Phobias are irrational, but they can make life difficult, and in some cases even affect your health and relationships. Psychiatrist Prof Michael Simpson responds to sufferers’ questions.

Q: Social phobia 1
I think I am crazy. At work I experience social phobia. I've been there for almost six years and have been on anti-depressants, and have had cognitive behavioural therapy (CBT). However, when I am with people I don't know, including people from other departments at work, I am chatty, energetic and happy. It's as if I’m leading two lives. What is this, and why does this happen? Would changing jobs help me change my behaviour?

A: I don't hear anything crazy in what you describe. Apparently your social anxiety is caused by worrying excessively about what people you know think of you. You feel more relaxed among strangers because you don't care what they think. These are issues which a competent CBT therapist would want to know about and work on. The fact that you are socially adept in some settings proves beyond doubt that you can act normally in a social situation. You just need to learn how to act the same way in all settings.

Q: Social phobia 2
I've been struggling with social phobia for most of my life and as a result developed depression. I addressed the problem, but only after my second visit to a psychiatric hospital and many sessions with a psychologist can I truly say I've beaten my phobia.

The problem is that I now want to find work. Although I completed a few academic courses I wasn't ever able to work and gain experience, and also have no references. What should my answer be if a potential employer asks me what I've been doing all this time?

A: I'm pleased to hear you feel that you're no longer suffering from social phobia, but I would urge you to complete a full course of treatment to make sure that the problem doesn't return.

As for work-seeking, it's hard for even the most healthy and brilliant of us, these days. Some will advise you to lie (though I'm not sure what you would say and if it would work). Also, if you get caught lying, it could have unfortunate consequences. You could of course just tell the truth – ask your therapist about this. Personally, I'd rather employ someone who has fully recovered from a recognised disorder than someone who’s just been idling around for a number of years.

Q: Needle phobia
I have to go for a blood test, but I'm petrified of needles and I can hardly look at one without passing out. I have never been hurt by a needle, or suffered any trauma involving needles that I can remember – they just scare me. Are you familiar with this phobia, and how do I overcome it? Any advice would be great; I'm prepared to try just about anything.

A: The good news is that this kind of phobia responds beautifully to treatment. I once treated one of my medical students with needle phobia, and he went on to become a plastic surgeon. Cognitive behavioural therapy (CBT), or the earlier form of behaviour therapy, works well and fairly rapidly and can help you to quickly unlearn this inappropriate and inconvenient phobia and fear.

An important point about phobias is that they are not rational. It's not the pain you fear but some aspect of the idea of needles, which can fairly easily be removed. We usually don’t know why the situation arose in the first place, and fortunately it’s not something we need to know – you can lose the fear without ever having to understand it in the traditional way.

Q: Earthworm phobia
I've had a phobia of earthworms since the age of 4 (I'm now 36). To other people it sounds utterly stupid, but it seriously impacts my life. When it rains, I don't want to leave the house as there are always worms on the pathway, and it takes all the strength I have to venture out to my car. When I see worms, I can't describe the terror inside me: I feel nauseous and my whole body shakes.

I can remember the incident which sparked this phobia. I was 4 years old, playing in the garden with a hose pipe with my sisters. I'd never seen a worm before and somehow one got onto my shoe, and I remember screaming as my sisters taunted me, saying it was going to eat me. Stupid, I know! But the phobia has stuck ever since. My parents tried to help me overcome my fear as a child by getting me into the garden to look at worms, but it never worked. I can't stand the sight of worms even if it's a picture in a magazine or on TV. Snakes don't bother me, nor do snails etc. – it’s only worms. How do I overcome this phobia? And do medical aids cover treatment for phobias? I really need help to overcome this problem.

A: Yes, phobias are a bother, and they involve being scared of something that isn't particularly frightening to anyone else (nobody complains of a phobia for bombs or man-eating tigers because you’re supposed to be scared of those) – and how very specific they usually are. I'm however surprised that you manage to encounter so many earthworms. Apart from the occasional spineless wonder (of the human variety), I hardly ever run into them.

Actually, your description of the situation is excellent, and also reminds us of the senseless cruelty of sisters and others who think it’s harmless fun to taunt a frightened child. Such a specific phobia is a well-recognised diagnosis. It can be quite disabling, and certainly any good medical aid should pay for such treatment. Fortunately, this can be effectively treated. Personally, I'd recommend seeing a good psychologist, as the best treatment would be behavioural therapy, which needn't take long.

Eventually you could become not only a keen gardener, but even run a worm-farm, if you chose to. The point is that you could soon be free to make the choice, rather than be too frightened to even think about it. A psychiatrist would probably prescribe a drug, though I think they are far less useful in these very specific phobias than in more generalized anxiety disorders. So, go and see a psychologist, and set yourself free from your fear.

Q: Cockroach horror
I was recently told that my life-long fear of cockroaches could in fact be a phobia. I have always laughed at the number of phobias out there, and am convinced that most of them are nonsense – so I don't really want to believe that I might have one.

When faced with cockroaches, I can't breathe and scream and cry like a crazy person. If one touches me I have to bath or shower in insanely hot water to remove any traces of it. Even thinking about those horrible creatures makes my heart race and my palms sweaty and causes my chest to feel tight. I can't look at pictures of them without feeling sick.

I've never been attacked by one, nor have I had an infestation or anything like that. I am just really terrified of them. Does this sound like a phobia or do I just hate them?

A: Few people actually like cockroaches, and they are definitely nasty creatures. Depending on the degree of dislike, one could indeed have a phobia of cockroaches. And the sort of reaction you describe certainly sounds excessive and phobic. Indeed, you provide a textbook description of a phobia.

Go and see a good psychologist who will assess you and provide CBT (cognitive behavioural therapy). This will rid you of your phobia. It doesn't mean that you'll come to like the critters, but you will be able to deal with them calmly (possibly with a can of insecticide) without the usual overreaction.

Q: Daughter's fear of choking
My daughter suffers from a choking phobia. She seems to be eating well, but is still losing weight. Could this be because of her fear of choking?

A: This is hard to diagnose without a consultation. Phobias are common, and fear of choking isn't particularly rare. If it's severely limiting the quantity and quality of food she is consuming, obviously that could cause weight loss. There could be other reasons for weight loss, which would need to be checked out. There are also physical reasons for choking sensations, which can also cause weight loss.

She needs to be seen by a psychiatrist for a full assessment, and perhaps, after a session with the psychiatrist, she should also see a specialist in internal medicine or gastrology to examine her swallowing mechanism and check for any other possible physical cause of these problems.

Q: School phobia
I have a 15-year-old son who is in Grade 9 and has not been to school for the past two weeks. He gets dressed but at the last minute will not go. When questioned why not he says that he does not know why he cannot go.

A: He is rather old for the more usual form of school phobia, and one wonders what he’s not telling you. It may indeed be bullying (kids can be extraordinarily cruel to each other) or perhaps adolescent problems about feeling odd about oneself, perhaps in relation to teachers.

Kids mature sexually at different rates, and they can feel awful if the school compels for example nude showers, and they've been teased by other kids. There are many such possible causes. It's worth spending time, not in the early morning crisis-time, but in the more relaxed evenings, talking at length about school, how he finds it, what he enjoys most, what he enjoys least, what the different teachers are like, how the other kids behave and so forth. Talk to his teachers to see if they're aware of any problems. Does he have close friends you could ask – and who could come and talk with him?

Q: Colour phobia
Can one develop a phobia, fear, dislike of colours, such as black and red? They aren't exactly relaxing colours to me. I don't think I associate them with pleasant things. How would this be treated? I think I've developed this problem and don't even want to wear black or red. I spot these colours straight away without looking out for them. I hope I’m not losing my mind. I must add that I've been under a lot of stress. It’s a real problem because these colours are everywhere.

A: What you are describing surely happens, though I don't think it's really a phobia – it's more of a dislike. I dislike guavas, and avoid them, but I have no phobia, and don't actively fear them. Black and red aren't generally the most popular colours, nor generally found to be relaxing, even to those who like them.

You certainly are not losing your mind, though you may be suffering from general anxiety, which you focus on these (quite innocent) colours, rather than on whatever is really bothering you. Go and see a good CBT  counselor/therapist, who could rapidly help you to understand this, learn how to cope better with your stressors, and lose your annoying association with these colours.

Image via Thinkstock.

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