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Getting a scare every now and then does not in itself have any disease value. In certain situations, for example when a very loud noise unexpectedly occurs or a horror film takes a dramatic turn, it is perfectly normal to react in a frightened manner. However, there are also people who suffer from chronic anxiety. Deep psychological stress often plays a role here, which makes therapeutic treatment necessary. Learn more about the causes and suitable treatment options in this article.
How does fright arise?
Actually, the fright is a completely natural reaction to a surprising situation that creates frightening or threatening feelings in us. It cannot be controlled either and is an instinctive reflex from a gray period when the survival of humans in the wild still depended very heavily on whether they were able to assess dangers early enough. Different smells, noises and also environments had to be classified as dangerous or harmless. What frightened people back then brought about immediate protective mechanisms and protective behaviors that still occur reflexively today. This includes, for example, squinting the eyes or wincing as a protective reaction against flying objects, even if they are not present.
Even a reflex-like cry as an expression of horror is not uncommon. At the time, it served to signal danger to one's own pack. In addition, there is often an intense retreat from people who want to avoid possible conflict situations that are particularly frightening for them. Hiding when there is danger is also a behavior that is closely related to the feeling of terror. But how exactly does such a fright arise?
From a medical point of view, it is a relatively short-term fear reaction that usually lasts only a fraction of a second, at most one real second. In this short period of time, there is an extremely extreme release of adrenaline due to fright, which puts the entire body in a state of high alert. The senses sharpen, the muscles are tense and the heart beats faster. All of this in order to act as quickly as possible in the event of an actual danger, for example by defending yourself, evading or running away. There are numerous scenarios that justifiably create such horror. Which includes:
- loud shots or explosion noises,
- sudden encounters with dangerous creatures,
- Natural disasters,
- War scenarios,
- physical disputes.
However, there are also situations in which horror is erroneously raised, for example in the case of nightmares or when a loud noise resembles the bang of a firearm, but it is just a burst tire. As soon as our brain recognizes the harmlessness of such situations, the mind usually calms down very quickly. However, for some people such a situation repeatedly triggers panic - even without any danger value. There are even people who react frightened for no reason or who, in certain situations, become terrified because they are reminded of past trauma experiences, the images of which come back at the moment of the horror. In such a case, one speaks of pathological frightfulness.
Causes of pathological frightfulness
The causes are usually of a psychological nature, but this does not fundamentally rule out physical influencing factors. For example, if the body is in a life-threatening state, for example due to a serious illness or signs of poisoning, this can also trigger a feeling of terror. For a better overview, the most important causes at a glance.
Those who have suffered severe trauma in the past generally tend to react in so-called trigger situations with a momentary fearfulness that is due to the memory of the traumatic experience. In this regard, a whole range of trauma experiences are conceivable, including
- War trauma,
- Near-death experiences,
- Accident trauma,
- Loss experiences.
The post-traumatic stress disorder shows how severe such a trauma can be. She became particularly well-known for the frequent cases among war veterans and soldiers, in which the patients are put into a state of terrible flashbacks by mere trigger noises (e.g. helicopter noises) in apparently harmless situations. Those affected repeatedly live through past but life-threatening war experiences and are in an absolutely exceptional state of total panic during this traumatic flashback. This goes so far that they are no longer able to move or react. They are literally trapped in the traumatic horror they once experienced for several minutes.
Important: In addition to war trauma, all other trauma experiences shown can lead to post-traumatic stress disorder with acute flashback phases. Such a disorder has to be treated urgently, as it is not only a mental, but also a serious physical health burden in the long term!
If left untreated, trauma can sometimes develop into anxiety disorders. As with post-traumatic stress disorder, trigger stimuli trigger an unfounded frightfulness. In this regard, the fear of narrow spaces (claustrophobia) is well known. It often arises when people were locked up in a confined space in their childhood or adolescence.
The situation is different, for example, with the fear of spiders (arachnophobia), in which spiders cause panic fear to those affected by their mere appearance, possibly also by their hairy surface or their rapid crawling. Anxiety disorders often do not necessarily have a logical cause, but are linked to the mere fear of something going wrong. Good examples are here:
- Fear of flying (aviophobia),
- Fear of the dentist (dental phobia),
- Fear of great heights (acrophobia).
Social phobias are much more complicated. These have innumerable sub-forms and cannot be traced back to a specific trauma event. Bullying experiences or domestic violence often play a role. But it can also be just very embarrassing events (e.g. wetting in public in childhood) behind such phobias. What the social phobias have in common, however, is that they give those affected a heightened fright in social situations, for example when they are addressed by others or someone seeks eye contact with them. Larger crowds also provoke panicked and frightening moments in people with social phobia.
Another form of anxiety disorder that can be more or less classified as social phobia and that can appear as an accompanying factor is panic disorder. Corresponding chronic panic attacks usually arise from very drastic changes in life, which do not necessarily mean trauma, but are similarly difficult for those affected to cope with. Panic attacks are conceivable, for example due to a loss of job or an end to a relationship. Likewise, however, actual loss trauma (e.g. through the death of a loved one) or trauma from a physically or psychologically stressful relationship can be considered. This shows that the transitions in the causes of a panic disorder are often fluid.
While phobias are among the mental illnesses, there are also some mental illnesses that cite a particular fright as a cardinal symptom. This includes, for example, bipolar disorder. Although referred to as a disorder, it is actually a tangible disease of the emotions (affects). There are extreme mood swings, which, in addition to particularly euphoric phases, also bring about such special sadness. Bipolar disorder is also closely related to depression.
Another mental illness that can drive the emotional world towards unusual fright is schizophrenia. The disease has a major impact on the perception, thoughts and feelings of those affected, which not only means that they perceive apparently harmless situations as dangerous or threatening, but also hear voices and feelings uncontrollably.
Far from mental illnesses, neurological illnesses can also manifest themselves in the brain, which are accompanied by increased fearfulness. Particularly worth mentioning here is epilepsy, which is characterized by involuntary seizures, but which are often announced by those affected by a so-called aura. Many report developing a threatening emotional state in this aura phase or even perceiving an unpleasant presence, which can of course be accompanied by tremendous terror. In the context of a long-term seizure disorder, the insecurity in everyday life is very pronounced, as these people eventually develop the fear of having a seizure in public. The epidemic caused by illness can be exacerbated by social phobias in epilepsy. Again, it shows how closely psychological and physical factors can be linked.
Of course, neuropathies cannot be ruled out as neurological causes of the fear. This is understood to mean diseases of the peripheral nervous system, such as those that occur with nerve inflammation. Neuralgias, i.e. pronounced pain symptoms, which are of course always nervous, can also be triggers.
Influence of substance
Neuralgia can sometimes also be triggered by heavy alcohol consumption. Apart from that, it is not uncommon for the psyche of intoxicants and drug users to play tricks, which can be accompanied by perceptual disorders, panic and fearfulness. In this context, certain medications are also mentioned as a possible cause. Above all, psychotropic drugs, which are intended to consciously influence the psyche, repeatedly list anxiety states as possible side effects.
Other physical triggers can be found on the one hand in the area of poisoning, heart problems (e.g. in the event of a heart attack) and life-threatening diseases, which attack the vital functions in such a way that these people become fear of death. On the other hand, it is also possible that injuries will scare those affected. In such cases, the course of the accident itself also makes a not inconsiderable contribution, which is often due to a frightening impact or fall.
Stress as a trigger for a frightening personality should not be underestimated. Because everything that constantly energizes the nerves can also mean increased irritability in (supposedly) terrifying situations. In this context, insufficient sleep hygiene is also mentioned as a possible cause. Because lack of sleep is known to cause perceptual and sensory disturbances, which in addition to increased irritability can also be expressed in mood swings and fearfulness.
Incidentally, unusual physical processes such as the start of pregnancy can also cause horror. Pregnant women who suddenly vomit are all too familiar with this experience. Since they often do not know that they are pregnant at the time of vomiting, the vomiting reflex initially triggers fear and panic. However, there is no disease value in this regard.
Basically, those terrible physical conditions that were associated with a dangerous situation in prehistoric times are associated with frightfulness. Which includes
- Racing heart,
- inner unrest,
- shaking hands.
If the whole is based on certain diseases, there are of course a variety of disease-specific symptoms that can go hand in hand with the instant horror. For example, are conceivable
- Perceptual disorders,
- Nausea and vomiting.
Such side effects often increase the fright and make it even more difficult for those affected to cope with their fear.
Warning: Chronic fright can be a serious burden not only for the psyche, but especially for the heart and the immune system! Since the body is repeatedly in an alarming state of emergency due to the horror, the weakened immune system is constantly on standby, which is energy and force-depleting for the body's defense. Likewise, from a certain repetition rate, the rapid heartbeat associated with terror can cause the heart rhythm to be out of rhythm and even cause a heart attack!
Often, fearfulness only helps to find the actual cause of the disease, since it alarms those affected and thus prompts them to see a doctor. The first point of contact is often the responsible family doctor. However, since the majority of all causes are psychological or neurological in nature, a subsequent visit to the specialist is usually not absent. Before that, however, standard physical examinations are carried out, within which a physical cause is either found or excluded.
The direction in which the diagnostic measures ultimately run depends very much on the information that is learned during the initial patient interview (anamnesis). It is very important that those affected answer honestly and openly to all questions about existing accompanying symptoms and possible causes - including in the psychological area - so that a suitable form of therapy can be found promptly. Depending on the suspicion, various laboratory and imaging procedures are then possible in the initial examination. If the doctor has reason to believe that there is a certain substance influence behind the disease, a blood sample is taken, for example, which is then examined for the relevant parameters. An ECG is common for heart problems.
Neurological and mental illnesses or anxiety disorders, on the other hand, require referral to a neurologist or psychiatrist. In addition to imaging methods such as the EEG, extensive diagnoses are also made here after discussions. The treatment is then usually carried out under neurological or psychotherapeutic care.
Almost all cases of pathological frightfulness require more or less extensive psychotherapeutic care. This applies even to those cases in which there is a physical cause of the disease. Regardless of the cause, there is a persistent psychological emergency in terrible people, which can only be alleviated by suitable psychotherapeutic measures. The following treatment measures are available to those affected:
Preparations from the area of the sedatives are mainly used for the medicinal treatment of frightfulness. These are medicines that have a calming effect on the nerves and can also be used to treat various anxiety disorders. Classic drugs include diazepam, nitrazepam, citalopram or amitriptyline. The latter two also serve as antidepressants, such as those prescribed for anxiety disorders.
If epilepsy can be identified as a trigger, antiepileptics with a calming effect are used instead (e.g. phenobarbital). In the area of neuroleptics, there are also preparations such as promethazine or chloroprothixes.
It should be noted that many of these preparations have a high addictive potential and should only be used if other treatment measures are unsuccessful. If no relevant mental or neurological diseases are identified as the cause, it is therefore better to work with disease-specific medication (e.g. cardiac medication for heart complaints) or psychotherapeutic treatment.
Behavioral therapies, which provide patients with a suitable coping strategy for dealing with their fear, are primarily used within psychotherapeutic treatment. Such behavioral therapy can also help with nicotine and alcohol addiction, which generally also cause increased nervous sensitivity and thus more frightfulness in everyday life.
In the case of phobias, after an initial conversation therapy, which usually comprises several sessions, there is a targeted confrontation with the anxiety-causing situations or objects. In the case of severe trauma, such measures are also followed by conscious relaxation therapies.
Relaxation offers such as progressive muscle relaxation, yoga, sound therapy or qigong are not just about coping with existing trauma and anxiety. Rather, those affected should be given more serenity, which is able to prevent excessive panic, fears and thus the pathological fearfulness. A special combination of relaxation and psychotherapy is also given with hypnosis. Nowadays, it is used more and more in trauma management and anxiety therapy and, interestingly, it also achieves good results. The only contraindication to hypnosis is the presence of a mental illness. Patients with bipolar disorder or schizophrenia are therefore not allowed to undergo hypnosis treatment.
As is so often the case, more than just an herb has grown against fright. The effective medicinal sedatives include:
- Johannis herbs,
- Passion flower,
- Lemon balm.
The herbs are mainly prepared as tea, but can also be part of a relaxing aromatherapy or massage. Both can do terrible people very well and reduce the situations in which they react with excessive terror.
Of course, there are also a lot of measures that people can take to alleviate their fearfulness. Even when it comes to behavioral therapy, initiative is particularly in demand in order to deliberately confront fear-triggering factors. Making more space for relaxation offers in everyday life is also part of the private measures, although doctors and health insurers often support corresponding offers here. Apart from that, you can also make everyday life more relaxed and pay more attention to calming activities such as gardening, walking, embroidery or painting.
In addition to these everyday measures, it is also advisable to put off certain unhealthy habits. This includes, for example, nicotine and alcohol consumption. Two substances that are extremely stressful for the nerves and thus promote fearfulness. It is also important to have healthy sleep hygiene during the day or rather at night in order to be rested and balanced. In the area of nutrition, caffeine and sugar should be avoided, since both strain the nerves unnecessarily. (ma)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Miriam Adam, Dr. med. Andreas Schilling
- Bessel van der Kolk: Embodied Terror, G.P. Probst Verlag, 5th edition, October 29, 2018
- German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology e. V. (DGPPN): S3 guideline on schizophrenia, long version, version 1.0, last changed on March 15, 2019, (accessed June 24, 2019), DGPPN
- Andreas Maercker (ed.): Post-traumatic stress disorder, Springer Verlag, 4th edition, 2013
- Luise Reddemann, Cornelia Dehner-Rau: Trauma: Recognizing, Overcoming and Growing Consequences: An Exercise Book for Body and Soul, Medical Publishers Stuttgart, 2nd Edition, February 8, 2006
- Gottfried Fischer, Peter Riedesser: Textbook of Psychotraumatology, Ernst Reinhardt Verlag Munich Basel, 4th edition, 2009