First, a phobia usually involves having a fear of spiders, dogs, fire, open or closed spaces, heights, animals, blood, or something else. Often, people are affected only when faced with their specific phobia; yet, they can generally switch off when their fear is out of sight.
A specific phobia is persistent and intense. There is a compelling need to flee or avoid the feared object, substance or situation. These are factors that are determined before the symptoms are classified as a phobia. Also, confirming that the person’s fear is seen as irrational and not reasonable in the given situation.
In comparison, people who have obsessions are usually never free from their fears, even though these don’t legitimately exist. For example, having a fear of harm coming to a loved one if certain items are not symmetrical, is an obsession. Subsequently, the corresponding ritual to “prevent” harm is to align the objects repeatedly. It’s these rituals that strengthen the obsession.
There is another factor to consider, which comes from Isaac Mark’s expression “obsessive phobia” which is not, as he puts it, ‘a direct fear of a given object or situation, but rather of the results which are imagined to arise from it’. While there is a distinction between a standard phobia and an obsession, an overlap can be noticed when a person shows signs of one and the other.
So let’s say a person fears spiders but doesn’t think about them when they are out of sight – this would indicate the norm for a standard phobia. For instance, obsessive-compulsive symptoms seen in a person who has OCD is non-existent in the person who has a phobia. However, when someone who fears spiders repeatedly locks all windows and covers door gaps to avoid spiders getting into their home, the diagnosis might be better suited as “obsessive phobia”. This is because obsessional behaviour is being used to counter the feared thing (Issac Mark).
I struggled with an obsessive-phobia similar to that which is described above about spiders; later, I’ll explain how I overcame this. For now, another example is of a man who has a fear of high-rise buildings. Many are visible on his way to work. This man doesn’t think of tall buildings when they are not in sight. But when he walks a different route to work every morning, where the areas are flat, he is using an avoidance ritual, indicating that he has an obsessive-phobia.
In the same way cognitive behavioural therapy (CBT) and exposure response prevention (ERP) are both used to help a person reduce symptoms seen in OCD, the same methods are used to help people overcome phobias and also obsessive-phobias. Medication (SSRIs) and Mindfulness are also often integrated into the person’s treatment plan.
The cognitive side of therapy helps change the perception about feared things, and exposure-response prevention means a person systematically resists giving into compulsions. For example, in graduated steps, the person who has an obsessive-compulsive fear of high-rise buildings would agree to walk by areas where there are tall buildings. First with just one or two, and to tolerate associated anxiety until it reduced naturally, and before going on to the next step, which might be to stand by the buildings; next, to go inside the premises, and so on. The main goal would be to climb the steps of the buildings or to ride up in the elevator.
Overcoming my obsessive-phobia of spiders
TRIGGER WARNING: I dealt with my obsessive-phobia of spiders by initially agreeing not to cover door gaps and to bear with my anxiety until it came down. When my anxiety reduced to 30% on the distress scale overall, I was ready to tackle my next fear on my list, which was agreeing to look at small spiders, then to hold them; next, I looked at bigger spiders, and before letting one crawl on me. Finally, I was able to handle a tarantula!
My Misophonia by Carol Edwards
This educational document takes the reader through an interesting journey in which the author (Carol Edwards) explores personal accounts of living with Misophonia (hatred of sounds) coupled with obsessive-compulsive disorder. Researched information including proposed diagnostic criteria as a standalone neurological disorder for entry into the DSM-5 is added to this fascinating description of one's aversion to sounds, colours, smells and movements with the added detail of grief, sensory processing problems and more. This document comes with a 15-question homework assignment to reinforce the learning objectives and lists some important treatment goals. The article is approx 4,500 words priced at only £2 or currency equivalent. A unique password that links to this document is sent to the buyer's email address following purchase.