Phobophobia is a

phobia A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avo ...

defined as the

fear Fear is an intensely unpleasant emotion in response to perceiving or recognizing a danger or threat. Fear causes physiological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear ...

of phobias, or the fear of fear, including intense

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...

and unrealistic and persistent

of the

somatic sensation In physiology, the somatosensory system is the network of neural structures in the brain and body that produce the perception of touch ( haptic perception), as well as temperature (thermoception), body position (proprioception), and pain. It i ...

s and the feared phobia ensuing. Phobophobia can also be defined as the

of phobias or fear of developing a phobia. Phobophobia is related to

anxiety disorders Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...

and

panic attacks Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing ...

directly linked to other types of phobias, such as

agoraphobia Agoraphobia is a mental and behavioral disorder, specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. These situations can in ...

.Griez, E. J. and Van den Hout, M. A. . Treatment of Phobophobia by Exposure to CO2-Induced Anxiety Symptoms. The Journal of Nervous and Mental Disease 171 (1983): 506-508. . When a patient has developed phobophobia, their condition must be diagnosed and treated as part of anxiety disorders. Phobophobia: is the fear of fear itself, but more specifically, of the internal sensations associated with that

and

, which binds it closely to other anxiety disorders, especially with

generalized anxiety disorder Generalized anxiety disorder (GAD) is a mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily function ...

s (free floating fears) and panic attacks. It is a condition in which anxiety disorders are maintained in an extended way, which combined with the psychological fear generated by phobophobia of encountering the feared phobia would ultimately lead to the intensifying of the effects of the feared phobia that the patient might have developed, such as agoraphobia, and specially with it, and making them susceptible to having an extreme fear of panicking. Phobophobia comes in between the

stress Stress may refer to: Science and medicine * Stress (biology), an organism's response to a stressor such as an environmental condition * Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...

the patient might be experiencing and the phobia that the patient has developed as well as the effects on his/her life, or in other words, it is a bridge between anxiety/panic the patient might be experiencing and the type of phobia he/she fears, creating an intense and extreme predisposition to the feared phobia. Nevertheless, phobophobia is not necessarily developed as part of other phobias, but can be an important factor for maintaining them. Phobophobia differentiates itself from other kinds of phobias by the fact that there is no environmental

stimulus A stimulus is something that causes a physiological response. It may refer to: *Stimulation **Stimulus (physiology), something external that influences an activity **Stimulus (psychology), a concept in behaviorism and perception *Stimulus (economi ...

per se, but rather internal dreadful sensations similar to psychological symptoms of panic attacks. The psychological state of the mind creates an anxious response that has itself a conditioned stimuli leading to further anxiety, resulting in a

vicious cycle A vicious circle (or cycle) is a complex chain of events that reinforces itself through a feedback loop, with detrimental results. It is a system with no tendency toward equilibrium (social, economic, ecological, etc.), at least in the short r ...

. Phobophobia is a fear experienced before actually experiencing the fear of the feared phobias its somatic sensations that precede it, which is preceded by generalized anxiety disorders and can generate panic attacks. Like all the phobias, the patients avoids the feared phobia in order to avoid the fear of it.

Cause and symptoms

Phobophobia is mainly linked with internal predispositions. It is developed by the

unconscious mind The unconscious mind (or the unconscious) consists of the processes in the mind which occur automatically and are not available to introspection and include thought processes, memories, interests, and motivations. Even though these processes exis ...

which is linked to an event in which phobia was experienced with

emotional trauma Psychological trauma, mental trauma or psychotrauma is an emotional response to a distressing event or series of events, such as accidents, rape, or natural disasters. Reactions such as psychological shock and psychological denial are typical. ...

and stress, which are closely linked to anxiety disorders and by forgetting and recalling the initiating trauma.Mark, Isaac M. Fear and Phobias. Great Britain: Academic Press, 1969, LCCN 75084222. Phobophobia might develop from other phobias, in which the intense anxiety and panic caused by the phobia might lead to fearing the phobia itself, which triggers phobophobia before actually experiencing the other phobia. The extreme fear towards the other phobia can lead the patient to believe that their condition may develop into something worse, intensifying the effects of the other phobia by fearing it. Also, phobophobia can be developed when anxiety disorders are not treated, creating an extreme predisposition to other phobias. The development of phobophobia can also be attributed to characteristics of the patient itself, such as phylogenetic influence, the prepotency of certain stimuli, individual genetic inheritance, age incidence, sex incidence, personality background, cultural influence inside and outside the family, physiological variables and biochemical factors. Phobophobia shares the symptoms of many other anxiety disorders, more specifically panic attacks and generalized anxiety disorder: #

Dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a common medical c ...

# Heart pounding # An excess of

perspiration Perspiration, also known as sweating, is the production of fluids secreted by the sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and apocrine glands. The eccrine sweat glands are distrib ...

# Slight

paresthesia Paresthesia is an abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) with no apparent physical cause. Paresthesia may be transient or chronic, and may have any of dozens of possible underlying causes. Paresthesias ar ...

# Tension #

Hyperventilation Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blood. ...

Angst Angst is fear or anxiety (''anguish'' is its Romance languages, Latinate cognate, equivalent, and the words ''anxious'' and ''anxiety'' are of similar origin). The dictionary definition for angst is a feeling of anxiety, apprehension, or insec ...

# Faintness # Avoidance

Association with generalized anxiety disorder

Generalized anxiety disorder is when our minds are troubled about some uncertain event,Mark, Isaac M. Living with fear: understanding and coping with anxiety. USA: McGraw Hill, 1978, . or in other words, when we feel threatened, although the source of the threat might not be obvious to us. It is a disorder when it happens frequently, and disables people from accomplishing some of their daily activities. Generalized anxiety disorder always comes before phobophobia, and some of its symptoms are listed below: # Paleness of skin # Sweating # Dilation of pupils # Rapid pounding of heart # Rise in

blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...

# Tension in the muscles # Trembling # Readiness to be startled # Dryness and tightness of the throat and mouth # Rapid breathing # Desperation # A sinking feeling in the stomach # A strong desire to cry, run or hide The main problem with this disorder is that we do not know what we are troubled about, which may lead to our desire to escape. Anxiety becomes a disorder only when we experience psychological trauma, in which our knowledge of past events trigger a fear of uncertain danger in the future. In other words, the primarily event is anxiety which arises for no accountable reason, panic might develop from anxiety and the phobophobia is developed in the very end as a consequence of both of them, sharing some of the symptoms. If either of these initiating disorders are not treated, phobophobia can be developed because an extended susceptibility and experience of this feelings can create an extreme predisposition to other phobias. Anxiety is mainly fixed to a certain specific event or specific events, a strong learned drive which is situationally evoked which is stressful to one person but not to another, and this makes it much easier for phobophobia to develop, as well as other phobias.Levitt, Eugene E. The psychology of Anxiety. USA: The Bobbs-Merrill Company, 1967, LCCN 67-19654.

Association with panic attacks

When people experience panic attacks, they are convinced that they are about to die or suffer some extreme calamityBaker, Roger. Panic Disorder: Theory, Research and Therapy. Ed. Roger Baker. Great Britain: John Wiley and Son Ltd., 1989, . in which some kind of action is done by the individual (such as fleeing or screaming). In case of phobophobia, a panic attack might be encountered as the fear that they will in fact experience the calamities of the feared phobia and see it as something inevitable. Also, the nature of the panic is of profound personal significance to the individual, on a similar way phobophobia is related to the individual. This is why panic attacks are closely related to phobophobia. Nevertheless, they can differentiate themselves by the fact that phobophobia is a psychological fear of the phobia itself that intensifies it, while panic attacks are extreme fear of encountering the calamities of an imminent disaster, and in this particular case, of encountering other phobias, which can be often accompanied by at least four of the following common symptoms of panic attacks: #

Dyspnea Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathing, breathe well enough. The American Thoracic Society defines it as "a subjective experience of brea ...

Palpitations Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart. Symptoms include a rapi ...

Chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...

or discomfort # Choking or smothering sensations #

Vertigo Vertigo is a condition where a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties w ...

or unsteady feelings # Feelings of unreality (depersonalization or derealization) #

Paresthesias Paresthesia is an abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) with no apparent physical cause. Paresthesia may be transient or chronic, and may have any of dozens of possible underlying causes. Paresthesias ar ...

(tingling in hands or feet) # Hot and cold flushes # Faintness # Trembling or shaking # Difficult breathing # Sweating Panic attacks can also be accompanied by disturbance in heart action and feelings of desperation and angst. Being closely related, phobophobia and panic attacks, the first one can be treated like a panic attack with psychological

therapy A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis. As a rule, each therapy has indications and contraindications. There are many different ...

. Moreover, in combination with phobophobia, a patient might be more susceptible to believe that their continuing anxiety symptoms will eventually culminate in a much more severe mental disorder, such as

schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...

Treatment

There are many ways to treat phobophobia, and the methods used to treat panic disorders have been shown to be effective to treat phobophobia, because panic disorder patients will present in a similar fashion to conventional phobics and perceive their fear as totally

irrational Irrationality is cognition, thinking, talking, or acting without inclusion of rationality. It is more specifically described as an action or opinion given through inadequate use of reason, or through emotional distress or cognitive deficiency. T ...

. Also, exposure based techniques have formed the basis of the armamentarium of behaviour therapists in the treatment of phobic disorders for many years, they are the most effective forms of treatment for phobic avoidance behavior.Wolfe, Barry E., et al. Treatment of panic disorder: A Consensus Development Disorder. Ed. Barry E. Wolfe and Jack D. Maser. USA: American Psychiatric Press, 1994, . Phobics are treated by exposing them to the stimuli which they specially fear, and in case of phobophobia, it is both the phobia they fear and their own sensations. There are two ways to approach

interoceptive exposure Interoceptive exposure is a cognitive behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle t ...

on patients: *

Paradoxical intention Paradoxical intention (PI) is a psychotherapeutic technique used to treat recursive anxiety by repeatedly rehearsing the anxiety-inducing pattern of thought or behaviour, often with exaggeration and humor. Paradoxical intention has been shown to ...

: This method is especially useful to treat the fear towards the phobophobia and the phobia they fear, as well as some of the sensations the patient fears. This method exposes the patient to the stimuli that causes the fear, which they avoid. The patient is directly exposed to it bringing them to experience the sensations that they fear, as well as the phobia. This exposure based technique helps the doctor by guiding the patient to encounter their fears and overcome them by feeling no danger around them. * Symptoms artificially produced: This method is very useful to treat the fear towards the sensations encountered when experiencing phobophobia, the main feared stimuli of this anxiety disorder. By ingestion of different chemical agents, such as

caffeine Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used recreationally as a cognitive enhancer, increasing alertness and attentional performance. Caffeine acts by blocking binding of adenosine t ...

, CO₂- O₂ or

adrenaline Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...

, some of the symptoms the patient feels when encountering phobophobia and other anxiety disorders are triggered, such as hyperventilation, heart pounding, blurring of vision and paresthesia, which can lead to the controlling of the sensations by the patients. At first, panic attacks will be encountered, but eventually, as the study made by Doctor Griez and Van den Hout shows, the patient shows no fear to somatic sensations and panic attacks and eventually of the phobia feared. Cognitive modification is another method that helps considerably to treat phobophobics. When treating the patients with the method, doctors correct some wrong information the patient might have about his disease, such as their catastrophic beliefs or imminent disaster by the feared phobia. Some doctors have even agreed that this is the most helpful component, since it has shown to be very effective especially if combined with other methods, like interoceptive exposure. The doctor seeks to convince patients that their symptoms do not signify danger or loss of control, for example, if combined with the interoceptive exposure, the doctor can show them that there is no unavoidable calamity and if the patient can keep themselves under control, they learn by themselves that there is no real threat and that it is just in their mind. Cognitive modification also seeks to correct other minor misconceptions, such as the belief that the individual will go crazy and may need to be "locked away forever" or that they will totally lose control and perhaps "

run amok Amok syndrome is an aggressive dissociative behavioral pattern derived from Malaysia that led to the English phrase, running amok. The word derives from the Malay word , traditionally meaning "an episode of sudden mass assault against people or obj ...

". Probably, the most difficult aspect of cognitive restructuring for the majority of the patients will simply be to identify their aberrant beliefs and approach them realistically. Relaxation and breathing control techniques are used to produce the symptoms naturally. The somatic sensations, the feared stimuli of phobophobia, are sought to be controlled by the patient to reduce the effects of phobophobia. One of the major symptoms encountered is that of hyperventilation, which produce dizziness, faintness, etc. So, hyperventilation is induced in the patients in order to increase their CO₂ levels that produce some of this symptoms. By teaching the patients to control this sensations by relaxing and controlling the way they breathe, this symptoms can be avoided and reduce phobophobia. This method is useful if combined with other methods, because alone it doesn't treat other main problems of phobophobia.

Etymology

The word ''phobophobia'' is an English adaptation of the

Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...

φόβος, ''phobos'', "fear". ''Phobophobia'' literally translates to "fear of fear".

References