Andy, a 32-year-old IT consultant, is used to people laughing at him when he tries to explain his crippling fear of buttons, specifically those on shirts and jackets.  “I’ve worked in corporate environments, full of people in suits, and there are buttons everywhere you look. This situation is to me what other people may feel being locked in a burning building, or drowning and not be able to swim to the surface,” he says, his voice audibly shaking at the mere thought of rooms full of shirt buttons.  Andy’s condition is called koumpounophobia. It is not as common as some phobias – but still affects around one in every 75,000 people. Sufferers report losing contact with family and friends because they are unable to attend weddings and funerals, or abandoning their careers and doing jobs that allow for remote working or casual clothing.  Phobias are irrational fears which are classified as either simple – of a particular object, such as in Andy’s case – or complex, when they pertain to a circumstance or situation. Because of the ridicule sufferers are often met with, people tend to suffer in silence and phobias go untreated. “I thought I’d be laughed out of a GP’s office,” says Andy. “I knew this was a real thing, but didn’t know how to explain it without feeling like an idiot.”  Another reason many people don’t seek help is because of what the treatment entails. The NHS offers cognitive behavioural therapy (CBT) to people with phobias, which includes “exposure” to the object of the fear. A person develops a phobia when their brain has learned to respond to certain non-dangerous situations (such as seeing a small spider) with a “fight-or-flight” response, which causes symptoms that include panic attacks, palpitations, hysterical crying, and the urge to run. Exposure can work because if patients slowly learn to respond to seeing, say, a spider in a calm way – eventually even holding one in their hands – they can essentially “rewire” their brains. But the thought of facing a phobia in such a way can, understandably, be terrifying.  Around 10 million people in the UK suffer from phobias, yet research into causes and treatments is incredibly limited compared with other mental health conditions. Nicky Lidbetter, chief executive of Anxiety UK, has herself suffered from phobias and is a keen supporter of CBT treatment, but argues it needs to be improved and that further research is crucial.  “I remember when anxiety used to be bundled in with depression, despite being a very different condition. We worked hard to raise the profile of anxiety as a separate disorder that could be just as crippling. This is what we need to do with phobias,” she says. “Because they often seem comical and irrational, the media doesn’t take them seriously and I think this mentality has seeped into the medical world, which is why there’s so little funding and research.”  Amy is a 25-year-old marketing manager based in Leeds. She says: “I knew that if I told a doctor I was scared of heights they’d make me go on a rollercoaster or something. Just seeing a long flight of stairs was making my heart race. I’d start to shake, and couldn’t stop myself from running away.” Amy eventually sought help when she and her boyfriend were looking to move in together and it became too limiting to find a ground-floor or basement flat.  Her treatment involved various exercises, such going up in a lift every day and getting off one floor higher each week. She is now able to manage her phobia, although it hasn’t disappeared.  CBT and exposure therapy has been proven effective in a lot of cases, but some experts disagree with the way it is applied across-the-board to all patients. Guy Baglow is the director of Mindspa Phobia Clinic in Harley Street, London. “CBT is about correcting thinking patterns, and it works really well for a lot of conditions, but I don’t think it’s effective in treating phobias,” he says. “We deal with a lot of clients who have had exposure therapy, and it has actually reinforced the patterns we want to break. CBT tackles the conscious mind, trying to teach us to reason against our phobias, but most people know their phobias are irrational to begin with, so this doesn’t feel helpful.”  Despite being overwhelmed at the prospect of exposure, Andy did eventually see his GP, who referred him to a counsellor. “She was really friendly but I had to wait a month for a half-hour phone consultation, and then all I was going to have was one 45-minute session every two weeks. By this point I was too terrified to leave the house.”  Even at home, Andy was in a constant state of alert. TV and movies were impossible, in case a close-up of a button appeared onscreen. He needed urgent help. “I moved back in with my parents and spent hundreds of pounds on intensive private therapy, but after a couple of sessions they tried to make me look at some pictures of shirts, and I started panicking. I couldn’t get the image out of my head for weeks and it made me constantly terrified. I couldn’t go back.”  More recently, though, life has become a little easier, and he recently bought his first ever pair of button-fly jeans. “I’m so lucky to have had the support system I do, because without my family I really think I might have considered taking my own life,” he says. “Looking back, it’s so tragic to realise that while my friends were joking about my weird little quirk and playing pranks on me, on the inside I was battling my own brain every minute of every day. It was so exhausting and stressful, I can’t imagine anyone would find it funny if they knew what it was really like.”
Having a fear of buttons may sound hilarious, but in reality it can be debilitating. Patients need to be taken more seriously, by both the media and doctors, say experts