FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S FEAR OF HEIGHTS A PHOBIA

Question: One of the common vacation spots my family goes to on the East Coast requires driving over one of the world's longest bridges. I always get scared and feel my palms sweat and my heart pound as we approach this huge bridge and go over it. I have a great sense of relief when we make it safely to the other side. What causes this feeling that I have? It's not shared by other members of my family who love being up on this bridge, but I'm the one that usually does the driving!

Answer: The physical reaction of sweating palms, pounding heartbeat and a sense of foreboding are part of the normal "fight or flight" reaction to a stressful situation. We all get a similar response under the appropriate circumstances. I'm sure you felt this way the first time you took a driving test or did other important but stressful things.

From your question, it is apparent that you feel your reaction is unusual or perhaps inappropriate. I'm sure the bridge won't collapse just because you drive across it, and you know this too. Despite your intellectual understanding, the situation is still very stressful for you. Your response fits the classic definition of a phobia. Your mind says it's safe to cross the bridge, but your emotions tell you differently.

Phobias are the most common emotional problem. Studies have found between 2 to 13 percent of people have phobias of some sort, but I suspect the figures underestimate the their prevalence since most people don't report episodes like yours. Phobias most commonly start in childhood or adolescence, and it's unusual for them to start after age 25. Statistically, about one-half of individuals with phobias have other psychiatric disorders such as depression or alcohol abuse, but I suspect these figures mainly reflect the difficulty we have in identifying those with phobias but without other psychiatric problems.

Phobias tend to be a life-long problem. In severe cases, specific treatment can give great benefit, but for many sufferers this is impractical. Many choose to avoid the situation like taking another route that avoids the bridge rather than invest the time, money and effort in treatment. For others, specific behavioral therapy and occasional use of medication can give satisfactory relief.

Question: Although I experience similar fears when I'm near the edge of a cliff, or climbing up a tall ladder, I don't feel the same fear in an airplane. Why is this? It doesn't make sense to me.

Answer: You answered your own question without realizing it. Phobias never make sense! They are an emotional response that is contrary to your rational judgment. You have a fear of heights, not of flying, so flying seems like a safe activity.

It may be worth your time to see a psychologist or psychiatrist about your phobias if you find they interfere with your ability to do necessary activities. On the other hand, if your palms sweat and your heart pounds for only a few minutes each vacation, you may choose to do nothing. Just view the reaction as one of those wonderful idiosyncrasies that contributes to making you who you are.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.