Evidence / Health

Fears, Phobias and Facts

An article in the NY Times recently captured my attention, in which the author, a professor of medicine at NYU, divulges:“I have misophonia, a condition with which certain sounds can drive someone into a burst of rage or disgust. Although only identified and named in the last 20 years, misophonia has been enthusiastically embraced, with websites, Facebook pages and conferences drawing small armies of frustrated visitors… Coined by the married researchers Margaret and Pawel Jastreboff of Emory University in 2002, misophonia (“hatred of sound”) is sometimes referred to as selective sound sensitivity syndrome.”

Graph taken from Pediatrics 2011 Nov 128(5) 917-25, FIGURE 1Now, I hate the sound of someone chewing gum, but I wouldn’t label myself as having misophonia. But certainly an interesting aspect of human experience is what distinguishes a routine dislike or fear into a phobia or pathology. For example, while many people dislike public speaking, far fewer actually exhibit the diagnosed fear of public speaking known as glossophobia.  Similarly, while approximately 50-60% of adolescents can be classified as shy, only 12% of these shy adolescents are characterized as possessing social phobia, a classified psychiatric disorder.
NCS soc specifSo what distinguishes the routine from the extraordinary in terms of our fears, anxieties and phobias? Much of the difference appears to be in our neuronal networks, as individuals with extreme phobias exhibit “patterns of hyperactivation in emotion-generating regions and hypoactivation in regulatory regions.” Too much emotion, and too little regulation. Other research in identical twins suggests that while 30-40% of phobias are heritable (i.e., genetic), there is also a large environmental component that contributes to the development of phobias in the context of social, individual and home experiences. Interestingly, the prevalence of phobias is increasing, with approximately 11% of the population suffering from them (they are the most common psychiatric disorder). The onset occurs typically in childhood and adolescence, and sadly, less than 25% of phobics receive treatment.

As someone who doesn’t suffer from debilitating fear or emotion over any one particular thing, having such an extreme dislike, fear or anxiety is difficult to imagine. The impact on every day life and well-being seems extraordinary, especially if the object of the phobia is something as common place as a fear of walking (ambulophobia). On a positive note, I guess perhaps the least destructive phobia would be this condition I read about a few years ago in the New York Times: cicadophobia, or fear of the coming of the 17 year cicada.

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