Specific phobia

What is a specific phobia?

Previously known as a simple phobia, a specific phobia is an anxiety disorder that can cause fearful, anxious, and nervous reactions to an object or situation. Usually, the object or situation is not known to be dangerous, or the object/situation in question may not warrant the extent of the sufferer's response.

Unlike those with general anxiety, the overwhelming unreasonable fear in those with specific phobias is connected to one or more causes that produce an irrational reaction. Sometimes, even thoughts or a sense of dread of encountering the sources will produce the response. The reaction can vary from mildly uncomfortable to severely disabling.

These phobias, and the anxiety around them, can interfere with personal relationships, school attendance, and work. Patients with specific phobias are often aware that the source of their fear is not dangerous. Still, they are unable to control their reaction. Physical symptoms may resemble a panic attack (e.g., a fast heartbeat, nausea, diarrhea, shaking, tingling, sweating, shortness of breath, dizziness, or a feeling of choking). ^[1]

Types of specific phobias

Phobias that interfere with daily life can stem from various items or circumstances. There is a long list of specific phobias that have occurred in patients. The following are groupings of the more common types: ^[2]

• Situational phobias - Fear of a specific circumstance makes people with situational phobia avoid a chance of this happening at all costs, which can interfere with their quality of life. Examples are a fear of flying, of being alone in a car, of closed spaces, or of crowds or open spaces (agoraphobia).
• Animal phobias - Also called zoophobia, this can refer to the fear of all animals or a specific animal. This can be a fear of spiders, cattle, reptiles, dogs, and so on. A person with a fear of dogs might avoid walking in the street, as there is a chance of an encounter.
• Natural environment phobia - Fear of nature, situations that occur in nature, and natural events like darkness, thunder, lightning, hurricanes, and floods. This extends to a fear of heights, which is relatively common. Of the more debilitating of these phobias is a fear of water, also known as hydrophobia.
• Injury phobia - People living with traumatophobia experience extreme amounts of anxiety at the thought of having an injury. This may manifest in a fear of injections or blood, sometimes resulting in fainting at the sight or even mere thought of these things. In extreme cases, the patient will be so scared of sustaining physical harm that they may be housebound to reduce the risk.
• Others - Whereas some situations or objects make various people uncomfortable, the list of anxiety or fear sources for those with specific phobias seems never-ending. Some known specific phobias range from a fear of dolls or clowns to a fear of germs, a fear of being buried alive, a fear of poison, performance anxiety, and more. Some other phobias include:
  
  • Phobophobia - an intense fear of fear
  • Iatrophobia - an excessive fear of doctors or medical procedures
  • Ergophobia - a fear of working
  • Megalophobia - a fear of large objects
  • Scopophobia - a fear of being watched

Symptoms of specific phobia

Even though specific phobias vary in nature, they tend to produce the same symptoms and behaviors: ^[2]

• A sudden sense of intense anxiety, panic, and nervousness when encountering the source or sometimes even just by thinking about it
• A feeling of powerlessness even if it is evident that the reactions are unreasonable or exaggerated
• Difficulty acting, working, or functioning normally due to the fear
• Physical reactions such as sweating, shortness of breath, accelerated heartbeat, and tight chest
• Feeling dizzy, fainting, or getting nauseated, especially in the case of a fear of blood or injury
• Worsening anxiety if the event, situation, or object gets closer in time or physical proximity
• Children might throw tantrums, cling to a parent, cry, or refuse to leave a parent's side
• An awareness that the fear is unreasonable and simultaneously that the reaction is uncontrollable

Causes of specific phobia

The cause or origin of certain specific phobias is still a mystery, even to experts. Some causes and risk factors include: ^[3]

• Traumatic experience: distressing events such as almost drowning can bring about specific phobias
• Learned reaction/parenting: children who see their parents react with exaggerated fear to something specific may mimic this behavior
• Genetics: those with a close relative with an anxiety disorder
• Temperament: those with behavioral inhibitions such as shyness
• Ongoing health issues: a higher incidence of phobia is found in those who have suffered traumatic injuries
• Substance abuse: may make phobia symptoms worse
• Brain function: changes in brain functioning may lead to the development of phobias
• Age: phobias can appear in childhood, usually by age 10, but can also start later in life
• Receiving negative information: learning about events and repeatedly hearing information can lead to a phobia, e.g., COVID-19 news leading to the phobia of germs

Diagnosing specific phobia

Fears and phobias aren't the same. Simply having an aversion to an object or a situation, or feeling anxious around some thing or experience, does not mean there is a specific phobia. Phobias are diagnosed by a mental health professional using the Diagnostic and Statistical Manual, 5^th edition (DSM-5).

No biological markers determine phobia, meaning that a lab test will not find evidence of phobia. Mental health professionals use the following diagnostic criteria, where all criteria must be met: ^[4]

• There is an unreasonable, persistent, and intense fear brought about by a specific situation or object.
• The anxiety response is immediate and out of proportion with the actual danger.
• The individual goes out of their way to avoid the trigger.
• The phobia significantly affects the individual's personal relationships, work, or school.
• Symptoms last at least six months.
• Other similar anxiety disorders have been ruled out, e.g., obsessive-compulsive disorder.

Prevention of specific phobia

Because most phobias start at a young age, parents must treat their own phobias and manage their reactions around children. This prevents the child from mimicking this behavior and developing phobias.

Those who have been through a traumatic experience should seek mental health therapy to avoid a reaction that turns into a specific phobia.

Treatment for specific phobia

There are different types of treatments for specific phobias and most patients will benefit from either one or a combination of both:

Psychotherapy

Talking with a mental health professional can help to manage the specific phobia. This can be in the form of Exposure therapy or Cognitive behavioral therapy (CBT).

Exposure therapy introduces the patient's specific phobia, related thoughts, feelings, and sensations in gradual and repeated activities.

CBT involves exposure to the source and learning other techniques, such as coping mechanisms and re-framing the feared object or situation. CBT emphasizes confidence and empowerment so that patients understand bodily reactions and are not overwhelmed by their thoughts and feelings.

Medications

Short-term use of medications may be needed, especially in the initial phases of treatment. ^[2]

• Beta-blockers decrease the physical symptoms brought about by adrenaline.
• Antidepressants may have value when the specific phobia accompanies other mental health conditions, such as depression.
• Sedatives or anti-anxiety medications reduce the amount of anxiety, allowing the patient to not be overwhelmed in short-term situations, such as catching a flight or giving a speech.

Self-care for specific phobia

Managing a phobia can keep the physical and mental responses to a fearful object or situation under check. Mindful techniques such as meditation can help tolerate anxiety and reduce any avoidant behavior that affects one’s everyday life.

Relaxation techniques such as muscle relaxation have also been known to help in cases of specific phobias. These methods decrease anxiety and help a person cope with the stress of a situation as it unfolds. Physical activity also helps manage the stress that comes about with specific phobias.

Some people choose to face their fears. Much like exposure therapy, tiny steps in facing a phobia can be conducted in a safe and controlled way by creating small steps to become acclimated to the situation or object in question.

Support groups can help you connect with others with your same fears, so that you can find help in each other too. ^[5]

Helping someone with specific phobia

However, there are ways to support those with specific phobias to have a better quality of life.

Specific phobias should not be considered taboo subjects, but should be talked about freely. In particular, let a child know that everyone has scary thoughts sometimes, and some will find these thoughts more distressing than others.

Specific phobias should not be reinforced by avoiding situations where these can be met. Instead, assist a child in facing their fear if the occasion arises, always remaining close enough so that they feel safe and supported. In consequent events, increase the exposure slowly.

A child will learn by watching. When exposed to something you fear, you can demonstrate how to work through your fear and cope with the situation.

FAQs about specific phobias

How common are specific phobias?

It is estimated that around 9% of adults in the US have a specific phobia during a calendar year. Among adults, the prevalence is higher in females. Approximately 12.5% of adults in the US will experience a specific phobia in their lifetime. The good news is that almost half of those with specific phobias experience mild symptoms. ^[6]

What is the outcome for people with specific phobias?

Most people with phobias can get better with therapy, medications, or a combination of both. This outlook is better for those who get early treatment or receive an intervention following a traumatic event. With the right treatment, most patients with specific phobias can lead full and productive lives.