I recall an incident that happened to me many years ago in the Manhattan building where my wife and I resided. I was returning home from work and I entered the somewhat crowded elevator. The door slid shut to begin its ascent, but the elevator did not move. After a few moments of playing around with the buttons, it became apparent that it was not going to move, nor could we exit the elevator. The elevator door's small glass window allowed us to look out and people to look in, but we were stuck. We were an interesting mix of people, including an elderly woman, a few middle-aged adults, a young boy, a college-age female and a man in his 60s. As we waited for help, the man in his 60s (we will call him Ben) began to sweat profusely and became increasingly anxious, significantly more anxious in comparison to the other passengers. Everyone was feeling somewhat uncomfortable from the socially inappropriate physical closeness; however, Ben started to lose it. As he fidgeted around with his tie and took his handkerchief to wipe the sweat off his brow, Ben looked at the college-age woman and screamed: “Why are you staring at me?” I was a professional psychotherapist trying to keep my own anxiety under control as I watched Ben going into a full-blown panic attack. I was certain he was about to have a heart attack. Luckily, at that very moment, the fire department rescue squad forced the door open with crowbars. We all exited with a great deal of relief. Later, I asked Ben what had happened to him in the elevator. He told me that he had been claustrophobic his entire life. Claustrophobia, the fear of small and closed spaces, is one of more than 500 phobias listed in the psychological literature. A Roman encyclopedist, Cornelius Celsus, was the first to use the term phobia in the first century when he referred to the morbid fear of water as hydrophobia. A 2011 National Institute of Mental Health study estimates that between 8.7 percent and 18.1% of Americans of all ages suffer from phobias. More women than men suffer from phobias. So what is a phobia? A phobia is excessive and persistent fear of a specific object, situation or activity that is generally not harmful. Phobic individuals know that their fear is excessive, but they cannot overcome it. These fears cause such strong, distressful symptoms that some people go to great lengths to avoid what they fear. Examples are fear of flying or fear of spiders. Phobias, as defined by the American Psychiatric Association, are part of a class of anxiety disorders – generalized anxiety disorder, post-traumatic stress disorder and panic disorder, among others. Many factors combine to create the conditions that generate phobias. Genetics – There has always been a debate in the science field between nature vs nurture in explaining how human beings develop different disorders. For instance, medical research shows that exposure to carcinogenic materials puts a person at risk for developing some type of cancer, but we also know that not all people exposed to the same carcinogens develop cancer. Clearly, genetics are at play but are not the whole story. The same holds true when we examine how and why phobias develop in some individuals and not in others. Some people are born with a more anxiety-prone personality or temperament. Other people are just calmer and more resilient in dealing with similar anxiety situations. Early childhood experiences – Freudian psychology espouses that phobias often result from traumatic childhood events that overwhelm the child. Remembering the original event is so overwhelming that the child represses the memory. In place of remembering the original trauma, a phobia develops as a displacement of the anxiety that resulted from the original traumatic event. For example, I have treated people who have developed social phobia from growing up in an abusive home. In these cases, the fear of people is a way of psychologically avoiding the underlying emotional wound or abuse. Learning – Many people develop specific phobias through learning. For example, growing up in a household where important role models like a mother or father are terrified of spiders can influence the developing child's perception as to how safe or dangerous the creature is. The fear of spiders, arachnophobia, is one of the top 10 phobias around the world. On the other hand, parents might introduce curious young children to dogs and cats. Some children are cautious and others seem fearless to approach or touch the animal. Nevertheless, if something scary happens in this initial encounter, the child could develop a specific phobia concerning these animals. Post-trauma and phobias – Natural disasters such as earthquakes or tornadoes can trigger phobic reactions in many people. I once treated a young man who saw a tree fall on his uncle after lighting struck the tree. This individual was terrified to go outdoors during a thunderstorm. Victims of terror often develop post-traumatic stress disorder. PTSD symptoms, which include hypervigilance, anxiety and avoidance, are repeatedly triggered by things that are associated with the original traumatic event and produce a specific phobia. In Israel, some people are phobic about riding public buses after years of exposure to terrorists blowing them up. The very thought of riding a bus or even seeing others get on a bus can trigger phobic symptoms for these individuals. No apparent reason – Many phobias just seem to develop and are not linked to anything specific. In the next article, I will describe several common phobias. In the third article, I will present some information about how phobic individuals can be helped to overcome this problem. The writer is a marital, child and adult cognitive-behavioral psychotherapist with offices in Jerusalem and Ra'anana. He also provides online videoconferencing psychotherapy. www.drmikegropper.weebly.com. drmikegropper@ gmail.com This is the first in a three part series. The next installment will be in the November 6 issue.