Phobophobia: features, possible consequences and treatment methods

“There is nothing more pleasant than disappearing fear,” wrote the famous American writer and philosopher Richard Bach. Only the person who has experienced “fear of fear” - phobophobia can appreciate this dignity and accuracy. By itself, fear, as a habitual reaction to any danger, is a useful feeling, but phobophobia is fear in the absence of an object of fear.

Phobia is an intense, unaccountable fear that appears during the perception of a particular object. The resulting condition is pathological, irrational and uncontrollable. At the same time, a feeling of fear appears regularly, which is explained by the existence of many stressors. With phobias, fears, as a rule, are imaginary, that is, they depend on the individual characteristics of a person's perception of situations and objects. Phobophobia (“fear of fear”) is the fear of the appearance of obsessive fear. This mental disorder is closely related to panic attacks and other phobias.

A distinctive feature of this mental phenomenon is that its manifestations are not associated with a real object, they are born within the psyche of the sick person and depend exclusively on the specifics of his emotional-associative perception of the world. For phobophobia, the intense and painful individual sensations that are fixed in the person’s memory are not always amenable to control and self-control. The emergence of such sensations is irrational, they are not associated with the external environment and its stressors. Provoked by the horror of the possible onset of previously experienced feelings of deep anxiety, helplessness and hopelessness, phobophobia is a closed figure of fear.

Obsessive fear caused by thoughts and feelings of the patient gradually, as the disease progresses, acquires a generalized, all-encompassing quality, which in its development becomes dominant. The patient involuntarily begins to monitor the state of his emotional and mental sphere, waiting for a new attack. Gradually, the expectation of fear becomes permanent and extremely painful, while attempts at self-control and mastering the situation remain hopeless. In the future, forced and painful monitoring of the state of its emotional and mental sphere becomes dominant. The process leads to significant limitations of the patient's capabilities in almost all areas of his activity and, as a result, to possible social self-isolation.

The life of a phobophobic patient is reminiscent of the famous character from the poem for children by A. Barto “Bullhead”.

Going go, swinging,

Sighs on the go:

“Oh, the end is over,

Now I will fall!

Only a person in this situation does not just “sigh”, he really and deeply worries, painfully and cautiously expecting a fall into this oppressive, dark abyss of fear. Such a tense expectation exhausts the psyche, depletes the body until the occurrence of serious diseases of somatic origin.

The disease is triggered by the following external factors:

• circumstances in which the sick person has ever been and was afraid;
• events remembered from books or films;
• emotions are similar to those experienced by patients in previous bouts of phobophobia;
• randomly recorded phrases of the interlocutor and others.

The development of phobophobia occurs in stages.

1. The anxiety period develops from a “shock phase” that overcomes the resistance of the organism. The formation of anxiety sensations is also facilitated by somatic - malfunctions in the adrenal glands, immune and digestive systems occur. Often the appetite is getting worse.
2. Stage of resistance - the mobilization and adaptation of the organism to new conditions. The feelings of anxiety, aggression, and excitability that are characteristic of the first stage are dulled. Despite relative calm, the sense of expectation of sinister fears persists and continues its destructive work.
3. The stage of exhaustion - the resistance of the organism is exhausted, psychosomatic disorders are exacerbated. Possible long-term depressive states and nervous breakdowns. Need medical assistance.

The defining elements of the process of occurrence of the disease are the features of perception of the situation of fear and its sealing. With typical phobias, when they get into a provoking situation, patients link fears with a particular object. In phobophobia, the main element is strong, incomprehensible, spontaneously (as it seems to the patient) pop-up inner feelings of the patient, existing autonomously and depending solely on his emotional state.

Often, different fears can be combined, and one of them, for example, the fear of insanity, dominates, while others form a fatal background for the picture of the disease. Depending on the various circumstances and characteristics of the emotional-associative series of the patient, alternate activation of various fears occurs. Thus, fearing fear, the sick can be afraid of the following aspects:

• a repetition of the experience of the painful sensation of horror;
• experiencing fear as a threat to one's health, since the symptoms of horror may remind you of the symptoms of a heart attack or an asthma attack; hence the fear for their lives, and any strange bodily sensations become suspicious;
• some symptoms of fear form unusual sensations in the head, dizziness, a sense of loss of touch with reality, visual distortions; after which the patient begins to fear for his sanity;
• Often the dominant role in the process is fulfilled by the fear of losing control over oneself (over one’s body, behavior, memory, attention).

The main cause of phobophobia is the influence of negative factors of psychogenic origin, reducing the degree of stress resistance and worsening the patient's physiology. The features of the manifestation of the initial symptoms depend on the level of power and the mode of action of the original negative stressor. If the initial traumatic event was relevant to the individual, then there is definitely a possibility of the occurrence of the disease. With repeated, but weak effects of stressors, the disease will develop gradually, flowing covertly until reaching its peak. People most prone to this disease are:

• highly emotional;
• with low stress resistance;
• shy and timid;
• overly suspicious;
• with choleric or melancholic temperament;
• conflicting.

There are a number of scientific concepts in one way or another, explaining the causation of phobic disorders.

• Psychoanalytic. Psychoanalysts believe that one of the causes of the disease may be costs in the family upbringing of children (over-care, isolation, and others). In their opinion, the cause of phobias can be the suppression of sexual desires, fantasies, reincarnated into neuroses and panic attacks.
• Biochemical. Biochemists hold the opinion that fear develops due to disturbances and failures in the work of hormonal and other body systems.
• Cognitive. The cognitive-behavioral concept defends the view that the formation of prerequisites for the disease is promoted by: concern for one's health, conflict and a negativist way of thinking, social isolation, unhealthy family environment.
• Hereditary. Inherited views on the causes of the disease are related to the likely influence of genes on its development. Data from some scientific studies support this concept.

The following factors may affect the possible development of phobophobia in varying degrees:

• traumatic brain injury;
• overwork, lack of proper rest;
• alcoholism, drug addiction;
• nervous overexcitement and conflicts;
• poisoning;
• diseases of internal organs.

The psychosomatic picture of the disease determines an extremely wide range of symptoms (signs) in the development of phobophobia. Disturbing memories can be triggered by completely different factors. Moreover, such a variety of symptoms largely depends on the individual characteristics of temperament, character, personal characteristics of a person and his life experience, the combination of which, as is known, is unique. Self-control, as one of the key traits of a person’s character, which determines not only the ability to control oneself, emotions, act effectively in meaningful and critical circumstances, makes it possible to obtain a decent social status. A person who is not able to control himself, as a rule, becomes an outcast in any social group. This social taboo in tandem with psychasthenic and demonstrative personality traits often leads to the formation of phobias.

Sensing the futility of personal control over their thoughts and memories, phobophobic patients attempt to control the outside world. To do this, they often form a complex system of rituals, usually hidden from others. In particular, the absence of a certain object of fear leads to a strengthening of the tendency to avoid. A phobophobic person may be afraid of claustrophobia during a trip in a car, flying in an airplane, or afraid to communicate with another person.

Often, patients with phobophobia associate personal fears with anxiety about their health. In these cases, possible focus on the autonomic symptoms or violations in the perception of themselves and the world. As a rule, such patients complain of palpitations, lack of air, weakness in the legs, dizziness, discomfort in the stomach, nausea and involuntary urination to urinate. Some patients record a feeling of loss of control over their bodies, a certain "emptiness" in the head, a narrowing of the visual field and visual distortions. Such symptoms lead to the appearance of fear of death, insanity, or loss of memory.

The imagined images of the tragic consequences of phobophobic attacks lead to adrenaline rush, affecting the functioning of the vegetative system - the rhythms of pulse and breathing increase, the tone of smooth muscles changes. All this leads to the occurrence of the above symptoms. Thus, mental phenomena lead to somatic changes in the body - the prophecies of the patient with phobophobia become reality, self-fulfilling.

To provoke an attack can and any bodily sensations. In the future, they begin to be caused not only negative, but also positive emotions. The more the disease is started, the more frequent and intense the attacks become. Other mental disorders are added to the fear of fear: depression, generalized anxiety and obsessive-compulsive disorders. Becoming possible: alcoholism, abuse of benzodiadepines or sedatives.

Thus, the following can be attributed to the main features of phobophobia:

• a sense of powerlessness from the inability to exercise control over your thoughts;
• attempts to form and maintain a special protective ritual system leading to isolation;
• bouts of claustrophobia and social phobia;
• appropriate autonomic symptoms.

In its development, phobophobia becomes a pathological process, an obsessive, dominant over the mind and an objective assessment of reality. The self-reinforcing mechanism of phobophobia triggers a significant deterioration in the overall condition of the body. In addition, it can be a real basis for the emergence of a number of negative dependencies (alcoholism, drug addiction and others), by resorting to which patients try to avoid painful conditions. As a result of the triggering of the defense mechanisms, patients have a persistent desire for self-isolation so that casual communication with someone does not lead to another attack.

The real danger is that the phobophobia is a constant test for the whole organism. First of all, the cardiovascular, nervous, endocrine and digestive systems suffer. The psychological state is also significantly worsening, and severe mental illnesses develop. The damage to the body is significant and sometimes irreparable. Seeking medical help becomes necessary. The doctor, examining the patient, will select the appropriate method of correction and therapy.

The diagnosis of the disease is determined on the basis of the patient's complaints, the results of the examination and special testing. Anxiety and depression scales of Beck, Hamilton and HADS, Zang scale (for self-assessment of anxiety) and other methods can be used to diagnose the disease. If you suspect any somatic pathology of the patient is sent for consultations to the therapist and other professionals. The treatment is carried out according to an individual plan, taking into account the patient's condition, the presence or absence of other mental and somatic deviations.

Drug treatment is implemented when it is associated comorbid depressive disorders, a high level of anxiety, psychological exhaustion, and the absence of any resources in the patient for psychotherapeutic work. Often used beta-adrenergic receptor blockers, benzodiazepine tranquilizers, tricyclic and serotonergic antidepressants.

In order to eliminate the causes of its development, various psychotherapeutic methods are used: cognitive-behavioral and rational therapy, psychoanalysis, hypnosis, and neuro-linguistic programming.The main focus in psychotherapy of phobophobias is to strengthen the adaptive abilities of the body to traumatic sensations, to create a new way for the patient to respond to the “terrible” reality, which manifests itself in the following:

• in the course of cognitive work with the disease, the individual realizes the mechanism of development of phobophobia and what exactly he is afraid of, a real or imaginary threat;
• the building of the so-called anticipating consciousness of perception of fear, readiness and ability to meet an attack occurs, forming a preliminary basis for productive response;
• teaching the patient how to act (not passive waiting); such actions must be active, conscious and purposeful.

An effective way of gradually mastering and curbing a phobia is desensitization. The significant bodily tension generated by fear is reduced by using a special technique of voluntary relaxation, which allows you to master your mind and emotional state. The emergence, development of phobophobia and other phobias associated with the disease is a completely unexplored psychological phenomenon. It is important to understand that mental tension, irrational and negative ways of thinking contribute to the development of anxiety and fear. This is a clear hint to the patient and an undoubted resource for a productive way out of the situation and victory over the disease. The prognosis of the results of treatment depends on the severity of the phobophobia, the duration and stage of its development, the presence of other mental disorders, maturity and the readiness of the individual for a final cure.