Phobias that can make life misery
IMAGINE riding on the MTR and being suddenly overcome by a fear so intense that your heart begins racing and your lungs gasp frantically for air. Or being so obsessed with hygiene that you spend hours in the shower, painfully scrubbing your arms and legs until they are raw. Or being convinced you have contracted AIDS, and worrying so much about it that you appear to develop symptoms of the disease.
'I would start shaking when I drew the shower curtain because I feared the lack of fresh air,' explained Janet, a 40-year-old office worker. 'I would imagine myself dying of suffocation. Travelling through a tunnel, or walking in a crowded street could trigger the same fear. I feared other people were going to consume my oxygen.' Janet is one of thousands of sufferers of panic attacks in the territory who find that certain situations scare them rigid.
One day, on the MTR, her heart began racing. She began sweating, felt dizzy and gasped for air. Fearing a heart attack, she started trembling.
'I covered my heart. I was so frightened I thought I was going to die,' she said.
Janet has a healthy heart. Her problem is panic attacks, one of the most frightening forms of anxiety disorder. Such attacks occur without warning, and reach an intense and terrifying crescendo within minutes. It is estimated that 90,000 to 210,000 Hong Kong people suffer from the psychiatric condition.
Psychologists at Queen Mary Hospital believe the numbers could be higher because many sufferers believe the problem is in their body, rather than their mind. Janet, for example, sought treatment from a cardiologist instead of a psychologist - until two years ago when she responded to an appeal for research subjects by the University of Hong Kong.
The study, jointly carried out with psychologists from Oxford University, aims to provide effective treatment to patients suffering from panic attacks, a condition which is often associated with phobias.
When a phobia is a significant source of distress or interferes with daily functioning, it is considered a mental disorder. There are several hundred listed phobias, which are sub-classified as agoraphobia, social phobias, and simple phobias which include fear of animals, particularly dogs, snakes and insects.
Fear of closed spaces, claustrophobia, and fear of heights, acrophobia, are also simple phobias.
Dr Peter Lee Wing-ho, senior lecturer at the University of Hong Kong's Department of Psychiatry, said agoraphobia could trigger severe panic attacks.
While some phobics learn to endure a phobia by avoiding the subject of fear, others see their day-to-day activities seriously disrupted and suffer deep stress because of their violent, deep and uncontrollable feelings.
New phobias are being discovered all the time. 'I have been treating a patient with an AIDS phobia,' said Dr Lee.
'He convinced himself he had got AIDS since he went to an unlicensed dentist in the Kowloon Walled City. Because he read in books that infected patients would have enlarged lymph glands, he would keep pressing his lymph glands in the neck until they hurt.
'He was not only obsessed with his own lymph glands but his wife's and daughter's. He would feel theirs too. Because he pressed his lymph glands they were bound to hurt after some time and he would become more convinced he had AIDS. He could have a panic attack while having a meal.
'His disorder had induced worries and fears in him, which resulted in a loss of weight. But as he saw it, he was thin because he had AIDS.' In Janet's case, her panic and generalised anxiety disorders disrupted her day-to-day life. For two years she shunned newspapers and TV news simply because bad news in general triggered a sudden upsurge of terror.
There were times when she would spend all night pacing her room, wracked by feelings of doom.
'I dreaded bad news. If I heard a friend had had an accident, or a relative had got cancer, my heart and mind would start racing, and I would have difficulty breathing,' she said.
'Other times I would have anxious concern about nothing. There was one night when I could not sleep. I could not even sit down because I felt something bad was going to happen.' Dr Lee said panic attacks began most commonly between the ages of 18 and 27. Many people, however, will experience an occasional panic attack at some point in their lives. It only becomes a problem when it occurs more frequently, between twice a month to every day.
MANY sufferers of frequent panic attacks will go on to develop agoraphobia. Sufferers of the disorder dread situations where they feel escape will be difficult or help unavailable. Dr Lee said panic attacks could strike at anyone regardless of their position in life, age or gender.
'I have come across a case of agoraphobia; a young, fit Hong Kong Chinese soldier in the British forces would not venture out of his barracks. He knew it was silly, but every time he walked to the bus stop near his barracks, he would have a panic attack.
'He told me his heart was beating very fast and his legs were shaking. He thought if he stayed at the bus stop he would either have a heart attack or he would end up at a mental hospital. So he returned to the barracks. Once he was there, the panic attack subsided.' Dr Lee said in this and many other cases, fear was maintained because the patient was avoiding it. 'If he had stayed at the bus stop, he would know he was not suffering from a heart attack, and he certainly was not dying.' He said the rule of thumb in handling fear, whether it was simple phobia or a psychiatric disorder, is to face the fear. It is essential for the patient to find out for himself whether the feeling of devastation will be as great as he anticipates and to test his fears that he will not survive the situation.
'One of my patients developed an irrational fear of faeces. It sounds ridiculous, but it really isn't funny. This patient would take medicine to reduce her bowel movement so she only needed to use the toilet once a week. And after she'd been to the toilet, she would go through an elaborate ritual to clean herself.' Because the patient was also suffering from obsessive-compulsive disorders, she could spend up to 20 hours washing herself.
'A lot of sufferers of obsessive-compulsive disorders tell themselves they must wash their left hand 15 times, their right hand 15 times, and their right and left arm 15 times eachand so on,' he said.
'In the case of my patient, she ended up spending 20 hours in the bathroom because she lost count in the process and had to start all over again. Can you imagine her anguish?' Dr Lee said treatment would include telling the patients to place themselves in situations that cause anxiety and to stay there until the anxiety reduced.
'In the case of the woman, I told her to go into the toilet and lock herself in until she felt better. I told her she could not wash her hands. I told her she had to stay with her discomfort until her anxiety was reduced.
'I was slowly exposing her to her fear in order to show her that her anxiety levels would come down eventually, even if she stayed in the situation.
'I was showing her she did not need to wash her hands to reduce her anxiety levels.' Dr Lee said a person could develop aerophobia after a single panic attack on a plane. Similarly, a childhood nightmare about thunder storms or spiders could turn somebody vulnerable into a phobic.
But while some phobics eventually discover the cause of their disorders, others never find out.
'One of my patients developed acrophobia out of the blue,' said Dr Lee. 'He was at a seaside villa which he had wanted to buy. The villa was located on a cliff, and he was inspecting it. Suddenly he was overwhelmed by an irrational fear. He feared the ground would give way then and there and he would die. He had to rush off.' Dr Lee said the man eventually sought help when his fear started to interfere with his daily life.
'He worked in a high-rise commercial building with floor-to-ceiling windows. He did not want his colleagues to notice his trembling legs every time he walked near the windows. He feared his office but he had to go to work.' Dr Lee said among all phobias, nosophobia - the fear of illness - was most difficult to treat because patients would hold on to a belief that was not easy to challenge.
'A minor symptom could be exaggerated by virtue of the patients' paying attention to it. It is difficult to make them understand their fear is maintained by a pseudo symptom.' Whether patients were suffering specific phobias, or a generalised anxiety, Dr Lee said an underlying fear among Chinese people is loss of face.
'A lot of patients have told us that what they feared most during a panic attack was they would collapse while other people were watching. Their panic was reciprocated by a social concern, a fear of making a fool of themselves in public, of embarrassment.' Dr Lee said the stigma associated with the disorders were unique to Hong Kong patients.
'People who have never had a phobia may be deeply insensitive, and patients could make things worse by stigmatising the disorder themselves, or going to the wrong doctor for treatment.
'The doctor may brush a patient off by telling him he has a perfect heart and his family may tell him to pull himself together. It is quite sad.
'My advice to patients who suffer prolonged, persistent physical symptoms such as sudden breathlessness, dizziness and palpitations is if their symptoms cannot be accounted for by repeated medical tests, they should seek help from a psychiatrist or a psychologist.
'They may then discover that, contrary to their belief, they are not suffering from an asthmatic or heart problem. Panic is their problem.'