Living with fear

In any family with children at school, the chances of someone contracting a tummy bug run fairly high. But when the dreaded lurgy strikes any of our three children, it is not only the afflicted one we have to nurse all night, but also the one with emetophobia – a chronic fear of being sick. The symptoms of her fear are often far worse than the reality of the illness itself. And the irony is that the daughter with the phobia knows this.

"I know people feel better after they've been sick," says Polly, age 13. "I tell myself that, but it doesn't make any difference, I still feel panicky and awful if I know anyone near me has a tummy bug."

This is typical of phobias. Phobias are irrational, they do not have any regard for statistical or anecdotal evidence and no amount of reasoning on the part of the sufferer or reassurance from others can help to shift their distressing symptoms. Polly's symptoms are palpable. She does not have to describe them. She comes out in a cold sweat, she goes as white as a sheet and she is unable to lie down, for somehow she associates this with throwing up.

The last time her little brother had a tummy upset, Polly's symptoms persisted long after his were over, affecting her appetite, her ability to concentrate, and making her life at school miserable. "When someone at school tells me they have a tummy ache, it's as if I can't think for myself any more. I just have to get away," she says.

At an age where bravado is all-important, admitting to her phobia can be like a red rag to a bull. Some children are quick to seize on its potential for ridicule. "One girl comes up to me and retches in my ear because she knows I'll panic," says Polly. "I know she's joking, but I feel like one of those cartoon characters, who, when they hear bad news, falls backwards down a big, black hole."

It can be very difficult for anyone not susceptible to similar phobias to empathise with a sufferer when it is so obvious that the object of their fear presents no real danger. But reacting to a person's phobia with intolerance, or with ridicule, only serves to exacerbate their sense of isolation.

According to the Royal College of Psychiatrists, phobias affect about one in 10 of us at some time in our lives, but only a tiny proportion of sufferers ever seek help. One of the reasons for this may well be the worry that the phobia will not be taken seriously, or that it will be misunderstood.

While it is possible to develop a phobia about almost anything (lists in self-help books include hair, mirrors and knees) some are obviously easier for most of us to relate to than others. Patterns of avoidance can vary widely, too, from someone who dislikes touching spiders to someone who can't bear to see a picture of one. At its worst a phobia can become severely debilitating.

The devastating effect phobias can have on a person's life is illustrated in Lemony Snicket's third tragicomic tale of the Baudelaire orphans. In it, Aunt Josephine is afraid of telephones, doorknobs and radiators, among other things. Her fears are so extensive she ends up holing herself up in an inaccessible cave in order to keep herself safe from all the imagined dangers she perceives in her life. Aunt Josephine's experience may not be so very far from that of people who suffer from genuine phobias.

Nicky Lidbetter, of the National Phobics Society, says: "Often people go to enormous lengths to avoid the object of their fear, their whole lives becoming affected by the precautions they have to take to avoid situations which might spark it off."

It is easy to see why something classed as a simple phobia such as Polly's emetophobia (where the sufferer is afraid of a specific thing or situation) can develop into more all-encompassing ones such as agoraphobia (fear of leaving the perceived safety of the home) or claustrophobia (fear of being trapped in enclosed spaces) which can limit the sufferer's life substantially.

While one explanation for the development of phobias is that they are sparked by a specific traumatic event (a bout of severe illness might explain emetophobia, or being stuck in a lift, claustrophobia, for example) this may not always be the case. After all, not everyone goes on to develop a phobia after a trauma, and conversely not everyone with a phobia can trace it back to one upsetting event.

Michael Friedrich, a psychologist and psychotherapist, believes the origin for a person's phobia probably lies in their experience of how anxiety was dealt with by their parents when they were very young.

"We all live with anxiety to one degree or another," he says. "Anxiety about death, separation, intimacy or anger is a basic feeling we all have. If within a family there is a culture of saying, even in distressing situations, 'I can cope with this', then the child will introject that feeling. Conversely, if the parents fail to give this impression, the child will absorb the idea that the world is a frightening place and that stressful or difficult situations can't be dealt with." This message, he believes, can be conveyed even to a very young baby by an anxious mother.

So when is it appropriate to seek help? As adults we may simply decide that if our lives are being restricted beyond a point we can comfortably accommodate, then it is time to look for some treatment. But making this decision on behalf of a child can be more difficult. Young children typically develop fears and phobias, which they grow out of as they develop cognitively and make sense of the world around them. Intervening with a child's phobia too soon may have the counterproductive effect of making the child feel there is something wrong with them, when it is actually just a normal part of growing up.

Lidbetter says: "When a person's lifestyle is having to be significantly changed in order to accommodate the phobia, it probably needs some attention." This might present itself in children as avoidance of school or social occasions, refusal to participate in things the child would otherwise enjoy, and obsessive compulsive rituals that actually begin to dominate their life, such as having to count or check things repeatedly, in an attempt to impose control over the anxiety the phobia engenders.

"If other children in the family begin to pick up the pattern of anxiety and fear, or if they are having to play second fiddle to the phobic child even when they are ill or needy themselves, it is also probably a sign that the phobia is intruding into family life further than is acceptable," she explains.

The search for treatment, once it is established that the phobia is affecting the sufferer's life adversely, however, may not be very straightforward. For a child under the age of 10, the NPS recommends asking the GP for a referral to a child psychologist. But this may not be the quickest or most effective route for older children. Therapists are few and far between on the NHS and there are often long waiting lists. The NPS urges caution when looking for a therapist privately, however. Although there are regulatory bodies for counsellors and therapists, anyone can still set themselves up without necessarily having reached the required level of training to deal with children. One of the safest courses of action is to seek a therapist through an umbrella organisation, such as the National Phobics Society.

"CBT [cognitive behavioural therapy] is very fashionable and is useful for changing negative thought processes," Lidbetter says. "But it requires commitment on the part of the patient to follow through the behavioural experiments, which children may find too demanding. This may sometimes include a gradual exposure to the object of fear [termed systematic desensitisation]."

The NPS believes clinical hypnotherapy can be very helpful for children. This works by encouraging a relaxed state in the patient, similar to daydreaming. Suggestions are then made that help the client to develop strategies to cope with their phobia. It is a gentler sort of systematic desensitisation achieved through visualisation of the frightening thing.

Friedrich favours a psychotherapeutic approach to dealing with a person's phobias, but is aware that entering into psychotherapy is dependent on a person's situation and economic resources. It can be a long-term commitment and very expensive. It is a course of treatment that deals with the underlying causes of the phobia, rather than simply treating the symptoms.

As we have found, it is necessary to keep an open mind when seeking appropriate treatment. Polly has her own views about how much time and energy she is prepared to devote to helping herself, and what sort of therapy she wants to enter into. She has chosen to see a hypnotherapist who she hopes will help her to deal with the phobic symptoms in the short term, but hasn't ruled out other routes.