Phobophobia

What is phobophobia?

Phobophobia is an intense fear of fear. It may be related to the individual feeling afraid of the physical sensations associated with anxiety, such as sweating, shaking, and fast heartbeat, or of developing a specific phobia such as claustrophobia (fear of small spaces), or of unforeseen anxiety-provoking events occurring ^[1][2].

People with phobophobia become so afraid of the emotions or physical manifestations of fear that this becomes a phobia in and of itself. This phobia has the potential to cause persistent anxiety ^[1][3].

Although not specifically mentioned in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5), phobophobia is considered a specific phobia. Specific phobias are characterized by an irrational and disproportionate level of fear or anxiety when faced with a certain stimulus ^[4].

Current research on phobophobia is limited, due to the fact that many people do not seek professional help for phobias and because symptoms often overlap with other disorders ^[5]. As such, further research is needed to understand the causes and risk factors of the development of specific phobias such as phobophobia.

Symptoms of phobophobia

Symptoms of phobophobia may vary from person to person but can include ^[1][5][6]:

• Thinking about becoming afraid or anxious causes immense fear and anxiety.
• Being afraid of the physical symptoms of anxiety or a panic attack, such as sweating, shaking, fast heartbeat, dry mouth, difficulty concentrating, and breathing difficulties.
• Avoiding situations that may cause fear or physical symptoms associated with anxiety, such as rollercoasters, being in a moving vehicle, attending a dentist appointment.
• Impairments in one or more areas of life, including social and/or 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 phobophobia

The exact cause of phobophobia is not known and may vary from person to person. However, some research shows potential theories relating to the development of this phobia and certain factors that may increase the risk of a specific phobia.

Genetics

Research suggests that there is a strong familial link associated with the development of specific phobias. Studies have found that people with a specific phobia are more likely to have a relative with an anxiety disorder or phobia than those without a phobia, thereby suggesting that genetics can increase the risk ^[7].

Brain functioning

Research suggests that some people may be more sensitive to fear, thereby increasing their risk of developing a phobia. Studies have indicated that those with a specific phobia often have a difference in the activation and function of the fear response in the amygdala, suggesting that this could be a cause or contributing factor to specific phobias ^[8].

Past traumatic experience

Phobias can develop as a response to a traumatic experience ^[6]. For example, someone with phobophobia may have experienced an intensely scary or traumatic event as a child that caused them to feel extreme emotional and physical sensations of fear and they become so afraid of experiencing this again that it develops into phobophobia.

Similarly, if someone has experienced a panic attack or severe anxiety due to another phobia, this could then develop into phobophobia. For example, someone who is afraid of spiders and experiences a panic attack every time they see a spider could become as afraid of having a panic attack as they are of the spider itself, thereby having both arachnophobia and phobophobia ^[1][2].

Diagnosing phobophobia

Specific phobias are often not diagnosed. Some choose to live with their fear and avoid the stimulus that causes it, while others may believe that they have a different condition such as OCD or generalized anxiety disorder ^[5].

However, if you think you have phobophobia, it is important to seek a diagnosis and receive appropriate treatment so that this phobia does not cause a negative impact on your quality of life or cause an avoidance of potentially anxiety-provoking situations.

To diagnose phobophobia, you will be asked questions about your symptoms as they relate to diagnostic criteria. The diagnostic criteria for a specific phobia according to the DSM-5 includes ^[4]:

• Anticipating or facing a situation with the potential to cause fear causes intense feelings of anxiety, which may lead to prolonged or repeated avoidance of certain situations.
• 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 are not due to another condition, such as a personality disorder, posttraumatic stress disorder (PTSD), or social anxiety.

Treatment for phobophobia

Due to limited research of specific phobias, it is not currently clear if each phobia can be treated effectively in the same way. However, treatment for phobias usually involves systematic exposure, response prevention, and desensitization, to gradually alleviate the fear associated with the stimulus, while also managing symptoms of anxiety ^[6].

Therapy

• Behavioral therapy: Cognitive behavioral therapy (CBT) is generally effective at treating phobias and various types of anxiety, as it can help to adjust emotional responses and behaviors that have been learnt as a fear response, provide strategies and skills in distress tolerance, and teach helpful coping techniques ^[5][9].
• Exposure and response prevention (ERP): For people with phobophobia, treatment may include ERP, to provide exposure to the physical sensations of anxiety and desensitize the individual, thereby reducing the fear of experiencing these sensations ^[3].
• Other therapies: Therapies, such as family therapy or psychotherapy, can be useful for the individual to receive ongoing support and validation, while helping them manage the symptoms of anxiety and reduce the negative emotions that may occur due to their phobia ^[9].

Medications

Although there are no approved medications for the treatment of a specific phobia, medication can be prescribed to help reduce the symptoms of phobophobia, including ^[5][8][9]:

• Antidepressants: Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine, selective serotonin reuptake inhibitors (SSRIs) such as citalopram and sertraline, and tricyclic antidepressants (TCA) such as clomipramine, can be helpful in the treatment of phobophobia to reduce feelings of anxiety.
• Antihistamines: The FDA have approved the use of an antihistamine, hydroxyzine, to treat anxiety disorders such as specific phobias, as it is typically effective at reducing symptoms.
• Benzodiazepines: Diazepam can be used to treat acute anxiety and phobias as a short-term treatment but have the potential to cause abuse and addiction so are often not a first choice or are not used as a long-term treatment.
• Beta-blockers: Beta-blockers such as propranolol have been found to be effective at managing certain physical symptoms of acute anxiety, such as a rapid heart rate, and may also be useful in managing the symptoms of phobophobia.

It is crucial to take your medication exactly as your doctor has prescribed, because taking higher doses, missing doses, or suddenly stopping a medication can cause serious effects and can worsen your physical and mental health.

Self-care for phobophobia

If you have phobophobia, you might find some self-help techniques to be useful in managing your symptoms, including ^[9][10]:

• Talking to others: Sharing your concerns and fears with friends and family or with a professional can help to reduce negative emotions and provide a space to rationalize your anxieties and fears.
• Relaxation exercises: Breathing exercises, yoga, mindfulness, and meditation have been shown to be effective at reducing anxiety symptoms. Breathing exercises can be especially helpful in reducing acute symptoms of a panic attack.
• Support groups: You may find it helpful to attend a support group to gain a better understanding and acceptance of your phobia, while having an opportunity to share your experiences with others who have a similar condition.
• General health: By taking care of your overall health you can reduce anxiety and stress that may occur with phobophobia. Ensure you get plenty of sleep, eat a healthy diet, and regularly engage in exercise.

Frequently asked questions about phobophobia

How common is phobophobia?

Due to the limited research and reporting of the condition, the prevalence of phobophobia is not known. However, studies show that specific phobias are much more common in females than males and that between 1-10% of the population will have a debilitating phobia ^[11].

What is the outlook for people with phobophobia?

Untreated, phobophobia can persist and potentially worsen, which may have an ongoing negative impact on your life, such as an increased avoidance of certain situations, and result in a decline in mental wellbeing. However, with appropriate treatment, the symptoms of phobophobia can be effectively managed to improve quality of life and functioning ^[1][6].