Resources
Phobias
KE Y T E RM S
Finger stick—A technique for collecting a very
small amount of blood from the fingertip area.
Hemochromatosis—A genetic disorder known as
iron overload disease. Untreated hemochromatosis
may cause osteoporosis, arthritis, cirrhosis, heart
disease, or diabetes.
Thrombocytosis—A vascular condition character-
ized by high blood platelet counts.
Tourniquet—Any device that is used to compress a
blood vessel to stop bleeding or as part of collecting
a blood sample. Phlebotomists usually use an elas-
tic band as a tourniquet.
Venesection—Another name for phlebotomy.
their hematocrit checked with a finger stick test prior
to donation.
Aftercare
After blood is drawn and the needle is removed,
pressure is placed on the puncture site with a cotton
ball to stop bleeding, and a bandage is applied. It is not
uncommon for a patient to feel dizzy or nauseated
during or after phlebotomy. The patient may be
encouraged to rest for a short period once the proce-
dure is completed. Patients are also instructed to drink
plenty of fluids and eat regularly over the next 24
hours to replace lost blood volume. Patients who
experience swelling of the puncture site or continued
bleeding after phlebotomy should get medical help
at once.
Risks
Most patients will have a small bruise or mild
soreness at the puncture site for several days. Thera-
peutic phlebotomy may cause thrombocytosis and
chronic iron deficiency (anemia) in some patients. As
with any invasive procedure, infection is also a risk.
This risk can be minimized by the use of prepackaged
sterilized equipment and careful attention to proper
technique.
Normal results
Normal results include obtaining the needed
amount of blood with the minimum of discomfort to
the patient.
G A LE EN CY C LO PE DI A O F ME D IC I NE 4 T H E DI T IO N
(c) 2011 Cengage Learning. All Rights Reserved.
PERIODICALS
Appold, Karen. ‘‘An optimistic outlook: advances in phle-
botomy promise improvement.’’ Journal of Continuing
Education Topics & Issues. April 2010: 62–66.
Paula Anne Ford-Martin
Phobias
Definition
A phobia is an intense but unrealistic fear that can
interfere with the ability to socialize, work, or go
about everyday life, brought on by an object, event,
or situation.
Demographics
Phobias occur in all races, with social phobia
being the most common type of phobia and agorapho-
bia being the least common. Women are more likely to
suffer from a phobia than men at a ratio of about two
to one. Simple and social phobias appear earlier in life
(at a median age of 15 and 16) than agoraphobia
(which appears at a median age of 29).
Description
Just about everyone is afraid of something such as
an upcoming job interview or being alone outside after
dark, but about 18% of all Americans are tormented
by irrational fears that interfere with their daily lives.
They are not ‘‘crazy’’—they know their fear is unrea-
sonable, but they cannot control the fear. These peo-
ple have phobias.
Phobias belong to a large group of mental problems
known as anxiety disorders that include obsessive-
compulsive disorder (OCD), panic disorder, and post-
traumatic stress disorder (PTSD). Phobias themselves
can be divided into three types:
 specific phobias (formerly called ‘‘simple phobias’’)
 social phobia
 agoraphobia
Specific phobias
As its name suggests, a specific phobia is the fear
of a particular situation or object, including anything
from airplane travel to dental visits. Found in one out
of every 10 Americans, specific phobias seem to run in
families and are roughly twice as likely to appear in
females. If the person rarely encounters the feared
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 object, the phobia does not cause much harm. How-
Phobias
ever, if the feared object or situation is common, it can
seriously disrupt everyday life. Common examples of
specific phobias, which can begin at any age, include
fear of snakes, flying, dogs, escalators, elevators, high
places, or open spaces.
Social phobia
People with social phobia have deep fears of being
watched or judged by others and being embarrassed in
public. This may extend to a general fear of social
situations or be more specific or circumscribed, such
as a fear of giving speeches or of performing (stage
fright). More rarely, people with social phobia may
have trouble using a public restroom, eating in a res-
taurant, or signing their name in front of others.
Social phobia is not the same as shyness. Shy
people may feel uncomfortable with others, but they
do not experience severe anxiety, do not worry exces-
sively about social situations beforehand, and do not
avoid events that make them feel self-conscious. On
the other hand, people with social phobia may not be
shy; they may feel perfectly comfortable with people
except in specific situations. Social phobias may be
only mildly irritating, or they may significantly inter-
fere with daily life. It is not unusual for people with
social phobia to turn down job offers or avoid rela-
tionships because of their fears.
Agoraphobia
Agoraphobia is the intense fear of feeling trapped
and having a panic attack in a public place. This type
of phobia usually begins between ages 15 and 35, and
affects three times as many women as men, or about
3% of the population.
An episode of spontaneous panic is usually the
initial trigger for the development of agoraphobia.
After an initial panic attack, the person becomes
afraid of experiencing a second one. Individuals
‘‘fear the fear,’’ and worry incessantly about when
and where the next attack may occur. As they begin
to avoid the places or situations in which the panic
attack occurred, their fear generalizes. Eventually the
person completely avoids public places. In severe
cases, people with agoraphobia can no longer leave
their homes for fear of experiencing a panic attack.
Causes and symptoms
Experts do not really know why phobias develop,
although research suggests the tendency to develop
phobias may be a complex interaction between heredity
and environment. Some hypersensitive people have
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(c) 2011 Cengage Learning. All Rights Reserved.
unique chemical reactions in the brain that cause them
to respond much more strongly to stress. These people
also may be especially sensitive to caffeine, which trig-
gers certain brain chemical responses.
While experts believe the tendency to develop pho-
bias runs in families and may be hereditary, a specific
stressful event usually triggers the development of a
specific phobia or agoraphobia. For example, someone
predisposed to develop phobias who experiences severe
turbulence during a flight might go on to develop a
phobia about flying. What scientists do not understand
is why some people who experience a frightening or
stressful event develop a phobia and others do not.
Social phobia typically appears in childhood or ado-
lescence, sometimes following an upsetting or humiliating
experience. Certain vulnerable children who have had
unpleasant social experiences (e.g., being rejected) or
who have poor social skills may develop social phobias.
The condition also may be related to low self-esteem,
unassertive personality, and feelings of inferiority.
A person with agoraphobia may have a panic
attack at any time, for no apparent reason. While the
attack may last only a minute or so, the person remem-
bers the feelings of panic so strongly that the possibility
of another attack becomes terrifying. For this reason,
people with agoraphobia avoid places where they might
not be able to escape if a panic attack occurs. As the fear
of an attack escalates, the person’s world narrows.
While the specific trigger may differ, the symp-
toms of different phobias are remarkably similar.
These include feelings of terror and impending
doom, rapid heartbeat (tachycardia) and rapid breath-
ing, sweaty palms, and other features of a panic attack.
Individuals may experience severe anxiety symptoms
in anticipating a phobic trigger. For example, some-
one who is afraid to fly may begin having episodes of
pounding heart and sweating palms at the mere
thought of getting on a plane in two weeks.
Diagnosis
A mental health professional can diagnose pho-
bias after a detailed interview and discussion of both
mental and physical symptoms. Social phobia is often
associated with other anxiety disorders, depression, or
substance abuse.
Treatment
People who have a specific phobia that is easy to
avoid (e.g. fear of snakes) and that does not interfere
much with their lives may not need to get help. When
phobias do interfere with a person’s daily life, a
G AL E E NC Y CL O P ED I A O F M E DI C IN E 4 T H ED ITION

KEY TERM S
Agoraphobia—An intense fear of being trapped in a
crowded, open, or public space where it may be
hard to escape, combined with the dread of having
a panic attack.
Benzodiazepine—A class of drugs that have a hyp-
notic and sedative action, used mainly as tranquil-
izers to control symptoms of anxiety.
Beta blockers—A group of drugs that are usually
prescribed to treat heart conditions, but that also
are used to reduce the physical symptoms of
anxiety and phobias, such as sweating and
palpitations.
MAO-B inhibitors—Inhibitors of the enzyme mono-
amine oxidase B. MAO-B helps break down dopa-
mine; inhibiting it prolongs the action of dopamine
combination of psychotherapy and medication can be
quite effective in reducing the phobia to manageable
levels.
Psychotherapy
Cognitive-behavioral therapy adds a cognitive
approach to more traditional behavioral therapy. It
teaches individuals how to change their thoughts,
behavior, and attitudes, while providing techniques
to lessen anxiety, such as deep breathing, muscle relax-
ation, and refocusing. One cognitive-behavioral
approach is desensitization (also known as exposure
therapy), in which people gradually are exposed to the
frightening object or event until they become used to it
and their physical symptoms decrease. For example,
someone who is afraid of snakes might first be shown a
photo of a snake. Once the person can look at a photo
without anxiety, he or she might then be shown a video
of a snake. Each step is repeated until the physical
symptoms of fear, such as pounding heart and sweat-
ing palms, disappear. Eventually, the person might
reach the point where he or she can touch a live
snake. Three-fourths of patients are significantly
improved with this type of treatment.
Another more dramatic cognitive-behavioral
approach is called flooding. It exposes the person
immediately to the feared object or situation. The per-
son remains in the situation until the anxiety lessens.
Drugs
Medication can block the feelings of panic and
when combined with cognitive-behavioral therapy,
G A LE EN CY C LO PE DI A O F ME D IC I NE 4 T H E DI T IO N
(c) 2011 Cengage Learning. All Rights Reserved.
Phobias
in the brain. MAOs can be used to treat social
phobia.
Selective serotonin reuptake inhibitors (SSRIs)—A
class of antidepressants that work by blocking the
reabsorption of serotonin in the brain, raising the
levels of serotonin. SSRIs include Prozac, Zoloft,
and Paxil.
Serotonin—5-Hydroxytryptamine; a substance that
occurs throughout the body with numerous effects
including neurotransmission in the brain. Inad-
equate amounts of serotonin are implicated in
some forms of depression, obsessive-compulsive dis-
order, and anxiety disorders.
Social phobia—Fear of being judged or ridiculed by
others; fear of being embarrassed in public.
can be effective in reducing phobias. Drug therapy is
individualized based on the age of the patient, severity
of the phobia, co-existing physical and/or mental dis-
orders, and history of drug or alcohol addition.
Several drugs are used to treat specific phobias
and social phobia by controlling symptoms and help-
ing to prevent panic attacks. Treating agoraphobia is
more difficult than treating other phobias because
there are often so many fears involved, such as open
spaces, traffic, elevators, and escalators.
Drugs often used to treat phobias include anti-
anxiety drugs such as buspirone (BuSpar) and benzo-
diazepines such as such as alprazolam (Xanax), lor-
azepam (Ativan), clonazepam (Klonopin), and
diazepam (Valium). Antihypertensive beta-blockers
(drugs that lower blood pressure), such as propranolol
(Inderal), atenolol (Tenormin), and nadolol (Cor-
gard), appear to work well in the treatment of circum-
scribed social phobia when anxiety gets in the way of
performance, such as public speaking. These drugs
reduce overstimulation, thereby controlling the phys-
ical symptoms of anxiety.
In addition, some antidepressants may be effective
when used together with cognitive-behavioral therapy.
These include venlafaxine (Effexor), imipramine (Tofra-
nil), desipramine (Norpramin), nortriptyline (Pamelor),
duloxetine (Cymbalta), clomipramine (Anafranil), cita-
lopram (Celexa), escitalopram (Lexapro), fluoxetine
(Prozac), paroxetine (Paxil), sertraline (Zoloft) and flu-
voxamine (Luvox). The monoamine oxidase inhibitor
(MAO inhibitor) phenelzine (Nardil) may be used when
treatment with antidepressants fails or is not tolerated.
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 Home remedies
Phosphorus imbalance
In all types of phobias, symptoms may be eased by
lifestyle changes, such as:
 eliminating caffeine
 reducing or eliminating alcohol use
 eating a healthy diet
 getting plenty of exercise
 reducing stress
Prognosis
Phobias are among the most treatable mental
health problems. Depending on the severity of the
condition and the type of phobia, most properly
treated individuals can go on to lead normal lives.
Research suggests that once a person overcomes the
phobia, the problem may not return for many years, if
at all.
Although phobias are highly treatable, only about
20% of specific phobias will go away without treat-
ment, and agoraphobia will get worse with time if
untreated. Social phobias tend to be chronic and are
not likely go away without treatment. Moreover,
untreated phobias can lead to other problems, includ-
ing depression, alcoholism, and feelings of shame and
low self-esteem. Unfortunately, only about 25% of
people with phobias seek help to deal with their
condition.
Prevention
There is no known way to prevent the development
of phobias. Medication and cognitive-behavioral ther-
apy may help prevent the recurrence of symptoms once
they have been diagnosed.
Resources
BOOKS
Elliott, Charles H. and Smith, Laura L. Overcoming Anxiety
for Dummies. New York, NY : Wiley Pub., 2003.
Liebgold, Howard. Freedom From Fear. New York, NY :
Citadel Press, 2004.
Rachman, Stanley and de Silva, Padmal. Panic Disorder. 3rd
ed. Oxford; New York : Oxford University Press, 2009.
OTHER
Medline Plus. Phobias. January 21, 2010. http://www.
nlm.nih.gov/medlineplus/phobias.html
Richards, Thomas A., PhD. Anxiety Network Homepage.
Undated [accessed February 3, 2010]. http://www.
anxietynetwork.com
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(c) 2011 Cengage Learning. All Rights Reserved.
ORGANIZATIONS
American Psychiatric Association, 1000 Wilson Boulevard,
Suite 1825, Arlington, VA, 22209-3901, (703)907-7300,
apa@psych.org, http://www.psych.org.
Anxiety Disorders Association of America, 8730 Georgia
Ave., Suite 600, Silver Spring, MD, 20910, (240)
485-1001, (240) 485-1035, information@adaa.org,
http://www.adaa.org.
National Anxiety Foundation, 3135 Custer Dr., Lexington,
KY, 40517, 606-272-7166, http://www.lexington-on-
line.com/naf.html.
National Institute of Mental Health, 6001 Executive
Boulevard, Room 8184, MSC 9663, Bethesda, MD,
20892-9663, (301) 443-4513. TTY (301) 443-8431, (866)
615-6464 TTY (866) 415-8051 , (301) 443-4279,
nimhinfo@ nimh.gov, http://www.nih.nih.gov.
Carol A. Turkington
Rebecca J. Frey, PhD
Tish Davidson, AM
Phospholipidosis see Pulmonary alveolar
proteinosis
Phosphorus imbalance
Definition
Phosphorus imbalance refers to conditions in
which the element phosphorus is present in the body
at too high a level (hyperphosphatemia) or too low a
level (hypophosphatemia).
Description
Almost all of the phosphorus in the body occurs
as phosphate (phosphorus combined with four oxygen
atoms), and most of the body’s phosphate (85%) is
located in the skeletal system, where it combines with
calcium to give bones their hardness. The remaining
amount (15%) exists in the cells of the body, where it
plays an important role in the formation of key nucleic
acids, such as DNA, and in the process by which the
body turns food into energy (metabolism). The body
regulates phosphate levels in the blood through the
controlled release of parathyroid hormone (PTH)
from the parathyroid gland and calcitonin from the
thyroid gland. PTH keeps phosphate levels from
becoming too high by stimulating the excretion of
phosphate in urine and causing the release of calcium
from bones (phosphate blood levels are inversely pro-
portional to calcium blood levels). Calcitonin keeps
phosphate blood levels in check by moving phosphates
G AL E E NC Y CL O P ED I A O F M E DI C IN E 4 T H ED ITION