Specific Phobias

What are specific phobias?

Specific phobias are a common anxiety disorder. A phobia involves intense irrational fear or anxiety when encountering (or simply thinking about) a particular situation, place, or thing, such as lizards, flying, or public bathrooms.

Common types of phobias include fear of heights (acrophobia), animals (zoophobia), insects (entomophobia), flying (aviophobia), thunder (brontophobia), and confined spaces (claustrophobia).

Phobias often develop after a traumatic event, such as getting stuck in an elevator. They’re twice as common in females than males. Phobias can usually be treated with therapy.

Most common symptoms

If you have a specific phobia, you can’t control the fear or anxiety surrounding the feared situation or object. That causes intense distress.

Often, you will try to avoid the trigger. For example, a person who is afraid of heights will do just about anything to avoid crossing bridges. But this gets in the way of work and other responsibilities.

When unable to avoid the feared object or situation, you typically experience significant distress.  The anxiety symptoms vary, depending on the person and the phobia.

Many phobias trigger a fast heartbeat, sweating, shakiness, nausea, and shortness of breath.  Other phobias (for example, seeing or involving blood) may cause lightheadedness and near-fainting.

People with phobias typically recognize that their reactions are not reasonable and excessive. But they still feel like they are in extreme danger.

Main symptoms

• Significant fear or anxiety related to specific objects or situations.
• The trigger nearly always causes immediate fear.
• Trying to avoid the feared object or situation (for example, you cancel a doctor’s appointment because you have a phobia of blood).
• Feelings of fear and anxiety are excessive, compared to the actual danger of the object or situation.
• Symptoms last for at least 6 months.
• Fear, anxiety, and avoidance interfere with work, socializing, or other obligations.

Specific phobia causes

Specific phobias are most likely due to a combination of biological, psychological, and environmental factors. Some possible contributors include:

• Trauma: Most phobias seem to come out of the blue. Though some start after traumatic experiences, such as being bitten by a dog and then developing a fear of dogs.
• Genetics: People with relatives who have a certain phobia are more likely to experience the same type of phobia.
• Brain function: Changes in how the brain works may be a factor. Studies have focused on the amygdala, a part of the brain involved in perceiving and experiencing fear.

How is specific phobia diagnosed?

If overwhelming fears are disrupting your personal or work life, discuss your concerns with a mental health professional.

It’s important to differentiate phobias from other conditions, such as panic attacks and post-traumatic stress disorder (PTSD). Though these often have similar—even overlapping—symptoms, the treatments are different.

People with specific phobia are 60% more likely to attempt suicide. If you ever have any thoughts at all of self-harm or suicide, call 911 or go to the nearest ER for an immediate mental health evaluation.

Phobias in children

It is common for children to have a variety of fears. Children often do not have the words to express their fears. Instead, they express themselves through their behavior such as crying, tantruming, freezing, or clinging to their caregiver.

Although much of this behavior is normal at times, notice if your child repeatedly displays this behavior around a specific object or situation (like getting shots or around dogs). If so, your child might have a specific phobia to these things. If you have any concerns, talk with your child’s doctor. They may refer you to a child therapist for further help.

Treatment for specific phobia

Phobias are one of the most treatable types of mental disorders. The most effective treatment is exposure therapy, a type of talk therapy.

Medications may be prescribed for certain situations, such as helping someone who is afraid of flying go on an airplane.

Exposure therapy

Exposure therapy helps you become more comfortable and feel less anxious around the trigger. This is done by addressing three things—the physiological fear response (also known as fight or flight), the thoughts you tell yourself about the object or situation, and how you cope (what you do in response to the trigger).

The therapist learns the details of your trigger, and helps you change your physical response, thoughts, and behaviors associated with it.

For instance, if you were afraid of spiders, the therapist would ask you to look at a spider from across a large room. You are asked to monitor how your body reacts (like noticing when your heart rate gets faster). Then the therapist talks you through relaxation techniques to reduce your symptoms.

As you become less fearful, the therapist increases the intensity of the exposure until you can tolerate the trigger without feeling scared. Virtual reality systems are sometimes used for hard-to-reproduce situations, such as thunderstorms.

Most people who do exposure therapy can reduce their symptoms. Often just a few sessions can help. How long it takes depends on the intensity, frequency, and how long you’ve had symptoms. It’s different for everyone.

Other therapy approaches, such as talk therapy, are sometimes used for people with phobias but they are generally not as effective. Exposure therapy is the preferred treatment. Many therapists are trained in it. Look for a mental health clinician who has expertise in exposure therapy when seeking help.

Medication

Medications can relieve some physical symptoms, but the most effective, long-term treatment is through changing thoughts and behaviors with the help of a mental health clinician.

When you can’t avoid a situation that triggers a phobia, such as if someone with claustrophobia needs an MRI, there are two types of prescription medications that can help.

• Benzodiazepines: Anti-anxiety medications, such as lorazepam (Ativan) or alprazolam (Xanax), are taken a couple hours before a feared event. These can also lead to drowsiness, confusion, and poor coordination—and they can be addicting. Do not take them with alcohol or opioid medications.
• Beta-blockers such as propranolol (Inderal) block stress hormones to prevent your body from a fearful fight-or-flight response. The fight-or-flight response can bring on shakiness, sweating, and elevated heart rate.

Follow up

Studies have found that more frequent exposure therapy sessions are most effective for treating phobias. Feeling nervous about facing your fears is normal. But it’s important to attend sessions as scheduled. Your therapist will create a program that you are comfortable with to help ease your anxiety.

If your therapist gives you homework, try your best with the tasks. Be prepared to talk to your therapist about any difficulties you had.

After completing therapy, it’s important to not try to avoid your trigger. Avoidance of triggers can increase anxiety. You may also start avoiding things that are related to the trigger. To manage phobias, you have to keep facing the trigger and break the association.

Risk factors

Although anyone can develop phobias, some factors may make you more susceptible.

• Phobias often start in childhood and improve over time.
• Females are affected by phobias twice as often as men.
• Tendencies toward negative feelings and shyness are associated with phobias and other anxiety disorders.
• Growing up with overprotective parents, losing a parent, or experiencing abuse all raise the risk of phobias and other anxiety disorders.