Phobias

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Phobia facts

  • The definition of a phobia is the persistent fear of a situation, activity, or thing that causes one to want to avoid it.
  • The three types of phobias are social phobia (fear of public speaking, meeting new people or other social situations), agoraphobia (fear of being outside), and specific phobias (fear of other items or situations).
  • Although phobias often go underreported, the statistics for people who have phobias are thought to be more than 6 million people in the United States.
  • The average age that phobias begin is about 10 years of age.
  • Women tend to be twice as likely to develop a phobia compared to men.
  • While there are almost as many phobias as there are situations, the most common kinds of phobias include social phobia, agoraphobia, claustrophobia, coulrophobia, aerophobia, zoophobia, arachnophobia, dentophobia, aichmophobia, ophidiophobia, acrophobia, mysophobia, and hemophobia.
  • Agoraphobia often co-occurs with panic disorder.
  • If not treated, a phobia may worsen to the point where the person's life is seriously impacted by the phobia and by attempts to avoid or hide it, resulting in problems with physical health, friends and family, failure in school, and/or lost jobs while struggling to cope.
  • Phobias tend to run in families, can be influenced by culture and parenting style, and can be triggered by life events.
  • People with phobias seem to be more likely to deal with stress by avoiding the trigger for the stress and have trouble minimizing the severity of the fearful situation.
  • Symptoms of phobias often involve panic attacks.
  • The evaluation of phobias often includes questions by a health-care professional that explore the symptoms that are occurring, a medical interview, and a physical examination.
  • The treatment of phobias often includes the use of desensitization, cognitive behavioral therapy, and/or medications.
  • The groups of medications doctors tend to choose from when treating a phobia include selective serotonin reuptake inhibitors, beta-blockers, and occasionally, benzodiazepines.
  • Phobia sufferers sometimes cope with their fears by talking about it, refraining from avoiding situations they find stressful, visualization, and making positive self-statements.

Quick GuideWhat's Your Biggest Fear? Phobias

What's Your Biggest Fear? Phobias

Types of Phobias

Agoraphobia

The definition of agoraphobia is a fear of being outside or otherwise being in a situation from which one either cannot escape or from which escaping would be difficult or humiliating.

The fact that agoraphobia often occurs in combination with panic disorder makes it even more difficult to track how often it occurs. Other statistics about agoraphobia include that researchers estimate it occurs from less than 1% to almost 7% of the population. Its age of onset is most often during the mid to late 20s.

What is a phobia? What are the different kinds of phobias?

A phobia is defined as the persistent fear of a situation, activity, or thing that causes the sufferer to want to avoid it. The three types of phobias are social phobia (fear of public speaking, meeting new people, or other social situations), agoraphobia (fear of being outside), and specific phobias (fear of particular items or situations).

Phobias are largely underreported, probably because many people with phobias find ways to avoid the situations that they fear. Therefore, statistics for how many people have phobias vary widely. Phobias are fairly common. Women are thought to be twice as likely to develop a phobia than men.

Some of the most common phobias include fears of public speaking or other social situations (social phobia or social anxiety disorder), open spaces (agoraphobia), closed-in spaces (claustrophobia), the dark, clowns (coulrophobia), flying (aerophobia), blood, birds (ornithophobia) or all animals (zoophobia), commitment (gamophobia), driving (vehophobia), snow (chionophobia), spiders (arachnophobia) and bugs, needles (aichmophobia), snakes (ophidiophobia), death, math, heights (acrophobia or altophobia), bridges or tunnels, germs (mysophobia), and having dental work done (dentophobia). Fears of midgets, haunted houses, long words, helmets, pickles, feet, and phobias of holes are just a few unusual fears/phobias and may be considered weird or strange by some but can be just as debilitating as those phobias that are more common. Agoraphobia often coexists with panic disorder.

What are the complications of phobias?

If not treated, a phobia can worsen to the point in which the person's quality of life is seriously impaired, both by the phobia itself and/or by attempts to avoid or hide it. For example, a fear of flying can result in the sufferer being unable to travel. Some people have problems with their relationships, have failed in school, and/or been unable to maintain employment as the result of a severe phobia. While there may be periods of spontaneous improvement, a phobia does not usually go away unless the individual gets treatments that are specifically designed to address this condition. Alcoholics can be up to 10 times more likely to develop a phobia than nonalcoholics, and phobic individuals may be twice as likely to suffer from alcoholism or another addiction than those who have never been phobic. It has even been found that phobic anxiety can be life-threatening for some people, increasing the risk of suffering from heart disease in both men and women.

What are the causes and risk factors for phobias?

While there is no single known cause for phobias, they are thought to run in families, be influenced by culture and how one is parented, and can be triggered by different life events. Immediate family members of phobia sufferers are about three times more likely to also have a phobia than those who do not have such a family history. People whose parents either were overly protective or were distant in raising them may be at more risk of developing phobias. Phobia sufferers tend to be more likely to manage stress by avoiding the stressful situation and have trouble decreasing the intensity of the fearful situation. Another possible contributor to the development of phobias is classical conditioning. In classical conditioning, an individual responds to something that scares them by generalizing the fear of that specific thing or situation to more generalized things or situations. For example, a person may respond to a real threat by one dog to developing a phobia of all dogs.

What are phobia symptoms and signs?

Symptoms of phobias often involve having a panic attack -- in that they include feelings of intense fear, dread, or terror, despite understanding that those feelings are out of proportion to any real threat -- in addition to physical symptoms like tremors, sweating, "mind going blank," nausea, rapid heartbeat, trouble breathing, and an overwhelming desire to withdraw from the situation that is causing the phobic reaction. Also, extreme measures are sometimes taken to prevent or leave the situation.

How do health-care professionals diagnose phobias?

Many health-care providers may assess for the diagnosis of phobias, including licensed mental-health therapists, family doctors, or other primary-care medical providers, specialists whom you see for a medical condition, psychiatrists, psychologists, and social workers. If one of these practitioners suspects that you may have a phobia, you will likely be asked a number of questions to explore all the symptoms you may be having and you may need to have a medical interview and physical examination. A phobia may co-occur with a number of other mental-health problems, including schizophrenia, depression, obsessive-compulsive disorder (OCD), and substance-abuse disorders.

Phobias are particularly associated with other anxiety disorders. In addition to panic disorder, examples of other anxiety disorders include generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). In children, school phobia or a fear of being alone may occur with or without separation anxiety disorder. As anxiety disorders in general may co-occur with a number of medical conditions or can be a reaction to various medications, routine laboratory tests are often done during the initial evaluation to rule out other possible causes of the symptoms.

What is the treatment for phobias?

Helping phobia sufferers is thought to be most effective when psychotherapy and medications that are specific to the treatment of phobia are both used. One type of mental-health therapy involves the supportive and gradual exposure of the person with phobias to situations that are increasingly similar to the one they are phobic about (desensitization). These circumstances can either include actual or computer-generated anxiety-provoking stimuli.

Cognitive behavioral therapy (CBT) has been found to often quite effectively decrease phobic symptoms by helping the person with the illness change his or her way of thinking. CBT uses three techniques to accomplish this goal:

  • Didactic component: This part of treatment involves educating the person about phobias and treatment and helps to establish positive expectations for therapy and promote the cooperation of the individual with a phobia.
  • Cognitive component: It helps to recognize the ideas and assumptions that influence the behavior of the phobia sufferer, especially those that may predispose him or her to developing the disorder.
  • Behavioral component: This uses behavior-modifying techniques to teach the person with a phobia more effective strategies for coping with problems.

Selective serotonin reuptake inhibitor (SSRI) medications are often used to treat phobias, especially when desensitization and CBT are inadequately effective. These medications enhance levels of serotonin in the brain. Examples of these medications include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), vortioxetine (Brintellix), and vilazodone (Viibryd). The possible side effects of these medications can vary greatly from person to person and somewhat depend on which medication is being used. Common side effects of this group of medications include dry mouth, sexual dysfunction, nausea, tremors, trouble sleeping, blurred vision, constipation or soft stools, and dizziness. Some people gradually gain weight over time. In rare cases, people have been thought to become more acutely more anxious or depressed on the medication, even trying to or completing suicide or homicide. Children and teens are thought to be more vulnerable to this rare side effect compared to adults.

Phobias are also sometimes treated using beta-blocker medications, which decrease the physical symptoms associated with panic by blocking the effects that adrenaline (epinephrine) has on the body. One example of a beta-blocker is propranolol. These disorders are also sometimes treated with drugs in a medication class called benzodiazepines or minor tranquilizers. This class of medications causes relaxation but is used with caution these days to treat anxiety due to the possibility of addiction and the risk of overdose, especially if taken when alcohol is also being consumed. Examples of medications from that group include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).

What is the prognosis for phobias?

Cognitive therapy and exposure therapy alone, in combination, or with relaxation training have been found to be effective in treating phobias. Relaxation training alone has also been found to be effective in treating phobias. While some interventions, like sedating people who are phobic about getting dental work, may be useful in the short term, they may undermine truly overcoming the condition.

Is it possible to prevent phobias?

Phobia prevention that involves educating people with this illness, their loved ones, and other involved individuals like children's teachers have been found to be effective in preventing phobias from ever occurring.

How can people cope with phobias?

Ways that individuals with a phobia can work toward overcoming their fears include talking about their phobia, refraining from avoiding situations they find stressful, imagining themselves facing their fears (visualization), and making positive statements to themselves like, "I will be OK." In fact, when self-help methods are combined with brief psychotherapy, phobia sufferers may achieve significant improvement in symptoms.

Where can people get information and help for phobias?

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org

American Counseling Association
http://www.counseling.org

American Psychiatric Association
http://www.psych.org

American Psychological Association
http://helping.apa.org

Anxiety and Depression Association of America
http://www.adaa.org/

Freedom From Fear
http://www.freedomfromfear.org

National Association of Social Workers
http://www.naswdc.org

National Mental Health Association
http://www.nmha.org

National Panic/Anxiety Disorder News, Inc.
http://www.npadnews.com

What research is being done on phobias?

Research studies are focused upon how well phobias respond to various treatments over the long term, as well as how age-related changes in thinking ability (cognition) may interact with anxiety. The use of herbal and other dietary supplements in the treatment of phobias is being explored, as well.

REFERENCES:

Albert, C.M., C.U. Chae, K.M. Rexrode, et al. "Phobic Anxiety and Risk of Coronary Heart Disease and Sudden Cardiac Death Among Women." Circulation 111 (2005): 480-487.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, Virginia: American Psychiatric Association, 2013.

Anxiety Matters. Phobia List: A List of Phobia Names From A to Z. <http://www.anxietymatters.com>. 2008.

Aune, T., and T.C. Stiles. "Universal-based prevention of syndromal and subsyndromal social anxiety: A randomized controlled study." Journal of Consulting and Clinical Psychology 77.5 Oct. 2009: 867-879.

Bleakley, S. "Anxiety Disorders: Clinical Features and Diagnosis." Clinical Pharmacist January 2013.

Davey, G.C., I. Burgess, and R. Rashes. "Coping Strategies and Phobias: The Relationship Between Fears, Phobias and Methods of Coping With Stressors." British Journal of Clinical Psychology 34.3 Sept. 1995: 423-434.

Davidson, J.R.T., D.L. Hughes, L.K. George, and D.G. Blazer. "The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study." Psychological Medicine 1993: 709-718.

Forbes, M.D., C.A. Boyle, and T. Newton. "Acceptability of behaviour therapy for dental phobia." Community Dent Oral Epidemiol 40.1 Feb. 2012: 1-7.

Fernandes, P.P. "Rapid Desensitization for Needle Phobia." Psychosomatics 44 June 2003: 253-254.

Gersley, E. "Phobias: Causes and Treatments." All Psych Journal 17 Nov. 2001. <http://www.allpsych.com>.

Grant, B.F., et al. "Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders." Arch Gen Psychiatry 61.8 Aug. 2004: 807-816.

Kawachi, I., G.A. Colditz, A. Ascherio, et al. "Prospective Study of Phobic Anxiety and Risk of Coronary Heart Disease in Men." Circulation 89 (1994): 1992-1997.

Knappe, S., K. Beesdo, L. Fehm, et al. "Associations of Familial Risk Factors With Social Fears and Social Phobia: Evidence for the Continuum Hypothesis in Social Anxiety Disorder." Journal of Neural Transmission 116.6 June 2009: 639-648.

Leinonen, E., U. Lepola, H. Koponen, J. Turtonen, A. Wade, and H. Lehto. "Citalopram Controls Phobic Symptoms in Patients With Panic Disorder: Randomized Controlled Trial." Journal of Psychiatry Neuroscience 25.1 (2000): 25-32.

Lissek, S., J. Levenson, A. Biggs, et al. "Elevated Fear Conditioning to Socially Relevant Unconditioned Stimuli in Social Anxiety Disorder." American Journal of Psychiatry 165.1 Jan. 2008: 124-132.

Medical College of Wisconsin. Facing Fears: Most Patients Can Overcome Phobias. Feb. 26, 2007.

NIMH. Concerned Counseling. <http://www.concernedcounseling.com/communities/anxiety/nimh/index.asp>.

Norton, P.J., and E.C. Price. "A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders." The Journal of Nervous and Mental Disease 195.6 (2007): 521-531.

Parsons, T.D., and A.A. Rizzo. "Affective Outcomes of Virtual Reality Exposure Therapy for Anxiety and Specific Phobias: A Meta-Analysis." Journal of Behavior Therapy and Experimental Psychiatry 39 (2008): 250-261.

Pull, C. "Recent Trends in the Study of Specific Phobias." Current Opinion in Psychiatry 21.1 Jan. 2008: 43-50.

Rapee, R.M., M.J. Abbott, A.J. Baillie, and J.E. Gaston. "Treatment of Social Phobia Through Pure Self-Help and Therapist-Augmented Self-Help." The British Journal of Psychiatry 191 (2007): 246-252.

Saeed, S.A., R.M. Bloch, and D.J. Antonacci. "Herbal and Dietary Supplements for Treatment of Anxiety Disorders." American Family Physician 76.4 Aug. 2007: 549-556.

Schultz, S.K., D.J. Moser, J.R. Bishop, and V.L. Ellingrod. "Phobic Anxiety in Late-Life in Relationship to Cognition and 5HTTLPR Polymorphism." Psychiatric Genetics 15.4 Dec. 2005: 305-306.

Straube, T., M. Glauer, S. Dilger, H.J. Mentzel, and W.H. Miltner. "Effects of Cognitive-Behavioral Therapy on Brain Activation in Specific Phobia." Neuroimaging 29.1 Jan. 1, 2006: 125-135.

Thomas, S.E., A.K. Thevos, and C.L. Randall. "Alcoholics With and Without Social Phobia: A Comparison of Substance Use and Psychiatric Variables." Journal of Studies on Alcohol 60 (1999).

Villafuerte, S., and M. Burmeister. "Untangling Genetic Networks of Panic, Phobia, Fear and Anxiety." Genome Biology 4.8 (2003): 224.

Walker, J.R., M.A. Van Ameringen, R. Swinson, R.C. Bowen, P.R. Chokka, E. Goldner, et al. "Prevention of Relapse in Generalized Social Phobia: Results of a 24-Week Study in Responders to 20 Weeks of Sertraline Treatment." Journal of Clinical Psychopharmacology 20.6 Dec. 2000: 636-644.

Walkup, J.T., A.M. Albano, J. Piacentini, et al. "Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety." New England Journal of Medicine 359.26 Dec. 2008.

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References
REFERENCES:

Albert, C.M., C.U. Chae, K.M. Rexrode, et al. "Phobic Anxiety and Risk of Coronary Heart Disease and Sudden Cardiac Death Among Women." Circulation 111 (2005): 480-487.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, Virginia: American Psychiatric Association, 2013.

Anxiety Matters. Phobia List: A List of Phobia Names From A to Z. <http://www.anxietymatters.com>. 2008.

Aune, T., and T.C. Stiles. "Universal-based prevention of syndromal and subsyndromal social anxiety: A randomized controlled study." Journal of Consulting and Clinical Psychology 77.5 Oct. 2009: 867-879.

Bleakley, S. "Anxiety Disorders: Clinical Features and Diagnosis." Clinical Pharmacist January 2013.

Davey, G.C., I. Burgess, and R. Rashes. "Coping Strategies and Phobias: The Relationship Between Fears, Phobias and Methods of Coping With Stressors." British Journal of Clinical Psychology 34.3 Sept. 1995: 423-434.

Davidson, J.R.T., D.L. Hughes, L.K. George, and D.G. Blazer. "The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study." Psychological Medicine 1993: 709-718.

Forbes, M.D., C.A. Boyle, and T. Newton. "Acceptability of behaviour therapy for dental phobia." Community Dent Oral Epidemiol 40.1 Feb. 2012: 1-7.

Fernandes, P.P. "Rapid Desensitization for Needle Phobia." Psychosomatics 44 June 2003: 253-254.

Gersley, E. "Phobias: Causes and Treatments." All Psych Journal 17 Nov. 2001. <http://www.allpsych.com>.

Grant, B.F., et al. "Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders." Arch Gen Psychiatry 61.8 Aug. 2004: 807-816.

Kawachi, I., G.A. Colditz, A. Ascherio, et al. "Prospective Study of Phobic Anxiety and Risk of Coronary Heart Disease in Men." Circulation 89 (1994): 1992-1997.

Knappe, S., K. Beesdo, L. Fehm, et al. "Associations of Familial Risk Factors With Social Fears and Social Phobia: Evidence for the Continuum Hypothesis in Social Anxiety Disorder." Journal of Neural Transmission 116.6 June 2009: 639-648.

Leinonen, E., U. Lepola, H. Koponen, J. Turtonen, A. Wade, and H. Lehto. "Citalopram Controls Phobic Symptoms in Patients With Panic Disorder: Randomized Controlled Trial." Journal of Psychiatry Neuroscience 25.1 (2000): 25-32.

Lissek, S., J. Levenson, A. Biggs, et al. "Elevated Fear Conditioning to Socially Relevant Unconditioned Stimuli in Social Anxiety Disorder." American Journal of Psychiatry 165.1 Jan. 2008: 124-132.

Medical College of Wisconsin. Facing Fears: Most Patients Can Overcome Phobias. Feb. 26, 2007.

NIMH. Concerned Counseling. <http://www.concernedcounseling.com/communities/anxiety/nimh/index.asp>.

Norton, P.J., and E.C. Price. "A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders." The Journal of Nervous and Mental Disease 195.6 (2007): 521-531.

Parsons, T.D., and A.A. Rizzo. "Affective Outcomes of Virtual Reality Exposure Therapy for Anxiety and Specific Phobias: A Meta-Analysis." Journal of Behavior Therapy and Experimental Psychiatry 39 (2008): 250-261.

Pull, C. "Recent Trends in the Study of Specific Phobias." Current Opinion in Psychiatry 21.1 Jan. 2008: 43-50.

Rapee, R.M., M.J. Abbott, A.J. Baillie, and J.E. Gaston. "Treatment of Social Phobia Through Pure Self-Help and Therapist-Augmented Self-Help." The British Journal of Psychiatry 191 (2007): 246-252.

Saeed, S.A., R.M. Bloch, and D.J. Antonacci. "Herbal and Dietary Supplements for Treatment of Anxiety Disorders." American Family Physician 76.4 Aug. 2007: 549-556.

Schultz, S.K., D.J. Moser, J.R. Bishop, and V.L. Ellingrod. "Phobic Anxiety in Late-Life in Relationship to Cognition and 5HTTLPR Polymorphism." Psychiatric Genetics 15.4 Dec. 2005: 305-306.

Straube, T., M. Glauer, S. Dilger, H.J. Mentzel, and W.H. Miltner. "Effects of Cognitive-Behavioral Therapy on Brain Activation in Specific Phobia." Neuroimaging 29.1 Jan. 1, 2006: 125-135.

Thomas, S.E., A.K. Thevos, and C.L. Randall. "Alcoholics With and Without Social Phobia: A Comparison of Substance Use and Psychiatric Variables." Journal of Studies on Alcohol 60 (1999).

Villafuerte, S., and M. Burmeister. "Untangling Genetic Networks of Panic, Phobia, Fear and Anxiety." Genome Biology 4.8 (2003): 224.

Walker, J.R., M.A. Van Ameringen, R. Swinson, R.C. Bowen, P.R. Chokka, E. Goldner, et al. "Prevention of Relapse in Generalized Social Phobia: Results of a 24-Week Study in Responders to 20 Weeks of Sertraline Treatment." Journal of Clinical Psychopharmacology 20.6 Dec. 2000: 636-644.

Walkup, J.T., A.M. Albano, J. Piacentini, et al. "Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety." New England Journal of Medicine 359.26 Dec. 2008.

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