Fear Factors

Understand Your Phobias (Rational or Otherwise).

There are plenty of people who coast across the Chesapeake Bay Bridge without even a flicker of anxiety, never giving a thought to any greater calamity than whether they forgot the sunscreen or made an error in judgment in packing the Speedo.

But for some people, the 4.3-mile span sparks feelings from mild consternation to outright panic. What if the bridge sways or collapses? What if an erratic driver forces them out of their lane and into the drink? Or worse still, what if they completely freak out and in a state of panic accidentally drive themselves into the bay?

Some can't even express exactly what it is that terrifies them; they just know how they feel: heart racing, back of the neck on fire, irresistible urge to flee at the mere mention of the b-r-i-d-g-e.

Of course, it's natural to have a little fear. "Some level of anxiety helps warn us when there's danger or motivates us to behave in a certain way," says Jerilyn Ross, a psychotherapist and director of the D.C.-based Ross Center for Anxiety and Related Disorders. "It's healthy."

In other words, if you're eyeball-to-eyeball with a black widow spider, the desire to run screaming from the room falls under the domain of self-preservation. That's good. But if you spend 20 minutes every morning inspecting your shoes to make sure an eight-legged monster isn't lying inside waiting to bite your big toe, fear has probably crossed the line into the irrational. Not so good.

In fact, if your anxiety is so intense that it causes you to alter the way you live, you might be classified as a having a phobia, an anxiety disorder characterized by intense, irrational fear of an object, situation or person. If so, you have company: About 19 million Americans suffer from specific phobias and 15 million more have a social anxiety disorder (the fear of being scrutinized in social situations and found lacking), according to the Anxiety Disorders Association of America.

People with fears and phobias often have physiological responses (sweating, a racing pulse or trembling, for example) as well as a cascade of thoughts about all the terrible things that are about to befall them. They might fear the actual object or situation (the plane they think is going to crash, for example), but many also feel great anxiety over their own potential responses. "They might feel like they will die, go crazy, pass out or just suddenly go charging out of the room," Ross says.

As intense as it can be, the fear itself isn't the real problem. "People don't lose control. They don't drive off the bridge, or pass out, or have heart attacks," Ross says. "The feeling is real, and it's something you need to address, but it is not harmful."

What is harmful, though, is the behavioral response: when people with phobias change the way they live to avoid the thing they fear. They turn down a job offer because they're afraid of public speaking, they drive long distances because they're afraid to fly, they avoid buildings taller than three floors because they're afraid of heights. "I've had people do everything from sitting low in the back seat to locking themselves in the trunk" to get over the Bay Bridge, says Ross, who adds that the bridge, the Capital Beltway and Metro's dizzying escalators are high on the list of locals' fears. Nationally, common fears include public speaking, snakes, spiders, heights, small spaces and elevators.

What's Wrong With You?

Generally speaking, people with intense fears or phobias know their reactions aren't rational. They're well aware that the plane probably won't crash, the dog won't bite, the elevator won't get stuck. But throwing statistics at them won't help. "They say, 'I don't understand why, but I feel like if I do it, I'll die,' " Ross says.

Just what's behind those feelings isn't always clear, either, but phobias often are not rooted in reality, says Bethany Teachman, assistant professor of clinical psychology at the University of Virginia, who points out that Americans have a greater fear of snakes and spiders than they do of handguns. Given that handguns cause far more deaths in the United States than critters do, the fear doesn't make a lot of sense. "It's kind of like we have a leftover response that once was adaptive," she theorizes. "We're sort of predisposed to become afraid of certain kinds of stimuli that were very threatening to our ancestors."

That said, phobias can also stem from personal experience (the person who gets bitten by a dog and afterward has an intense fear of every dog she sees, for example) or from witnessing or reading about traumatic events (which can also cause post-traumatic stress disorder, another anxiety disorder that can have overlapping symptoms).