But phobias can be life-changing. My mother rarely comes into contact with rats. Other people are not so lucky with their fears – and it can be incredibly distressing when you sense danger – whether or not the danger is real.
Phobias usually fall into one of two categories – specific phobias and complex ones. My mother has a specific phobia. Animals are common, as are heights, blood, vomit and flying. If you have a fear of something specific you’ll normally go out of your way to avoid it. If your phobia is massive spiders and you don’t live in Australia you might not find this too restrictive but when it’s something you can’t always avoid, you can find your world shrinks. I developed a fear of flying aged eighteen. Having previously been fine on planes, I suddenly could not get on a flight. I was terrified. I missed fun family holidays, friends going on adventures, and work trips. I occasionally took dreary train trips and pretended it was a fun way to travel, but I felt absurd and immobilised. Just the thought of a plane journey would have me shaking, and I felt so restricted by it.
Complex phobias are even harder to overcome. This term usually refers to agoraphobia and social phobia. Agoraphobia is widely assumed to be a fear of wide open spaces (a desert? the surface of the moon?) but is more likely to mean anxiety about how to get out of somewhere without panicking or where help is not obvious. Anxious people are often looking for the literal or metaphorical emergency exit. This might mean you feel overwhelmed on the Tube, or in a busy supermarket. Again, this can mean a person with agoraphobia might limit the places they go to. In the worst case, this might mean becoming housebound – the only place a person might feel truly safe. Agoraphobia often comes on after a bad experience – being stuck in a lift, or after having had an accident. Professor Kevin Gournay, an expert in the condition, estimates around 1 per cent of the UK population is affected by severe agoraphobia.[29]
Maybe this sounds like claustrophobia to you – the difference is small, but important. Claustrophobia is the extreme fear of confined or closed off spaces. With agoraphobia, you have a fear of any place that might make an easy escape difficult, leading to a panic attack or extreme anxiety.
Social anxiety disorder
Social anxiety disorder is also called social phobia. Just as depression is not feeling a bit sad, social anxiety does not mean being a bit shy at the office Christmas party. It’s a crippling condition which can include fears of meeting new people, speaking in public, worrying you’ve embarrassed yourself in public, and having panic attacks in situations where you’re forced to interact with people. People with social anxiety experience a lower quality of life than those unaffected, an increase in alcohol and drug abuse and a risk of suicide. In the UK, about five in every hundred people are thought to have some degree of social anxiety and it affects women more than men.[30] Perhaps unsurprisingly, it tends to develop in a person’s teenage years and is unlikely to improve without help.
Ruchira told me that she’s had fears about how others perceive her for as long as she can remember. Although it was uncomfortable, it wasn’t until university that the anxiety element reared its head properly. ‘I would excuse myself from seminars and just hyperventilate in the toilets without being able to return without the same panic happening. This was what I would call the flare-up – before this my anxiety had hindered me in smaller ways such as nervousness in crowds, fear of being looked at, attending events – things I never realised were different or I didn’t have to feel.’
Ruchira explained that she never thought of herself as someone who would face such an issue – but then, who does? ‘I’m a really outgoing confident person. I had the best time going out and meeting new people [before] so the idea I had social anxiety baffled me. I think social anxiety comes in different forms for so many people, and mine was all about how I’m weighed up in career settings or by my looks. “Being taken seriously” was a big anxiety, as I’d built an assumption that my young-looking face meant I had to make up for it or counteract people’s thoughts before they got to know me.’
Eventually, her anxiety hit such high levels that she sought help, but it took a while. ‘This came at a time of me rarely leaving the house and hitting the lowest state first. CBT made me realise [that] much of this stemmed from a fear of dying or fainting in front of everyone who I imagined would judge me. This mixture of panic and social anxiety – which had grown unchecked for years – had become something that meant I couldn’t walk in crowds, get on the Tube, order food or anything without bursting into a panic attack. CBT really helped – along with a citalopram [SSRI] prescription.’
So you see – social anxiety – not just shyness at all.
Post-traumatic stress disorder (PTSD)
The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides definitions of mental-health problems. It explains that PTSD triggers include exposure to actual or threatened death, serious injury or sexual violation. The trauma, regardless of trigger, causes significant distress or impairment to a person’s social interactions, and their ability to work or function in other normal ways.
PTSD is most commonly understood to be seen in soldiers after combat – recorded throughout history during the American Civil War as ‘heart shock’, in the First World War as ‘shellshock’, and then in the Second World War as ‘combat fatigue’.[31] But it’s now known to affect those who have experienced sexual assault, violence and accidents, traumatic childbirth and disasters. Symptoms of PTSD include repeated thoughts of the assault or incident, nightmares, avoiding thoughts and situations related to the trigger; feeling unsafe, panic attacks, and difficulty sleeping and concentrating. According to NHS figures, PTSD is estimated to affect about one in every three people who have a traumatic experience, though it’s not known exactly why some people are affected and others aren’t.[32]
Sufferers don’t just experience the trigger clearly, they can also relive the experience through flashbacks, where a word, smell or noise might make a person think the trauma they endured is happening again. Understandably, those with PTSD will often go out of their way to avoid anything that might provoke a flashback – changing their routines or restricting their movements. They will be hyper-vigilant, watching for danger at every turn. This can provoke huge anxiety because of the constant mental pressure to be alert.
Further types of PTSD have since been defined, to better reflect the different experiences of it. They include:
Delayed-onset PTSD. If your symptoms emerge more than six months after experiencing trauma, this could be described as ‘delayed PTSD’ or ‘delayed-onset PTSD’.
Complex PTSD. This encompasses chronic and prolonged trauma or abuse. For example, if a person suffered from years of domestic violence, they might be said to have ‘complex PTSD’.
As with all mental-health problems, sufferers can live with the symptoms for years before diagnosis. Nicola was diagnosed with PTSD as an adult, having been sexually abused by her father as a young teenager. She only sank into a depression after leaving her job in the RAF and returning to civilian life. Even though she was offered counselling, Nicola found it hard to talk about what had happened to her, partly because a therapist wouldn’t ‘know what it is like to experience it’.
A fear of stigma is common in people who suffer with PTSD. For those who’ve been sexually abused like Nicola, victim-blaming attitudes and a fear of not being believed can prevent people from seeking help as early as possible. This is compounded by feelings of shame and guilt that many with PTSD experience.
I’ve been lucky not to experience this awful disorder in any real sense, though I am familiar with hyper-vigilance. After being stalked a few years ago, I was advised by the counselling service provided by Victim Support that I might experience some symptoms of PTSD. I didn’t think I was likely