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Ask the expert

If I had a phobia for needles, would I have a mental illness?

One of my very first clients when I was a student had a needle phobia. He had had root canal work done without freezing. The guy was the president of his own company and a very smart man, around fifty. He needed a blood test but he couldn’t go. The last time he had tried to have blood drawn, he had had a respiratory arrest in his doctor’s office and had to be revived. So, would you say he’s mentally ill? Well, he has a diagnosable condition. He has what we call a specific phobia. Do you consider that an illness? Well, the issue here is that it certainly affects his ability to function normally. And it might not be a big deal to some people, but, if he has an illness and he needs a blood test, or he’s avoiding going to the doctor because of it, then he could actually die because of this. So, in this particular case, the fear seriously affects his functioning. So we call that a “phobia” and it is a diagnosable condition. I don’t necessarily like to use the term “mental illness” because I don’t think that a person necessarily is sick, but it depends on how you define it. The bottom line is that there are clear treatments for it. In fact, I was able to get him to have his blood test and a number of other injections before the end of my internship. That’s a perfect example of using functioning as a criterion.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

Would you say a person who feels overwhelmed suffers from anxiety?

The answer to this question depends on the definition of “overwhelmed,” as this can involve too much stress and anxiety about confidence levels. Sometimes anxiety is appropriate and normal. For example, let's say that your boss asked you to write a letter and said that you had all day to do it. If you are like most people, you would not be too threatened or overwhelmed by this task. But what if you lack confidence in your writing skills? Then one letter becomes very threatening. We often have to ask ourselves whether the stress comes from our way of reacting to a situation or the situation itself.
-Camillo Zacchia, PhD, Mini-Psych School 2010

Do people to have more phobia/anxiety with age?

Not particularly. Some fears get worse over time and some get better. Our circumstances change as we get older. For example, sometimes our health starts to be an issue. If you have always been concerned with your health, you could become increasingly anxious as you get older. On the other hand, if you are concerned about social anxiety, you might have a harder time when you are younger—for example, at school. Generally speaking, every age group and every challenge we face can bring on new anxieties, depending on our circumstances.
-Camillo Zacchia, PhD, Mini-Psych School 2006

Does low self-esteem tend to be associated with anxiety disorder?

The more you are afraid, the less you think of yourself, and people with low self-esteem are going to have more social anxiety. They worry about what people think of them, and they are more threatened by exams and by being graded. The ultimate goal of almost every treatment is to try and build a person’s self-esteem.

-Camillo Zacchia, PhD, Mini-Psych School 2010

Is anxiety disorder often associated with depression?

Some people who suffer from an anxiety disorder may also be depressed because something is wrong with them. It’s hard to be anxious and not be depressed about it, just as it’s hard to be depressed and not be anxious. Anxiety is a little more geared towards specific things, as in “such and such a thing scares me.” Depression is more of a judgement, and your personality will make you down about something and afraid of things.
-Camillo Zacchia, PhD, Mini-Psych School 2010

How would you describe the difference between anxiety disorder and paranoia?

Anxiety is an emotion, so it can simply be a symptom and not always a disorder. For example, if someone is actually trying to kill you, you will be terrified. The real question is whether the threat is real or imagined. You cannot become psychotic by being too anxious. Paranoia, on the other hand, is a biological disease that affects a small percentage of people. The difference is generally that people who are socially anxious are more afraid of what others think of them, whereas paranoid people are more afraid of being harmed by others.
-Camillo Zacchia, PhD, Mini-Psych School 2010

Why do anxiety disorders seem much more prevalent today than 20 years ago?

Are they really? We don't know if people have more anxiety disorders than in earlier times or if we simply are more aware of it. We do know, however, that educational events such as this conference tonight are important because we can learn about and discuss our anxieties. In the past, people used to be ashamed, especially in cases of anxiety, of telling others what was going on in their minds. An anxious person might have been terrified of ending up in a psychiatric hospital. We want to welcome people to our institution if they need help and not be afraid. People will only reach out for our help if they are not ashamed–if they understand the illness.

The Douglas Hospital invites the public to come and learn about mental illness so people will know that if there is a problem, they can get treatment and it won't be a horrifying experience. Certainly, in recent years, there is growing awareness. We talk about it more. There are television documentaries about phobias, depression etc. (Mimi Israël, MD) We are less threatened by predators than our ancestors, but we have more day-to-day stressors. We live longer, more complex, lives. There may be good reasons for becoming anxious because we're always having to juggle new things. Unpredictability is one of the things that causes anxiety.
-Camillo Zacchia, PhD, Mini-Psych School 2006

Is it normal to wake up every morning with overwhelming anxiety?

Although we all experience anxiety, we call it a disorder when the person is highly preoccupied with it or can't function normally. If a person suffers from anxiety every day, and truly feels bad, I think it's certainly something that should be addressed. Again, this depends on what the person is worried about and the surrounding conditions.
-Camillo Zacchia, PhD, Mini-Psych School 2006

Why are people afraid of modern objects like airplanes or elevators?

People are not necessarily afraid of “airplanes”, for example. They fear falling from an airplane (i.e. crashing) the way our ancestors feared falling from cliffs or tree branches. Therefore, it is normal to feel anxious when looking down from above. Others may be phobic of airplanes because of the fear of being trapped. If you're locked in an elevator, you'll struggle to find a way out. If you trap animals in an enclosed space, they'll panic. It's normal.
-Camillo Zacchia, PhD, Mini-Psych School 2006

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