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PHOBIAS

A phobia can be described as an intense fear—which may be considered irrational—of a particular place, situation, animal, or object. This will typically be avoided by the person experiencing the phobia, and when it must be endured, it generally provokes significant fear and/or anxiety. Certain phobias may be more common than others, such as arachnophobia, ophidiophobia, acrophobia, and agoraphobia (the fear of spiders, snakes, heights, and open or crowded spaces, respectively), while some phobias may be much rarer.

When a phobia is so severe that it interferes with the ability to function, a therapist or other mental health professional may be able to help the person affected address and explore ways to overcome fear, anxiety, and other effects of the phobia.

Understanding Phobias

Most individuals have a particular fear, several particular fears, or experience fear in certain situations that are generally considered to be dangerous. A phobia, however, goes beyond ordinary fear and may often feature an object or situation that is not typically threatening, such as a ringing telephone.

Phobias are listed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5) under anxiety disorders. They are not considered to be a form of psychosis, as the person experiencing the phobia typically recognizes that the object of the phobia is unlikely to cause harm but still cannot help the terror and panic that often results upon exposure.

Symptoms of a phobic reaction may include:

  • Dizziness, a faint feeling, shortness of breath
  • Nausea or vomiting
  • Trembling, shaking, numbness, or tingling

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  • Sweating, chills
  • Chest pain, shortness of breath, heart palpitations
  • A fear of losing control, dying, or fainting
  • A feeling that one is detached from one’s body

A fainting or near-fainting response, heart rate acceleration, and blood pressure elevation typically characterize phobias specifically related to blood, injections, or injuries. Symptoms can trigger panic attacks when they occur at high intensity, and fear linked to phobic reactions may also lead to the development of anxiety, stress, and depression. Often, the fear of experiencing a phobic reaction will lead individuals to avoid all possibility of encountering the object of the phobia, and this avoidance may have a negative impact on well-being and the ability to function.

A phobia may develop after one experiences trauma, and a phobia generally first appears in childhood. In the majority of cases, the phobia develops before age 10. Phobias may wax and wane during childhood and adolescence, according to the DSM, but if they continue into adulthood, they are likely to persist throughout life.

Between 7% and 9% of the population of the United States is believed to experience a specific phobia. Twice as many women as men report experiencing a phobia, and women are more likely to experience phobias related to the environment, a situation, or animals. Phobias related to blood, injection, or injury are experienced almost equally by all individuals. A person who experiences a phobia is also likely to experience multiple phobias. About 75% of individuals with a phobia fear more than one situation, object, or event.

How Does a Phobia Differ from Fear?

Fear, the emotion often experienced when safety or well-being is threatened, is generally considered to be a rational response to something that is threatening. A person with a phobia may recognize that the thing or situation feared carries little or no threat and is unlikely to cause harm but still be unable to overcome the fear without help. For example, most people will experience fear when encountering a dog that is growling, barking, or foaming at the mouth. But a person who is afraid to approach any dog—even one leashed, behind a fence, or sleeping—and experiences fear at the sound of dogs barking in the distance likely has a phobia of dogs.

While a phobia may seem to have no apparent cause, addressing the phobia with the help of a mental health professional may reveal a phobia’s roots. Often, a phobia develops following some childhood experience, and a phobia may sometimes be associated with deeper fears. With the help of a mental health professional, it is often possible to overcome or at least significantly reduce the impact of a phobia .

Complex and Specific Phobias

A specific phobia most often develops in childhood and may be triggered by an unpleasant or traumatic experience. For example, the experience of nearly choking to death may lead to the development of a phobia of choking. Common specific phobias include the fear of blood, storms, enclosed spaces (claustrophobia), germs, heights, and flying. Phobias may also be learned; a child who witnesses the phobia of a family member may be more likely to develop the same phobia.

A complex phobia, such as agoraphobia or social phobia (social anxiety), is more likely to have a significant impact on a person’s function. Adult onset is also more likely with these phobias, which may develop as a result of life experiences, brain chemistry, genetic causes, or some combination of the above. Social phobia in particular may often develop following a stressful social experience. As with specific phobias, these complex phobias generally improve with treatment.

Phobias in Children

Phobias typically first appear in childhood, and most cases of specific phobia develop by age 10. However, because excessive fear—which may involve a variety of objects, situations, places, or people—is common in childhood, a mental health professional will generally take into account the severity of the fear, the degree to which it affects the child’s life, and whether or not the fear is appropriate to the child’s developmental stage. Often, childhood fears may be experienced intensely but fade rapidly or have little to no harmful impact on the child’s daily activity. In this case, a phobia would likely not be diagnosed.

Fear may be expressed in children through tantrums, crying, freezing, neediness, and unexplained pain, such as stomach or head pain. Children may also find it difficult to understand the concept of avoidance, so a mental health professional may rely on information from parents, teachers, and other adults.

Addressing Phobias in Therapy

For the most part, phobias are a treatable mental health condition. Once treatment has begun, a phobia is likely to improve and generally does not have long-lasting ill effects. Those experiencing a phobia may obtain significant benefits from therapy, especially when a specific phobia occurs along with another form of anxiety or a diagnosable personality disorder, as this comorbidity is believed to lead to an increased risk of suicidal ideation/attempts.

Those with phobias are generally aware of them, and many are readily able to discuss the condition with a mental health professional. Some may find their symptoms embarrassing or distressing, and they may be reluctant to discuss their phobia, which can be a barrier to effective treatment.

Cognitive behavioral therapy is considered to be an effective method of treating phobias, as CBT helps people in therapy to identify and address thought patterns that can have a negative impact on well-being.

Exposure therapy, also known as systematic desensitization, has also been shown to be an effective treatment method. This form of treatment involves exposing a person to the source of the phobia in small, gradual steps. This can help a person become able to encounter the object of the phobia in daily life without experiencing significant negative effects. For example, a person who is afraid of birds may first be encouraged to talk about birds with a mental health professional in the safety of a therapy session. The individual then might look at pictures of birds, then visit a pet shop to view birds in cages from a safe distance. Later, that person might spend time outside in a park or other area frequented by birds. Finally, when the person feels ready for it, a next step may be exposure to a tame bird. Eventually, the individual may find that it is possible to calmly enter places where birds may be encountered.

Relaxation techniques, including breathing and physical exercises and visualization may also be helpful. Visualization in particular may help an individual become better able to carry out tasks, as it may be easier to face a phobia when one first mentally plans each step.

Support groups may be helpful for some people who experience phobias, as many individuals may find sharing common experiences and coping methods to be a beneficial step in the process of addressing a phobia.

Case Example

  • Addressing phobia of hot water in therapy: Claudia, 23, enters therapy, reporting an extreme fear of being burned by hot water. Her phobia is such that she experiences extreme anxiety when showering, doing dishes, or washing her hands because she worries the water will suddenly become hotter and burn her. Although she recognizes that such an occurrence is unlikely, she still finds it nearly impossible to perform any related tasks without significant anxiety, and so she avoids using tap water as much as possible. She tells the therapist the phobia has been present for many years but it has recently worsened to the point where she finds it difficult to even use cold tap water. The therapist asks Claudia if she remembers when the phobia began, but she cannot tell him. It takes some time in therapy, but eventually Claudia is able to recall several instances from early childhood—the memories of which she had buried—of her mother punishing her by holding her hands under running water. Though her mother did not physically abuseher in other ways, further revelations reveal a history of emotional abuse that continued until Claudia went to live with her father at age 10. After her memories are uncovered, Claudia is able to begin working toward recovery with the help of the therapist. She learns relaxation techniques to help manage the anxiety she feels when using running water, and the therapist also suggests eye movement desensitization and reprocessing therapy (EMDR) to address the emotions related to her experience of abuse. Simply talking about her phobia and understanding its cause is helpful for Claudia, and as she continues in therapy, she sees significant improvement.