Each method of birth control has advantages, disad- vantages, and sources of anxieties. They should be discussed by couples before they engage in sexual intercourse. Women and men must weigh the fac- tors relative to a birth control method, including effectiveness in preventing unwanted pregnancy, protection from a sexually transmitted disease, free- dom from side effects, cost, or spontaneity of use.
METHODS OF BIRTH CONTROL*
The “pill” contains hormones that prevent conception.
Norplant—involves matchstick size synthetic rods that are inserted in the skin of a woman’s upper arm. For fi ve years at a slow, nearly steady rate, the rods release the hormone levonorgesterol, a form of progestin, which inhibits ovulation and thickens cervical mucus.
Depo-Provera, an injectable form of progestin administered every three months, has been used by 15 million women worldwide.
A diaphragm is a rubber disk with a fl exible metal rim that is inserted to fi t around the cervix. Spermicide placed inside the diaphragm kills most of the sperm in the area. The cervical cap is smaller and more rigid than the diaphragm but works the same.
Placed inside the uterus, an intrauterine device (IUD) is believed to set up a mild, harmless infl ammation that impedes sperm and keeps any fertilized egg from implanting.
The condom, one of the oldest forms of birth control, is a simple sheath that covers the penis, blocking sperm from the uterus.
Available since 1993 in the United States, the female condom is a long polyurethane sheath that is anchored between the cervix and the vagina.
Medications known as the “morning after” pill, which can be used by women who engage in unprotected sex or who fear pregnancy. These medications are oral contraceptives taken in prescribed dosage no longer than 72 hours after intercourse, followed by another dose 12 hours later.
* No one method of birth control has proven to be 100 percent effective.
According to the 1995 National Survey of Fam- ily Growth by the National Center for Health Sta- tistics, the most popular method of birth control is female sterilization (29.5 percent), followed by the birth control pill (28.5 percent), male prophylactics (17.7 percent), vasectomy (12.5 percent), the dia- phragm (2.8 percent), the IUD (1.4 percent), and all other methods (4.9 percent). The numbers total more than 100 percent because some women use more than one method of birth control.
See also CONDOM; FAMILY PLANNING; PREGNANCY, FEAR OF; SEXUALLY TRANSMITTED DISEASES, FEAROF;
UNWEDMOTHERS.
birthdays, fear of Some individuals fear telling others their birthday and also fear celebrating their birthday in any way. This fear may be related to a fear of aging and fear of getting old. Some individu- als fear telling anyone their correct age and consis- tently say they are younger than they really are. Some even fear celebrating the birthday of another; this may be related to a superstitious fear.
See also AGING, FEAROF.
birthing a monster, fear of Fear of birthing a monster is known as teratophobia. The term also relates to fear of giving birth to an infant with a severe birth defect. Some women fear pregnancy and childbirth because they have teratophobia, especially if they have been exposed to rubella or other agents known to cause birth defects.
See also CHILDBIRTH, FEAROF; MENTALDISORDER, FEAROF; PREGNANCY, FEAROF; RADIATION, FEAROF; X RAY, FEAROF.
birth order A term introduced by Alfred Adler (1870–1937), a Viennese psychologist, to describe different effects in personality and behavior due to birth position. Studies of birth order have led to some generalizations about how a child’s posi- tion in relation to his/her parents and siblings may affect his/her anxiety level, personality, and view of the world.
The first child born to a family has the advan- tage of undivided attention and resources. Whether
that child becomes the only child of the family or its oldest child, he/she may tend to be more adult in behavior and more interested in goals and per- sonal achievement. As a group, first children are strongly represented in the ranks of the successful and powerful. They also tend to score highest on intelligence tests.
Only children often have characteristics and resulting anxieties of their own. Having been the center of their parents’ attention, they are in danger of becoming selfish and spoiled. Likewise, their par- ents’ expectations for them to succeed at anything they do may be unreasonably high. With more exposure to adults, they may not relate well to other children and may have problems with sharing.
For older children, the arrival of a sibling, even though happily anticipated, has the ultimate effect of making them feel dethroned. They often assume a certain amount of responsibility for younger chil- dren in the family and may be responsible for set- ting a good example, showing younger children how to do things, and baby-sitting. Older children are frequently more aware of family difficulties and problems and their own parents’ insecurities. As a result, they tend to be more anxious, conservative, and responsible than younger brothers and sisters.
The middle child position in the family has more variables since the ages and sex of siblings may have a profound effect on him or her. Middle children usually become good at sharing, but also guard their privacy. They may perceive that they are too young for the privileges of the oldest and too old for the coddling of the youngest. As a result, middle children may show off to get attention and may also seek rewarding relationships outside the family. The need to belong to a peer group is strong in middle children, and they are team players, fre- quently quite popular. To compete with an older sibling, a middle child will develop his abilities in an area quite different from the talents of his or her older brother or sister.
The youngest child of a family never has the experience of having his position usurped. Younger children tend to preserve and use childish charac- teristics such as crying, acting cute, or emphasiz- ing their dependence and inadequacy to get what they want. Younger children frequently have very positive feelings about themselves because of their 98 birthdays, fear of
position in the family and tend to be charming and popular. They have the best sense of humor in the family. Their disadvantage is that they often obtain information and opinions from other children rather than adults and therefore lack the wisdom and realism they might gain from adult contact.
A very specific type of younger child is the “change of life” baby who arrives several years after the older siblings. This younger child is really more in the position of being the only child, but with sev- eral parents, since usually one or more of his or her siblings act as a parent. These children grow up with a great deal of attention and support, but may also have the additional stress of a confused sense of themselves from the variety of images and ideas from siblings they perceive as adult but who are, in fact, children.
Other positions in the family that can have long- lasting effects on personality are the “only daugh- ter” or “only son” syndromes. Only daughters have traditionally had the “feminine” chores of the fam- ily and, in many cultures, are expected to take care of the parents as they grow old, even if it means per- sonal sacrifice. “Only sons” were expected to enter the family business or succeed at some profession.
See also COMMUNICATION; FAMILIES; SIBLINGSRELA- TIONSHIPS.
Brownstone, David, and Irene Franck, The Parent’s Desk
Reference (New York: Prentice Hall, 1991).
Franklin, Deborah, “Why Are Siblings So Different?” In
Health, March/April, 1991.
Richardson, Ron, and Lois A. Richardson, Birth Order and
You: How Your Sex and Your Position in the Family Affects Your Personality and Your Relationships (Bellingham,
WA: Self-Counsel, 1990).
birth trauma A term coined by Otto Rank (1884– 1939), an Austrian psychoanalyst, to describe his concept that ANXIETY has roots in the traumatic event of birth. According to Rank, factors in psy- choanalysis represent birth SYMBOLS; for example, transference is the reenactment of the oneness with the mother, and the separation from the analyst at the end of the treatment corresponds to the expul- sion from the mother’s womb. A desire to return to the womb is seen as the universal neurotic wish,
and only when this is overcome is the analysis com- plete. More recently, natural childbirth advocates have expressed interest in the psychological effects of the birth process and have suggested that a calm separation of the baby from the uterus increases the infant’s mental health and facilitates the bond- ing process with the mother.
See also ANXIETIES; ATTACHMENTTHEORY; PRIMAL THERAPY.
black cats, fear of Some individuals fear black cats because they are associated with witchcraft and superstition. Some people avoid letting a black cat cross their path out of superstitious fear of future misfortune. Some fear black cats but not cats of other colors, while other individuals fear only lighter-colored cats.
See also CATS, FEAROF.
blennophobia Fear of slime. See also SLIME, FEAROF.
blocking Interruption of a train of speech before a thought or idea has been completed. After a period of silence, which may last from a few seconds to minutes, the individual indicates that he/she can- not recall what he/she has been saying or meant to say. Blocking should be judged as present only if the person spontaneously describes losing his thought or if, upon questioning, he or she gives that as the reason for the pause. Blocking is often due to low levels of ANXIETY that affect concentration.
Blocq’s syndrome Fear of standing or walking; also, a hysterical inability to stand or walk. The fear may be motivated by a desire for secondary gains of sympathy and support. Blocq’s syndrome is also known as astasia-abasia. The syndrome was named for Paul Oscar Blocq (1869–96), a French physician.
See also SECONDARYGAIN.
blood (and blood-injury) phobia Many individu- als are afraid of the sight of blood. Fear of blood
is known as hematophobia or hemophobia. While susceptible individuals may not say they have a fear of blood, when faced with the sight of their own or another’s blood, they may recoil, close their eyes, or even faint. A reaction may occur on hearing a description of blood and gore, such as a war scene, or even imagining seeing someone bleeding. Blood phobia is different from some other phobias in that the individual does not perceive danger of injury or death.
Blood phobics may experience more nausea and faintness than fear or anxiety. They may avoid their phobic stimuli because they fear fainting, and their fear of fainting in turn can cause them anxiety.
With most phobias, the individual’s pulse and breathing rate increase in response to the phobic stimulus. However, with blood phobia (and related blood-injury phobias, such as phobia of needles, injection, blood donation, etc.) there is often a sharp drop in heart rate and blood pressure, which is called a diphasic cardiovascular pattern. Why some blood phobics lose consciousness when faced with the stimulus is not clearly understood, but one hypothesis is that it is a “protective” biologi- cal mechanism that, in the event of actual injury, prevents the individual from doing anything that might cause further blood loss.
Like phobias of animals, those of blood and injury often begin during childhood. It appears to be relatively common in minor forms, and is exces- sive in very few instances. Epidemiological studies indicate that approximately 3.1 to 4.5 percent of the population report blood and blood-injury pho- bias. In one 1980 study, a high percentage of blood phobics (68 percent) reported that close relatives had the same fear.
Severe phobia of blood and injury can be seri- ously handicapping. For example, sufferers may avoid necessary medical procedures or avoid attrac- tive careers as medical professionals. Blood-injury phobic women may even avoid becoming pregnant in order to avoid medical examinations and the sight of blood.
Benjamin Rush (1745–1813), American physi- cian and author, said of blood phobia:
There is a native dread of the sight of blood in every human creature, implanted probably for the
wise purpose of preventing our injuring or destroy- ing ourselves, or others. Children cry oftener from seeing their blood, than from the pain occasioned by falls or blows. Valuable medicines are stamped with a disagreeable taste to prevent their becoming ineffectual from habit, by being used as condiments or articles of diet. In like manner, Blood-letting as a remedy, is defenced from being used improperly, by the terror which accompanies its use. This ter- ror rises to such a degree as sometimes to produce paleness and faintness when it is prescribed as a remedy. However unpopular it may be, it is not contrary to nature, for she relieves herself when oppressed, by spontaneous discharges of blood from the nose, and other parts of the body. The objections to it therefore appear to be founded less in the judgments than in the fears of sick people.
See also DEATH, FEAROF; FAINTING, FEAROF; FAM- ILYINFLUENCE; INJURY, FEAROF.
Beck, Aaron T., and Gary Emery, Anxiety Disorders and
Phobias: A Cognitive Perspective (New York: Basic Books,
1985).
Ost, Lars-Goran, and Kenneth Hugdahl, “Acquisition of Blood and Dental Phobia and Anxiety Response Pat- terns in Clinical Patients,” Behaviour Research and Ther-
apy 23 (1985): pp. 27–34.
Runes, D. D., ed., The Selected Writings of Benjamin Rush (New York: The Philosophical Library, 1947).
blood donating, fear of Fear of donating blood, for many people, is a fear of the sight of their own blood, a fear of needles, or a combination of these fears. Some fear the pain of the needle or fear becoming weak or ill because of the loss of blood. Many blood-donating phobics do not realize that there is very little pain in the actual donation pro- cess. Those who have donated blood say that the needle feels something like a pinch on the arm. Some who fear donating blood use the excuse that their blood is not the right type. This usually is a cover-up for their fear, because every type is the right type. Some phobics say that they do not have any blood to spare, although an adult in generally good health has about 10 to 12 pints of blood in his or her body, and one can safely donate one pint of 100 blood donating, fear of
blood every eight weeks. Other phobics say they do not have time to donate blood.
During the 1980s, when the spread of acquired immunodeficiency syndrome (AIDS) increased, many individuals became fearful of donating blood because they feared the possibility of acquir- ing AIDS during the procedure. Authorities have assured donors that it is impossible to get AIDS by donating blood because all materials involved in the donation procedure are used only one time and are completely sterile and disposable.
See also BLOODPRESSUREPHOBIA.
blood pressure, fear of high Because high blood pressure (hypertension) is closely linked with heart disease, many people fear having high blood pres- sure. Many who have illness or disease phobia fear having high blood pressure. The term blood pres- sure, as used in medicine, refers to the force of the blood against the walls of the arteries, created by the heart as it pumps blood through the body. As the heart beats, the arterial pressure increases. As the heart relaxes between beats, the pressure decreases. High blood pressure is the condition in which blood pressure rises too high and stays there.
Normal blood pressure varies from moment to moment within each individual. Blood pressure may be higher at one time than another. It goes up when one exercises or experiences ANXIETY and goes down when one rests or sleeps. In otherwise healthy adults, however, the generally recognized normal range of systolic (pumping) blood pressure is from 90 to 120 mm HG; the diastolic (resting) blood pressure ranges from 55 to 90 mm HG. In determining whether an individual has high blood pressure, the physician will be concerned with the usual pressure in one’s system. The physician may measure an individual’s blood pressure more than once during a visit. For example, if one has hurried to the office, one may feel out of breath, which could contribute to a high reading. Later during the visit, as one relaxes, one’s blood pres- sure may go down. Also, a physician may consider the average of several readings taken at different times before making a diagnosis of high blood pres- sure. If blood pressure is high on only one occa- sion, the physician will want to measure it again
under other circumstances to see if drug treatment is necessary.
Because so many people do not feel any symp- toms with high blood pressure, the disease has been called “the silent killer.” However, some people with advanced high blood pressure have persistent HEADACHES, DIZZINESS, fatigue, tension and short- ness of breath.
Some individuals who have PANICATTACKS may have elevated blood pressure at times; they should be checked periodically to be sure that their aver- age blood pressure is within a normal range.
See also HEARTATTACK, FEAROF; ILLNESSPHOBIA; “WHITECOATHYPERTENSION.”
Kahn, Ada P., High Blood Pressure (Chicago: Contemporary Books, 1993).
blood pressure phobia Fear of blood pressure, usually high blood pressure.
See also “WHITECOATHYPERTENSION.”
blood transfusions, fear of During the 1980s, fear of blood transfusion became widespread when it was recognized that the human immuno- virus (HIV), which is known to carry the dreaded acquired immunodeficiency syndrome (AIDS), can be spread through blood transfusions. Others fear blood transfusions because the procedure involves use of needles or tubes placed in the body. Still oth- ers who have blood phobia fear seeing blood or blood components being fed into their bodies.
While blood transfusions are feared by many, they are lifesaving for many others. Transfusions are given after great loss of blood in an accident or in a surgical operation, to treat the systemic shock and fluid loss caused by severe burns, in replacing the blood of an Rh-positive newborn infant, and to treat severe anemias.
Since the rapid spread of certain types of hepatitis and AIDS from blood transfusions, blood of donors is tested before it’s drawn, and blood is tested again before it is transfused into a recipient. An under- standing of how this is done will allay many fears.
See also BLOOD PRESSURE PHOBIA; DISEASE, FEAR OF; ILLNESS, FEAROF.
blushing, fear of Fear of blushing, or erythro- phobia, can be a painful and difficult symptom for therapists to treat. Fear of blushing is manifest only when other people are present. The phobic