Megalophobia

What is megalophobia?

Megalophobia is an intense fear of large objects, that can cause extreme feelings of anxiety and panic attacks when anticipating or being in the presence of large objects ^[1]. This can lead to the avoidance of certain situations and environments and may cause a severe decline in quality of life.

Megalophobia could develop as a fear of all large objects or of specific large objects, which may include:

• Large vehicles, such as airplanes, boats, lorries, or helicopters
• Large statues, monuments, or art installations
• Large animals, such as elephants, whales, or giraffes
• Large buildings, such as skyscrapers, hospitals, or malls
• Large expanses, such as oceans, the sky, or canyons

Although not specifically mentioned in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5), megalophobia is considered a specific phobia, which is in part defined by an irrational and disproportionate level of fear or anxiety when faced with a certain stimulus ^[2].

Current research on megalophobia is limited, partially due to the fact that many people do not report or seek help for phobias ^[3]. They may also be challenging to diagnose as symptoms of other conditions may appear similar. As such, further research is required to clarify the causes of and circumstances surrounding the development of specific phobias such as megalophobia.

Symptoms of megalophobia

Symptoms of megalophobia may vary from person to person but can include ^[2][3][4]:

• Large objects, seen in real life or in images or film, cause immense fear and anxiety.
• Physical symptoms of anxiety or a panic attack, such as sweating, shaking, fast heartbeat, dry mouth, difficulty concentrating, and breathing difficulties.
• Avoiding large objects, which may include not going outside, not visiting cities with tall buildings, or not being able to fly on a plane.
• Ongoing distress and anxiety that worsens when thinking about or anticipating the presence of large objects.
• Impairments in one or more areas of life, including social and professional functioning.
• The presence of other specific phobias, such as a fear of spiders or injections.
• The presence of other mental health conditions, such as other anxiety disorders, mood disorders, or substance use disorders.

Causes of megalophobia

The exact cause of megalophobia is not known and may differ from person to person. However, there are several potential causes and risk factors that can contribute to the development of a specific phobia.

Genetics

Research indicates that there is a strong heritability of specific phobias, as those with a specific phobia commonly have a relative with an anxiety disorder, phobia, or both, indicating a likelihood of a genetic predisposition ^[5].

Brain functioning

There have been studies looking into the neurobiology of fear and specific phobias that have found a potential difference in people with and without a phobia in the activation and function of the fear response in the amygdala. Therefore, this suggests that some people could have an increased sensitivity to fear that contributes to the development of a phobia ^[6].

Past traumatic experience

Phobias can develop as a response to a traumatic experience ^[4]. For example, someone may develop megalophobia if they were frightened by an event involving a large object as a child, such as an elephant charging them while on safari or witnessing a lorry overturn and crush a car. The fear experienced by this occurrence may then develop into a debilitating fear of large objects.

Diagnosing megalophobia

Specific phobias are often not diagnosed, as many people do not seek help and simply avoid the stimulus that causes them fear or believe that their anxiety is caused by a different diagnosis ^[3].

However, if you think you have megalophobia, it is important to seek a diagnosis so that you can receive appropriate treatment and prevent your symptoms from becoming worse or having further impact on your life.

To diagnose megalophobia, you will be asked questions about your symptoms, relating to diagnostic criteria for a specific phobia from the DSM-5, which includes ^[2]:

• Anticipating or being faced with the stimulus (large objects) causes intense feelings of anxiety, which may lead to prolonged or repeated avoidance.
• The associated symptoms cause distress and impair social and/or professional functioning.
• The level of fear and anxiety is disproportionate to the potential danger or outcome.
• These symptoms have persisted for at least 6 months.
• These symptoms cannot be explained by another condition, such as obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), or social anxiety.

Treatment for megalophobia

Many people with a specific phobia don’t seek treatment, as they may just continue to live with the phobia, avoid the triggering stimulus, or feel anxious about asking for help. However, without treatment, phobias can persist and may worsen, so it is important to seek professional advice ^[3][4].

Treatments for certain kinds of specific phobias have not yet been well researched, so it is not clear if each phobia requires a different type of treatment. Often, treatment for a phobia involves systematic exposure, response prevention, and desensitization, so that the fear associated with a stimulus is gradually lessened ^[4].

Therapy

• Behavioral therapy: Therapy such as cognitive behavioral therapy (CBT) helps to alter emotional responses and behavior that have been learned as a fear response, by providing skills to tolerate negative emotions, reducing distress caused by fear, and teaching coping techniques ^[3][7].
• EMDR: Eye movement desensitization and reprocessing (EMDR) is a specialized therapy, designed to treat trauma, that provides a gradual exposure to fear-inducing situations, with the aim to desensitize, increase tolerance, and reduce distress ^[8].
• Exposure and response prevention: Similarly, ERP also works by exposing the individual to a feared situation, while providing techniques to prevent negative responses and teach new and helpful responses ^[9].
• Virtual reality therapy: As a new treatment, virtual reality therapy utilizes virtual reality technology to provide safe exposure to a feared stimulus and gradually desensitize the individual, with the aim to eventually move on to real exposure to the trigger once tolerance is increased ^[3][10].
• Other therapies: Interpersonal therapy, family therapy, and other forms of therapeutic intervention can also be helpful for the individual to be provided with support and validation, also aiming to alleviate negative emotions associated with their phobia ^[7].

Medications

Although there are no approved medications for the treatment of a specific phobia, a medication may be prescribed to help manage the symptoms, including ^[3][6][7]:

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) such as citalopram and sertraline, serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine, and tricyclic antidepressants (TCA) such as clomipramine, may be used in the treatment of specific phobia to reduce feelings of anxiety.
• Antihistamines: Hydroxyzine, an antihistamine medication, has been found to be useful in the treatment of anxiety disorders and may help to reduce symptoms of a specific phobia.
• Anxiolytics: Benzodiazepines such as diazepam can be prescribed for short-term treatment of anxiety disorders and phobias but are not used as a long-term treatment due to their risks.
• Beta-blockers: Beta-blockers such as propranolol are commonly used to treat the physical symptoms of acute anxiety, such as a racing heart, and may also be helpful in managing the symptoms of a specific phobia.

It is important to ensure you take your medication exactly as prescribed by your doctor, as adverse effects can occur if you take too much, skip doses, or suddenly stop your medication, and this can worsen your mental and physical health.

Self-care for megalophobia

If you have megalophobia, you may be able to reduce the impact of your symptoms with some self-help techniques, including ^[7][11]:

• Talking to others: Communicating about your fears can help to lessen the impact of your anxieties and can potentially reduce irrational ideas and fears.
• Relaxation exercises: Calming activities, such as breathing exercises, meditation, or yoga, are effective at reducing anxiety and managing acute symptoms of a panic attack or severe emotional responses that may occur.
• Support groups: Attending a support group in person or online can provide an understanding and acceptance of your phobia and an opportunity to speak with people who have had similar experiences, which could reduce negative and distressing emotions.
• General health: By looking after your general wellbeing, with healthy eating, getting enough sleep, and engaging in regular exercise, you might be able to reduce the symptoms of anxiety caused by megalophobia.

Frequently asked questions about megalophobia

How common is megalophobia?

The prevalence of megalophobia is not known, due to a lack of research and reporting of the condition. Although, research indicates that between 1-10% of the population experiences a specific phobia, with females being several times more likely to have a specific phobia than males ^[12].

What is the outlook for people with megalophobia?

Untreated, specific phobias may continue and potentially worsen, which could have an ongoing negative impact on your quality of life and result in poor mental wellbeing. However, with appropriate treatment, the symptoms of megalophobia can be effectively managed to improve quality of life and functioning ^[4][7].