First, a phobia usually involves having a fear of spiders, dogs, fire, open or closed spaces, animals, blood, or something else. People are affected usually only when faced with their specific phobia but can generally switch off when their fear is out of sight; or when they are free from confronting a dreaded situation such as attempting to leave the house (agoraphobia) or having to be in a closed-in area (claustrophobia).
A specific phobia, which is persistent and intense and where a compelling need to flee or avoid the feared object, substance or situation are factors that are determined before it can be classified as a phobia. This is as well as confirming that the person’s fear is seen as irrational and not reasonable in the given situation.
In comparison, people who have obsessions are usually never free from their fears even though their fears do not legitimately exist. For example, the fear of contracting cancer from touching door knobs and going to lengths both physically and mentally to avoid the situation is an obsession based on irrational thoughts, not sound reasoning. Regardless of any voluntary attempt to stop these intrusions they unfortunately persist and are strengthened by corresponding compulsions – for example, prolonged handwashing after touching a door handle only serves to reinforce the problem.
There is another factor to consider, which comes from Isaac Mark’s expression “obsessive phobia” which is not, as he puts it, ‘a direct fear of a given object or situation, but rather of the results which are imagined to arise from it’. Basically, while there is a distinction between a standard phobia and an obsession, an overlap can be noticed when a person shows signs of one and the other.
First, let’s say a person appears to have a fear of washing machines whether it is the one at home, in a launderette or in an electrical goods store. Yet at home, they still do their laundry, even though this causes them distress. When other members of the family touch the washing machine, brush past it, or do their laundry, the person again suffers great distress. Despite their discomfort, they are able to gain momentary anxiety relief when doing their own laundry by repeatedly handwashing and so they feel they are in control. But because the family does not carry out the handwashing ritual means the person cannot control the situation. This is because the spread of germs from the family’s dirty clothes and hands onto the machine sends the person’s anxiety off the scale. This shows that they have contamination fears, not a direct fear of the washing machine.
In contrast, a person who fears spiders doesn’t think about them when they are out of sight, which indicates the norm for a standard phobia. This is because the obsessive-compulsive symptoms seen in a person with OCD is non-existent in the person who is phobic. However, when someone who fears spiders repeatedly locks all windows and covers door gaps to avoid spiders getting into their home, the diagnosis might be better suited as “obsessive phobia” because obsessional behaviour is being used to counter the feared thing. (Issac Mark)
In the same way cognitive behavioural therapy (CBT) with exposure response prevention (ERP) are both used to help a person reduce symptoms seen in OCD, the same methods are used to help people overcome phobias and also obsessive-phobias. Medication (SSRIs) and mindfulness techniques are also often integrated into the person’s treatment plan.
The image that accompanies this article shows how I overcame an obsessive-phobia. This was done in graduated steps where at first I resisted the compulsion to cover door gaps, and riding out the anxiety for the duration of my exposures. I then went on to look at and hold small spiders. Later I held larger house spiders… and finally a tarantula!
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Photo credit: flickr
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