobilise a reaction to fearsome situations even when you aren’t actually in the situation.

Physical symptoms

People with phobias often have panic attacks. Panic attacks can be very frightening and distressing. The symptoms often occur suddenly and without warning.

As well as overwhelming feelings of anxiety, a panic attack can cause physical symptoms, such as:

• sweating
• trembling
• hot flushes or chills
• shortness of breath or difficulty breathing
• a choking sensation
• rapid heartbeat (tachycardia)
• pain or tightness in the chest
• a sensation of butterflies in the stomach
• nausea
• headaches and dizziness
• feeling faint
• numbness or pins and needles
• dry mouth
• a need to go to the toilet
• ringing in your ears
• confusion or disorientation

Psychological symptoms

In severe cases, you may also experience psychological symptoms, such as:

• fear of losing control
• fear of fainting
• feelings of dread
• fear of dying

Complex phobias

Complex phobias such as agoraphobia and social phobia can often have a detrimental effect on a person’s everyday life and mental wellbeing.

Agoraphobia often involves a combination of several interlinked phobias. For example, someone with a fear of going outside or leaving their home may also have a fear of being left alone (monophobia) or of places where they feel trapped (claustrophobia).

The symptoms experienced by people with agoraphobia can vary in severity. For example, some people can feel very apprehensive and anxious if they have to leave their home to go the shops, whereas others may feel relatively comfortable travelling short distances from their home.

If you have a social phobia, the thought of being seen in public or at social events can make you feel frightened, anxious and vulnerable.

Intentionally avoiding meeting people in social situations is a sign of social phobia. In extreme cases of social phobia, as with agoraphobia, some people are too afraid to leave their home.

Several treatment options for phobias are available, including talking therapies and self-help techniques. However, it can often take some time to overcome a complex phobia.

Many people with a phobia don’t need treatment, and avoiding the object of their fear is enough to control the problem.

However, it may not always be possible to avoid certain phobias, such as a fear of flying. Therefore, you may decide to get professional help and advice to find out about treatment options.

Most phobias are curable, but no single treatment is guaranteed to work for all phobias. In some cases, a combination of different treatments may be recommended. The main treatment types are:

• self-help techniques (see separate page)
• talking treatments
• medication

Talking treatments

Talking treatments, such as counselling and psychotherapy, are often very effective methods for treating phobias. In particular, cognitive behavioural therapy (CBT) has been found to be a very effective method of treating phobias.

CBT is a type of counselling that can help you manage your problems by changing the way you think and behave. It can be used to develop practical ways of dealing with your phobia.

One part of the CBT treatment process that’s often used to treat simple phobias involves gradual exposure to your fear, so that you feel less anxious about it. This is known as desensitisation or exposure therapy.

For example, if you have a fear of snakes (ophidiophobia), your therapist may start by asking you to read about snakes. They may later show you a picture of a snake. They may then arrange for you to visit the reptile house of your local zoo to look at some real snakes. The final step would be for you to hold a snake.

Exposure therapy works by gradually increasing the level of exposure to your fear, which allows you to gain control over your phobia. As the treatment progresses, you should begin to feel less anxious about your phobia.

The National Institute for Health and Care Excellence (NICE) don’t recommend the use of computerised CBT to treat specific phobias in adults.

Medication

Medication isn’t usually recommended for treating phobias, because talking therapies are usually effective and don’t have any side effects. However, medication is sometimes prescribed on a short-term basis to treat the effects of phobias, such as anxiety.

Three types of medication are recommended for treating anxiety. These are:

• antidepressants
• tranquillisers
• beta-blockers

Antidepressants

Antidepressants are often prescribed to help reduce anxiety. Paroxetine (Seroxat), a selective serotonin reuptake inhibitor (SSRI), is licensed to treat social phobia.

Citalopram (Cipramil) and escitalopram (Cipralex) are licensed for the treatment of panic disorder. Venlafaxine (Efexor) is licensed for generalised anxiety disorder (GAD).

Common side effects of these treatments include:

• nausea
• headaches 
• sleep problems
• upset stomach 

They may also, initially, make your anxiety worse and can cause sexual problems.

Clomipramine (Anafranil) is a type of tricyclic antidepressant (TCA) that’s licensed to treat phobias. Side effects include:

• dry mouth
• drowsiness
• blurred vision
• tremors (shaking)
• palpitations (irregular heartbeat)
• constipation
• difficulty urinating

Moclobemide (Manerix) is a type of antidepressant from the monoamine oxidase inhibitor (MAOI) group of antidepressants. It’s sometimes prescribed to treat social phobia.

Moclobemide interacts with certain types of food, so if you’re prescribed this medication, read the information leaflet that comes with it to find out which foods to avoid.

Other possible side effects of moclobemide include:

• sleep problems
• dizziness
• stomach problems
• headaches
• restlessness
• agitation

If you’re prescribed antidepressants, it’s very important that you don’t suddenly stop taking them. Suddenly stopping can cause withdrawal symptoms. See your GP, who will be able to gradually lower your dose.

Tranquillisers

Benzodiazepines are a group of medicines that are categorised as minor tranquillisers. They include medicines such as diazepam (Valium) and are sometimes used on a short-term basis at the lowest possible dose to treat severe anxiety.

Like antidepressants, benzodiazepines should be stopped gradually to avoid withdrawal symptoms.

Beta-blockers

Beta-blockers are often used to treat cardiovascular conditions, such as heart problems and high blood pressure (hypertension). They’re also sometimes prescribed to help reduce the symptoms of anxiety, such as palpitations (irregular heartbeat).

Beta-blockers slow down your heart rate and decrease your blood pressure. Propranolol (Inderal) is a beta-blocker that’s commonly used to treat anxiety. Possible side effects include:

• stomach problems
• cold fingers
• tiredness
• sleep problems