Fear is a healthy response to a threatening situation; its origins lie in our natural instinct of self-preservation. But fear that comes for no reason, or obsessive forms of it, can be a symptom of a mental or physical disorder. In some people fear is so pronounced that it lowers their quality of life. Read on to find out what causes fear and how it can be dealt with.
A quick overview ((pathological) fear)
What is fear? Mostly a normal reaction to threatening situations. Some people feel it more often than others, because of their disposition and their experience. Fear becomes pathological if it occurs without a definite cause, turns into a frequent or constant companion and affects the quality of life.
Causes of pathological fear
There are various theories about how pathological fear, or anxiety disorders, develop:
Psychoanalytic approaches assume that anxiety disorders arise in people who have not learned to cope with normal anxiety. They become overwhelmed in situations of conflict, and this leads to uncontrollable childhood sensations of fear.
On the other hand, behavioural therapy approaches see fears as learned. One example is the fear of flying. It can come about if the person concerned has been through a threatening situation on board, such as severe turbulence. Fear can also develop out of simple observation — when a child senses, for instance, that its mother is afraid of a spider.
Neurobiological approaches, for their part, assume that the autonomic nervous system in anxiety patients is less stable than in healthy people and therefore reacts to stimuli especially fast and violently.
Factors
Stress: severe psychological stress can lead to constant anxiety or to panic attacks.
Trauma: traumatic experiences such as war, accidents, abuse or natural disasters can bring on recurring fears.
Alcohol and drug use: the use of drugs such as alcohol, LSD, amphetamines, cocaine or marijuana can also cause anxiety or panic.
Medicines: some medicines can cause a racing heart, shortness of breath and anxiety as a side effect. This is especially true of substances that act on the psyche, the brain and nerve function, that affect the heart and breathing or that disturb the hormonal balance.
Thyroid dysfunction. Both an overactive and an underactive thyroid gland can lead to bouts of anxiety and panic.
Heart conditions: organic heart problems such as cardiac arrhythmia or angina pectoris can also bring on a massive feeling of fear.
Brain diseases: in rare cases the feeling of fear is caused by an organic disease of the brain, such as an inflammation or a brain tumour.
Symptoms
A racing heart, a rapid pulse, sweating, tremor, difficulty breathing, dizziness. In severe cases chest pain, vomiting, diarrhoea, a feeling of oppression, loss of consciousness, the sense that you are outside yourself or going mad, the fear of dying during panic attacks, physical pain caused by the state of anxiety.
Fear: what is normal, what is pathological?
How prone a person is to fear depends on various factors. Disposition plays an important role. Life experience, especially in early childhood, also shapes this “readiness” to be afraid. For some people it is perfectly normal to be shy, to worry more often and to be more cautious than others.
One can speak of pathology if fear arises without any definite cause or even becomes a constant companion. It can then considerably lower the quality of life of the person concerned. Such fears are not a normal reaction to a concrete threat but an independent clinical picture, which should be treated with psychotherapy.
Kindsof pathological fear: generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, phobias, post-traumatic disorder, hypochondria, schizophrenia, depression.
The term anxiety disorder refers to a group of mental disorders in which symptoms of anxiety appear without any external threat. These symptoms of anxiety can be physical (a racing heart, sweating and so on) and psychological (obsessive thoughts of an impending catastrophe, avoiding company, avoiding going out and so on).
An anxiety disorder can take various forms:
Generalised anxiety disorder
For people with generalised anxiety disorder, worry and fear are constant companions. Often these fears have no concrete cause (diffuse worry, fears and general nervousness). They may also relate to real threats (the possibility of a car accident, illness in close relatives and so on), although the symptoms of anxiety are out of all proportion. The feeling of fear is often so strong that everyday life is severely restricted in many areas.
Obsessive-compulsive disorder
This anxiety disorder is marked by obsessive thoughts and/or compulsive actions. Those affected react tensely and anxiously, for example, when they are prevented from carrying out certain rituals. This includes, say, a compulsion to wash the hands, to count objects or to check several times whether the windows are closed. Obsessive thoughts, for their part, may have aggressive, offensive or frightening content.
Phobias
People with a phobia are excessively afraid of certain situations or objects. Most of those affected know that their fears are in fact unfounded. Even so, the corresponding key stimuli sometimes set off violent reactions of fear. Such key stimuli can be certain situations (air travel, great heights, riding in a lift and so on), natural phenomena (thunderstorms, open water and so on) or certain animals (spiders, mice or cats, for example). Sometimes things connected with illness and injury (blood, injections and so on).
Experts distinguish three main forms of phobia:
- Agoraphobia (fear of open spaces): patients with agoraphobia are afraid of the outside world, especially of unfamiliar places or crowds. They are afraid of situations they cannot escape from or cannot control. The anxiety can build up to the point of a panic attack (panic disorder with agoraphobia). In the medium term, those affected suffer from the fear of the fear that comes over them outdoors, and they stop leaving the house at all.
- Social phobia: this is when a person feels fear in company. It seems to them that they are the centre of attention, and this brings on a fear of ending up in an awkward position or of failing, a fear of criticism or of not being accepted. And so they withdraw further and further from social life.
- Specific phobia: here the phobia has a narrowly defined trigger. These are the cases of spider phobia, needle phobia, fear of flying, claustrophobia (fear of confined spaces) and fear of heights.
Post-traumatic syndrome or post-traumatic stress disorder (PTSD)
PTSD arises as a result of an extremely stressful or threatening experience (a trauma). It may be, for example, the experience of war, a natural disaster, a serious accident, the death of a close relative, sexual violence or other violent acts. Post-traumatic stress disorder can subsequently develop not only in those directly affected but also in witnesses of such traumatic events.
So-called traumatic memories are typical of PTSD. These are suddenly surfacing, extremely stressful fragments of memory in which those affected live through the traumatic experience again and again. The memories are set off, for instance, by noises, smells or particular words closely bound up with the traumatic experience. To avoid these stimuli, many traumatised people withdraw. They are extremely nervous and irritable, they suffer from disturbances of sleep and concentration, and at the same time they seem more and more devoid of emotion.
Panic disorder
Patients with panic disorder are often overtaken by massive attacks of fear with severe physical and psychological symptoms. These include shortness of breath, a racing heart, tightness in the throat or a feeling of choking, sweating, nausea, the fear of dying or of losing control, and a sense of unreality.
A panic attack usually lasts less than half an hour. It can come completely out of the blue or it can be set off by certain situations. Panic disorder is very often bound up with agoraphobia (“claustrophobia”): in certain situations (in a crowd, for example) or in certain places (in public spaces or on public transport, for example) people who suffer from panic fear cannot get away on their own or rid themselves of the “trigger”, and on top of that they feel embarrassed at showing symptoms of panic.
Other kinds of pathological fear
People with hypochondria (the new name: hypochondriacal disorder) live in constant fear of suffering from a serious or even fatal illness. They misread harmless physical symptoms. Even doctors’ opinions about their health cannot convince them.
Hypochondria is one of the so-called somatoform disorders — just like cardiac neurosis: here people suffer from strong palpitations and shortness of breath and are afraid of a heart attack, with no organic cause behind the complaints.
Sometimes fear appears as a symptom of other illnesses. People with schizophrenia, for example, often suffer from massive fears. They perceive their outside world as a threat, hallucinations or persecution mania. Depression, too, is often accompanied by objectively unfounded fears.
When should you seek professional help?
In the case of excessive fear, of a state of anxiety that keeps growing and cannot be overcome on your own, of fear with no objective cause and/or a sharply reduced quality of life because of fear.
Assessment: a detailed discussion of the client’s condition, testing.
Therapy: cognitive behavioural therapy, depth psychology methods (psychoanalysis, transactional analysis), learning techniques of self-relaxation and calming, medication.
