Phobias

By Dr. Cheryl Lane, PhD

Phobias are characterized by the fear of a specific object or situation, such as spiders or flying. While many people have one or more phobias to some degree, most aren’t sufficiently impacted by them to warrant the diagnosis of “Specific Phobia” (the official clinical term). A specific phobia is a type of anxiety disorder. It is sometimes referred to as a “simple phobia”.

With specific phobias, the anxiety that’s experienced when you encounter (or anticipate encountering) the feared object or situation is excessive or unreasonable. You may even have a full-blown panic attack, especially if you are unable to get away or believe there’s no escape.

Also, your anxiety or fear is usually the most intense the closer you are to the feared object or situation. For example, if you have a phobia of snakes, you’ll be much more anxious if one is crawling alongside your foot than if it’s several yards away or inside a terrarium).

Types of Specific Phobias

There are 5 different types (or rather, subtypes) of specific phobias:

Animal Type - includes the fear of insects as well as any type of animal

Natural Environment Type - e.g. a fear of water, heights, or lightening

Blood-Injection-Injury Type - the fear of getting an injection or other type of invasive medical procedure, or the sight of blood or an injury; the anxiety response often involves fainting

Situational Type - e.g. the fear of flying or being in a small, enclosed space

Other Type - the fear of things or situations not included in the other four categories, such as a fear of clowns or the fear of a situation that might cause you to contract an illness

The average age of onset, as well as the sex ratio for phobias, varies depending on the type of phobia. Situational phobias usually develop in childhood or one’s mid-20s. Natural environment phobias and animal phobias typically develop in childhood. As a general rule, significantly more females (anywhere from 75% to 90%) than males develop specific phobias. The percentage of females with a fear of heights or blood-injury-injection phobias is approximately 55% to 70%.

Symptoms

The symptoms for a specific phobia include:

• Marked, persistent, and excessive or irrational fear triggered by encountering or anticipating a specific object or situation;
• The fear or anxiety almost always occurs immediately (upon encountering or anticipating the object or situation), and may involve a panic attack;
• The phobic person understands that the fear is irrational or excessive (this may not be true with children);
• The person either endures the situation with significant anxiety or goes out of the way to avoid it;
• The anxiety, fear, or avoidant behavior directly related to the phobia significantly disrupts the person’s life, or having the phobia causes a lot of distress; and
• The symptoms must occur for at least 6 months if the person is less than 18 years old.

A specific phobia is not diagnosed if the symptoms are better explained by another psychiatric disorder, such as social phobia, PTSD, OCD, separation anxiety disorder, panic disorder, or agoraphobia.

Risk Factors

You have a greater risk of developing a specific phobia is you are:

• Female
• In your mid-20s or younger
• Have an immediate family member with a specific type of phobia (e.g., if your mother or a sibling has an animal phobia, you’ll be more likely to also develop an animal phobia – although the type of animal may be entirely different)

Causes

Experts don’t know exactly why some people develop specific phobias and others don’t. More than likely, they are caused by a combination of different things including biology, brain chemistry, genetics, traumatic experiences (e.g. being bit by a dog or locked in a closet), past anxiety responses, and learned behavior. Constantly or frequently hearing about, reading about, seeing on the news, or being warned about a dangerous thing or situation - particularly in childhood - may contribute to the development of a specific phobia.

Treatment

One of the most common forms of treatment for specific phobias is exposure therapy. The therapist will have you gradually and repeatedly face the feared object or situation, with the exposure getting progressively more direct. For example, if you have a phobia of snakes, you may start by looking at a picture of one, then eventually observing one at close range, and ultimately picking one up and holding it (a non-poisonous one, of course!). The gradual exposure helps desensitize your emotional response so that you’ll be able to face the situation or object without any (or at least, with significantly less) anxiety or fear.

Cognitive behavior therapy may also be used to treat specific phobias. This therapy will help you identify and change the irrational and negative thoughts associated with the situation or object, as well as the maladaptive behaviors (e.g. avoidance) that reinforce your anxiety.

Hypnotherapy and the use of relaxation techniques may also be very helpful in the treatment of specific phobias.

Medication is not typically used to treat specific phobias. However, it may be used temporarily to alleviate symptoms of intense anxiety for some situational phobias. For example, benzodiazepines such as Ativan or Xanax may be prescribed if you have an intense fear of flying but have to do so once in a while.