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Phobic disorders

Being afraid of being afraid...

NB. In current classifications (DSM-IV), the chapter about anxious disorders includes panic attacks ("spasmophilia") with or without agoraphobia, social phobias, obsessive-compulsive disorders (OCTs) and generalized anxiety.


"Are you afraid of being afraid all over the day?"

The subject who suffers from phobic disorders fears some situations and adopts avoidant behaviours which gradually make up an important handicap.
Despite their high frequence, social phobias remain under-diagnosed and ruin the sick people’s daily psychological and relational life.

These illnesses are gathered together in international classifications (like DSM IV) under the chapter of "Panic disorders".
"Panic attacks", which punctuate their evolution, are characterized by recurrent and unexpected overwhelming feelings of anxiety.
These episodes of intense fear are combined with physical sensations often described as similar to a heart attack with a feeling of imminent death.
The acceleration of the breath, the suffocation and thoracic oppression sensations often evoke a vital emergency (Cf."spasmophilia").
Nb. From our point of view, these functional disorders match a strong signal from the "alarm system" which witnesses for the decompensation of an underlying state of tiredness.
Check the article about the "hypo-sleep syndrome".
The feeling of danger and the panic caused by it seem, to us, rather legitimate.
In our opinion, it is more pragmatic to approach them from the lighting of sleep hygiene and chronobiology.


  • Social phobia
  • Social phobia (or social anxiety) is a performance anxiety which can be assimilated to a total loss of self-confidence.
    The illness induces avoidant behaviours which cause two kinds of handicap.

    • A situational anxiety (fear to lose one’s performances and to do something irrational).
    • A relational anxiety (fear to lose one’s means and be judged badly).


      For each of these 17 items, choose the answers which matche your current state best.
      To obtain your score, just add up the answers.


      1. I am afraid of people in a position of authority.

      Not at all ................ "0"
      A little....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much......... "4"


      2. Blushing in front of others makes upsets me.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................."3"
      Extremely much ...... "4"


      3. I fear parties and fashionable activities.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much.......... "4"


      4. I avoid to talk to people I don’t know.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much ............. "4"


      5. I fear critics.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      6. I avoid to do things or to talk to people out of fear to feel embarrassed.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      7. To sweat in front of others is extremely unpleasant to me.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      8. I avoid parties or other social occasions.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      9. I avoid activities in which I am the center of attention.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      10. I am afraid to talk to strangers.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      11. I avoid to have to make speeches.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      12. I would do anything in order to avoid critics.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      13. I have palpitations if I have to approach other people.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      14. I am afraid to do things if someone can watch me.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      15. The fear of being embarrassed or to be ridiculous is one of my greatest fears.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      16. I avoid to talk to people who are in a position of authority
      .
      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"


      17. To shake in front of others is very unpleasant to me.

      Not at all ................ "0"
      A little ....................... "1"
      Quite much ............. "2"
      A lot .................. "3"
      Extremely much............. "4"

      If your total score on 64 is higher than 20, you may suffer from social phobia and maybe you should see a doctor.

      Social phobia is an extreme form of pathological shyness which often remains unnoticed by relatives but causes a great suffering which causes some forms of insomnia.

      It is associated with numerous "functional disorders" and the feeling of danger which comes over the subject’s life often induces a very "vigile" sleep, sometimes interrupted by very unpleasant and (rightly, in our opinion) worrying neurodystonic disorders.

      In case of disabling attacks, some medications (close to antidepressants) can contribute to restore sleep.
      "Spasmophilia" or panic attacks are very frequent in that context. It is admitted that more than four attacks in one year can benefit from a medication based treatment.


    • Agoraphobia
    • From the Greek "phobos": fear, and "agora" : the public square, it is a form of social phobia characterized by a pathological fear of empty spaces and public places.

      For each of the following items, choose the answer that matches your state best.
      Then, sum them up to obtain your score.

      • . You are able to stay at home.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You go out to walk in the streets of your neighbourhood.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You go out to buy something in a shop nearby.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You drive your car in the surroundings.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You can eat in a restaurant.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You can stand in line at the grocer’s or in the bank.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You are able to take lifts.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You can take the train, the bus, the subway.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You can go out more than 10 miles from your place.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You go to the hairdresser or the doctor.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • .You go to shows, to the cinema
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble .........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You visit big shopping centres.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You go to parties, to play bowling, lottery, and so on.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautionstions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • . You are able to travel to another town without being worried by bridges, motorways, hospitals, and so on.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautionstions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "
      • .You feel able to travel by plane.
        Alone, without trouble................................................................................." 0 "
        Alone, but with some precautionstions ......................................................" 1 "
        With somebody else, without trouble..........................................................." 2 "
        With somebody else, but with some restrictions or a medication ................." 3 "
        No, I totally avoid the situation ........................................................" 4 "

      .

      TOTAL score on 60

      • Lower than 3, you are probably a rather careful person.
      • from 4 to 15 : You still keep control over your fears but you show some agoraphobia type difficulties.
        Seing a specialist might help you to clarify things.
      • From 16 to 30 : Agoraphobia is an important problem for you.
        Fear causes you to live with great limitations of your daily activities and you should see a doctor to find a solution to your state.
      • More than 30 : Your life sometimes looks like hell.
        You probably sleep very poorly and you may suffer from a tendency toward "depression". You really have to try to get some help because it is very difficult to get out of it alone, at that stage.

      Caretaking of phobic disorders :
      "Do not stay alone! "

      These pathologies are very frequent but probably underevaluated by statistics.
      Studies suggest that 5% of the population suffer from it and there exist a lot of sick people support associations.
      One of the characteristics of phobic disorders is that they evolve toward a gradual aggravation of the handicap. They only rarely disappear without help.


      Cognitive behavioural therapies are especially well indicated in the treatment of agoraphobia for which their efficiency has been validated.

      Gradual desensitization techniques (by exposure to the anxiogenic situations combined with relaxation sessions, Cf. "Relaxing techniques") often succeed in defeating the handicap.

      Anxiolytic medications (benzodiazepines) are remarkably efficient when the attacks occur provided their intake is very exceptional because their effect is quicky exhausted.
      In case of frequent attacks, they quicly lead to an addiction and withdrawing from them risks to be combined with a rebound of the symptoms and of anxiety.
      As such, agoraphobia is an increased risk factor for addictive behaviours ("alcohol, narcotics" ) which often lead to a true anxio-depressive vicious circle.


      Antidepressants (which act by increasing an arousing brain hormone : serotonin) are sometimes indicated in some social phobias. We prefer short duration treatments (several weeks, at the most), opposite to the treatment of "depression".


      Beta-blockers are interresting medications to control "emotional symptoms linked to nerves".
      Àt a very low dosage, a quarter of a tablet on demand, they are officially indicated to alleviate physical symptoms of stress (shakings, sweat, diarrhea, dysuria).
      They are tools which contribute, without danger, to gain more self-confidence in front of situations which, then, become less anxiogenic.

      From a "somnicological" point of view (Cf. "neologisms"), the knowledge of "somnications" like (for example) sport, light or pleasure, can enhance the efficiency of sleep and, that way, contribute to space out the attacks.

      Here, again, "learning to sleep better" can help the subject to gain autonomy.

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