Coping With Common Fears

Experts explain how worry, fear, and anxiety can have a variety of medical consequences.

By Dulce Zamora
WebMD Feature

Reviewed By Louise Chang, MD

A lone brown leaf clings desperately onto its knobby branch as a bone-chilling gust dashes into the shadows of a full moon. Ghouls, vampires, werewolves, and other hideous creatures skulk in the dark, haunting homes filled with smothered apples and carved-up pumpkins.

Such is the scene for a frightfully delightful Halloween.

As amusing as this fall fright fest can be, there are real terrors that haunt people all year round. These demons take on the form of normal human emotions, such as worry, fear, and anxiety. Left unchecked, they can run amok, disrupting and sometimes destroying lives.

To find out which fears and anxieties typically plague people, WebMD contacted several health experts. They explained how certain worries can bring about unfavorable health effects and gave advice on how to face the monsters in the closet.

The Demons of Denial

Ever been so uneasy about something, you avoided it altogether? That's what a lot of people do when they're afraid of something, say health experts. It is a natural human reaction that can be a lifesaver.

For instance, if you know that walking down a certain street can be dangerous at night, you might avoid going there and take a safer route. That's when your worry meter and evasion tactics could be valuable.

"Anxiety, per se, isn't a bad thing," says Brian Doyle, MD, clinical professor of psychiatry at Georgetown University Medical School. "Anxiety is bad when it runs your life and keeps you from doing what you want to be doing with your life -- when it gets in the way of living, loving, and playing effectively."

To live effectively, it helps to have good health. One way of ensuring that is to make regular doctor visits. People who avoid going to a doctor because of some anxiety or another could be putting their lives at risk.

One group that has put itself at risk is made up of people who fail to get lifesaving screening tests for breast cancer, cervical cancer, and colon cancer. Over half of people aged 50 and older who are eligible for colon cancer screening have not taken it, says Len Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society.

"Part of the reason is that they may not like the test, or they may be afraid of getting the test and finding something," says Lichtenfeld. "But clearly, in colon cancer, when we find the cancer early or when we find a colon polyp to prevent the cancer in the first place, we can be very successful with our treatment."

Very effective treatment strategies are also available for breast and cervical cancers, particularly if they are found early.

Ogres That Keep the Doctor Away

Christine Laine, MD, MPH, a fellow of the American College of Physicians, cites four reasons why people avoid seeking medical care and offers some advice on how to overcome such reluctance:

  1. People are afraid that something is wrong with them. A person with risky sexual behavior, for example, may avoid a medical visit, fearing the doctor will confirm that his weight loss and fatigue are signs of an HIV infection. "Until a doctor tells them they have something bad, they can pretend they don't have it," says Laine. Ignoring the problem, however, won't make it go away. If a problem is serious, she says it will eventually show itself. Her recommendation is to seek medical care early for a better treatment outcome.
  2. People know they need to get a medical procedure done, but they are afraid of the procedure. Kids who try to avoid getting shots, or adults who shun colonoscopies or mammograms, may fall into this category. Of the fearful, Laine says, "They need to decide whether or not they're more afraid of the [medical procedure] or more afraid of having poor health -- since they didn't get something that could've helped them maintain their health."
  3. Those who don't have health insurance are afraid of paying doctors' bills. According to The Commonwealth Fund, nearly 47 million Americans do not have health insurance, and an estimated 16 million are considered underinsured because they have high out-of-pocket costs relative to their income. "It's a huge problem in this country," says Laine, who says the solution is largely political. To individuals, she recommends trying their best to find free clinics, which are available in some parts of the country.
  4. People are embarrassed to go to the doctor because they haven't done something they know they should. Some people know they need to stop smoking or lose weight. Others are afraid the doctors will find out that they haven't been taking their medications, or they haven't been following a recommended diet. "Realize that you are in good company," says Laine. "There are many patients who don't follow their physician's advice." For the fearful, she suggests a medical visit so you can talk to the doctor about possible strategies to help you do what you need to do. Sometimes, the doctor may be able to propose alternatives that could help you stick with a particular program.

The Horrors of Humiliation

Some people will do anything to avoid embarrassment. Men, in general, tend to be vulnerable to this predicament.

"For some men, the greatest fear might be the fear of fear itself," explains Jean Bonhomme, MD, MPH, member of the board of directors for the Men's Health Network. He says there are all types of terms society uses to describe men who express fear, such as coward or "yellow belly."

As a result, men tend not to want to admit that they're afraid, or that something is bothering them. This leads them to deny or ignore that something is wrong.

"If men are denying fear, they're basically saying 'I'm going to do this, and it won't affect me,'" says Bonhomme. "So men tend to engage in more risky behaviors."

For instance, he says some men drive without seatbelts or speed on the highway, ignoring the possibility that they could be injured or killed. Other men disregard the dangers of unprotected sex, fistfights, and alcohol or tobacco abuse.

To further substantiate how harmful men's risky behavior can be, Bonhomme notes that injuries are the No. 1 cause of death among males aged 1 to 38. He says males are the majority in the general population until the mid- to late-30s.

To encourage healthier and safer behavior in a man, Bonhomme recommends addressing the man's values. If the man is family-oriented, appeal to his sense of responsibility to be healthy in order to take care of his family. If the man values athletic performance, discuss how healthy behaviors can help him stay young and fit. If he attaches great importance to his physical appearance, point out how a visit to the doctor can help him either retain or improve his youthful looks (or waistline).

As for men who fear facing their fears because of possible humiliation, Bonhomme has this to say: "Nobody ever died of embarrassment."

How Women Cope With Fear

While men turn their backs on fear, women tend to face it on a more regular basis.

"In general, women tend to be more savvy users of health care than men," says Laine. She attributes women's familiarity with the health care system to two things: when women give birth, they enter the health care system; and women tend to care for and orchestrate health care for their children and elderly parents.

As a rule, women are also often more aware of and more fearful of their environment, says Linda Sapadin, PhD, author of Master Your Fears: How to Triumph over Your Worries and Get on with Your Life. "They tend to be more imaginative, and they think of all kinds of horrible things that could happen," she says. "As the primary caretaker, they are also fearful of a lot of things for their children."

The way women are hardwired -- and their life experiences -- contribute to their fears. Sapadin says society can be overprotective of females, which can deprive them of the necessary experiences to deal with the environment -- to make mistakes and correct them, and to develop confidence.

In some sense, American society has lightened up on restrictions on what females can do, but women also learn fear from the experiences of their mothers and grandmothers. Likewise, new immigrants to this country may pass on fears of an unfamiliar environment to their children, and also be stricter on their daughters.

Of course, women aren't the only ones worried about environmental things that seem to be out of their control. David Carbonell, PhD, a psychologist and director of the Anxiety Treatment Center in Chicago, says it's common for people to worry about things like fluctuating interest rates, the stock market, and terrorist attacks. Then some people start worrying about how much they're worrying.

Facing Fears

For people who find themselves worrying about and fearing things that are out of their control, Carbonell advises setting a specific time aside to worry. Try looking in the mirror for a 10-minute period in the morning and another 10-minute period at night. While in front of the mirror, say your worries and fears out loud.

"Most of the time when we worry, we are doing other things at the same time. So we tend not to really fully comprehend the worrying. That's what gives it its power," says Carbonell. "If you really, really focus on the worrying and then nothing else, you'll see that something you've been worrying about for days really boils down to one or two sentences, and yet it can seem to fill your mind for hours and days."

Sapadin, who is also author of Now I Get It! Totally Sensational Advice on Living and Loving, encourages women and men to face their fears head-on by creating a plan of action. If you are afraid of getting lost, for instance, think of what you could do to prevent it from happening, and prepare what you would do if it did happen. You may check Mapquest for directions, bring a map and a cell phone, and have phone numbers handy of people who could help you get on the right track.

She also recommends changing the way you think, since what you say to yourself can affect your experience. Instead of saying, "It's the worst thing that can happen to me," say '"It's bad, but I won't let it destroy me." Or in lieu of saying "I can't deal with this," say "It will be uncomfortable, but I can deal with this."

"Bring [self-talk] down a few notches, and you make it more realistic, because there are very few really horrendous things can happen in a person's lifetime," says Sapadin.

Published Oct. 9, 2006.

SOURCES: Brian Doyle, MD, clinical professor of psychiatry, Georgetown University Medical School. Len Lichtenfeld, MD, deputy chief medical officer, American Cancer Society. Christine Laine, MD, MPH, fellow, American College of Physicians. Jean Bonhomme, MD, MPH, board of directors, Men's Health Network. Linda Sapadin, PhD, author of Master Your Fears: How to Triumph over Your Worries and Get on with Your Life and Now I Get It! Totally Sensational Advice on Living and Loving. David Carbonell, PhD, psychologist; director, Anxiety Treatment Center, Chicago. The Commonwealth Fund Online: "Health Insurance."

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