Fear

Normal Versus Abnormal Fear

Normal fear is an essential warning about an internal or external threat that alerts the person to take necessary steps in prevention of harm or reduction of its probability or severity. In contrast, abnormal fear is a false alarm, eliciting the same uncomfortable emotional response to a situation which does not need to be avoided. An example is extreme fear and anxiety experienced by a person with social phobia when in a social situation (such as a party). Another form of abnormal fear is when a fear response is in excess to the level of threat. For example, many people do not feel comfortable with spiders, but a person with arachnophobia (fear of spiders) becomes extremely uncomfortable even at the mention of spiders or view of their image. A third form of abnormal fear is when a fear response appropriate to one context develops in a safe context. For example, a startle response to a loud noise in a combat zone is very much appropriate because the loud noise could present a life-threatening gunshot or an explosion. On the other hand, the same startle response to loud noise of children playing outside or a slamming door in a safe civilian environment is less adaptive. Clinical presentation of abnormal fear is commonly seen in situations such as specific phobias, agoraphobia (fear of being in places from which escape is difficult), social phobia, obsessive compulsive disorder, and post-traumatic stress disorder. Most of these disorders have a peak age of onset at early to mid-20s. Fear of the natural environment (e.g., heights, storms, lightning) and blood, injection, or injury (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition term: blood–injection–injury phobia) usually start between the ages of 4 and 9. Social phobia usually begins during the teenage years, the time when the person begins to assume a more prominent social role and expand the person’s social encounters outside the family environment.

Fear and Development

Fear should be seen in the context of the person’s developmental stage. A typical 5-year-old child might have a normal fear of monsters in the closet, and such a fear in an adult would be abnormal. A 1-year-old’s distress response to perceived or real separation from mother is developmentally appropriate and serves a survival purpose. Extreme distress in separation from parents in a school age child will cause impairment and needs attention. The child’s stage of cognitive development also contributes to their ability to process information relevant to fear. For instance, a child under the age of 4 does not have a clear understanding of death as an irreversible process and cannot comprehend one’s own death. Consequently, they are not able to have a fear of death that an adult would have. Children under the age of 9 more frequently report fear of animals, whereas children older than 10 show higher rates of fear of illness or school.

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