Phobias and Fears:

Understanding phobias

What is a phobia? A phobia is an excessive or unreasonable fear of a specific object or situation that is generally considered harmless. In fact, if you have a phobia, you probably realize that your fear is unreasonable, yet you still can’t control it. If you are exposed to the thing you’re afraid of, you become overwhelmed with extreme feelings of anxiety, fear, and even panic. This experience is so unpleasant that you will go to great lengths to avoid the object or situation you fear.

Of the different types of anxiety disorders, phobias are the most common. The American Psychiatric Association reports that each year, 7.8% of American adults suffer from a phobia. In fact, phobias are the most common psychological disorder among women and the second most common disorder among men over 25.

When fear becomes a phobia

When are fears considered phobias? Fear is an adaptive human response to danger. It serves a protective purpose, activating the “fight-or-flight” response of the sympathetic nervous system. When faced with danger, our sympathetic nervous system produces adrenaline. This excess adrenaline prepares us to fight or to flee the physical threat. The fight-or-flight response includes an increase in heart rate and blood flow to our large muscles, better enabling us to react to the emergency. Blood sugar also increases, providing us with more energy. With our bodies and minds alert and ready for action, we are able to respond quickly and protect ourselves.

Although it is normal and even helpful to experience fear in dangerous situations, with phobias the danger is greatly exaggerated or imagined. For example, it is only natural to be afraid of a snarling Doberman, but it is irrational to be terrified of a friendly poodle on a leash, as you might be if you have a dog phobia. Fears become a reason for concern when they are persistent and interfere with your daily functioning. When a fear reaches this level of intensity, it is often identified as a phobia.

Common types of phobias

What are the different types of phobias? Professionals divide phobias into three general types:

1. Specific phobias
2. Social phobia
3. Agoraphobia

Specific phobias

Specific phobias involve a strong, irrational fear of a specific situation or object. There are five types of specific phobias:

1. Animal phobias. Animal phobias are fears caused by an animal or insect. Examples include fear of snakes, fear of spiders, fear of rodents, and fear of dogs.
2. Natural environment phobias. Natural environment phobias are fears cued by objects found in nature. Examples include fear of heights, fear of storms, fear of water, and fear of the dark.
3. Situational phobias. Situational phobias are fears triggered by a specific situation. Examples include fear of enclosed spaces (claustrophobia), fear of elevators, fear of flying, fear of dentists, fear of driving, fear of tunnels, and fear of bridges.
4. Blood-Injection-Injury phobia. Blood-injection-injury phobia involves fear of blood, fear or injury, or a fear of shots or another medical procedure.
5. Other phobias. This includes all phobias that don’t fall into one of the first four categories. Examples include fear of choking, fear of illness, fear of injury, fear of death, and fear of clowns.

Specific phobias are very common. They usually begin in childhood or adolescence and as many as 50% go away on their own within five years. The most common phobias are of animals, storms, heights, illness, injury, and death. Animal phobias and blood-injection-injury phobias are most common in children. Situational phobias usually begin in the mid-twenties and are most common in adults. Although there are many possible causes of a specific phobia, some phobias are the result of a traumatic experience. Visit these links for more information on specific phobias:

Animal Phobias & Bird Phobias Claustrophobia Dental Phobia Fear of Flying Fear of Heights

Fear of Snakes Fear of Spiders  Fear of Water Needle Phobia

Social Phobia

Social Phobia (also called Social Anxiety Disorder) – Social phobia is an overwhelming and disabling fear of social situations where you may be scrutinized or evaluated negatively. If you have social phobia you may be excessively self-conscious and afraid of embarrassing or humiliating yourself in front of others. Fear of public speaking is the most common type of specific social phobia.

Agoraphobia

Traditionally thought to involve a fear of public places and open spaces, it is now believed that agoraphobia develops as a complication of panic attacks. Afraid that they may have another panic attack, people with agoraphobia become anxious about being in situations where escape would be difficult or embarrassing, or where help wouldn't be immediately available. If you have agoraphobia, you are likely to avoid crowded places such as shopping malls and movie theaters. Standing in line is another situation that can be panic provoking. You may also avoid cars, airplanes, subways, and other forms of travel. In more severe cases, you might only feel safe at home.

Signs and symptoms of phobias

What are the signs and symptoms of phobias? People with phobias experience many anxiety-related symptoms when exposed to their feared object or situation. The physical symptoms of phobias are the same as those that occur in the fight-or-flight response to genuine danger. Anxiety and fear can range from mild feelings of apprehension to a full-blown panic attack. The closer you are to the thing you’re afraid of, the greater your level of fear will be. Your fear will also be higher if escape from the feared object or situation is difficult.

Common phobia symptoms and sensations include:

Shortness of breath or smothering sensation Palpitations, pounding heart, or accelerated heart rate Chest pain or discomfort Trembling or shaking Feeling of choking Sweating Nausea or stomach distress

Feeling unsteady, dizzy, lightheaded, or faint Feelings of unreality or of being detached from yourself Fear of losing control or going crazy Fear of dying Numbness or tingling sensations Hot or cold flashes Fear of fainting

In addition to the physical symptoms of fear and anxiousness, people with phobias do everything they can to avoid their phobic stimulus. If you have a phobia, your avoidance of the feared situation disrupts your life and is a source of tremendous stress and anxiety.

When to get help for phobias

Although phobias are common, they rarely cause considerable distress or a significant disruption of everyday activities. For example, if you have a snake phobia, it may cause no problems in your daily life if you live in a city where you are not likely to run into one. On the other hand, if you have a severe phobia, it may impact every area of your life, from your relationships to your occupational functioning. If you have claustrophobia you might turn down a lucrative job offer if you have to ride the elevator to get to the office. If you have a fear of heights you might drive an extra twenty miles in order to avoid a tall bridge. When avoidance of the object, activity, or situation that triggers your phobia interferes with your normal functioning or keeps you from doing things you would otherwise enjoy, it is time to seek help.

Treatment for phobias

What are effective treatments for phobias? The most frequently used form of therapy for the treatment of specific phobias is a type of cognitive behavioral therapy (CBT) called systematic desensitization or exposure therapy.

Exposure Therapy

In desensitization or exposure therapy, you are exposed in a safe and controlled way to the object or situation you fear. The most commonly used exposure therapy involves gradual encounters with the fear-producing object, first in the imagination and then in reality. For example, if you have a spider phobia, you would first imagine seeing a spider, then view photos of spiders, and finally look at a spider in real life. In each of these situations, the fear is faced long enough, with support and increasing awareness of control that the panic and anxiety begin to go away. These exposures are combined with relaxation techniques and a therapist or friend at your side to provide support.

Through repeated experiences facing your fear, you begin to realize that the situation, while possibly unpleasant, is not harmful. With each exposure, you feel an increasing sense of control over your phobia. This sense of control over the situation and yourself is the most important benefit of exposure therapy. As you become desensitized to your fear, you no longer react with uncontrollable panic when confronted by it. For more information on this type of therapy, see Systematic Desensitization.

Another type of exposure therapy called participant modeling is also helpful. In participant modeling, the therapist models healthy ways of interacting with the object you fear. In the case of a spider phobia, you would watch while a therapist handles or looks at a spider in a relaxed state and without fear. Then you would be encouraged to do the same.

Some phobias are so common (such as fear of flying or driving) that there are therapists who specialize in their treatment. The number of treatments you will need depends on the severity of your phobia, but exposure-based therapy is typically brief. Phobias that are limited, such as dental phobia or animal phobia, can often be treated in as little as two to four sessions. Sometimes a single, long session is all that is needed.

Medication

Medication is rarely used in the treatment of specific phobias. However, if you are too anxious to participate in exposure therapy, you may benefit from benzodiazepines or beta-blockers. Taken before a session, these medications will help you relax enough to undergo exposure treatment.  

Other recommended treatments for specific phobia include:

• Hypnotherapy for specific phobias consists of systematic desensitization and other therapeutic techniques conducted under hypnosis by a clinical hypnotherapist.
• Group exposure therapy uses the same exposure and modeling techniques as in individual exposure therapy. However, you go through treatment in a group of three to eight people.
• Virtual reality exposure therapy uses 3-D computer graphics to simulate environments in the real world that you fear.
• Relaxation and stress relief techniques

Normal fears in children

What fears and phobias are normal in children? Phobias in children are common. According to The Child Anxiety Network, 90% of children between the ages of 2-14 have at least one specific fear. The following fears are shared by many children and are considered normal:

• 0-2 years – Loud noises, strangers, separation from parents, large objects.
• 3-6 years – Imaginary things such as ghosts, monsters, the dark, sleeping alone, strange noises.
• 7-16 years – More realistic fears such as injury, illness, school performance, death, natural disasters.

If your child’s fear is not interfering with his or her daily life, then it is unlikely that treatment is needed. However, if the fear is interfering with your child’s social activities, school performance, or sleep patterns, you should seek professional help from a qualified therapist.

Related links for phobias and fears

General information on phobias

Phobias – Describes symptoms, causes, treatments and when to get help. (Mayo Foundation)

High Anxiety – UMDNJ magazine article on specific phobias. Includes one woman’s account of her fear of driving. (University of Medicine & Dentistry of New Jersey)

Fighting Phobias, the Things that Go Bump in the Night – Describes specific phobias, social phobia, and agoraphobia. Features a review of treatment options, including medication. (U.S. Food & Drug Administration)

Anxiety Disorders– Comprehensive overview of anxiety disorders, including specific phobias and treatments. (National Institute of Mental Health)

Specific Phobias

Animal Phobias & Bird Phobias

Animal/Bird Phobias – Learn about animal and bird phobias, including how to treat them. (Anxiety Care)

Claustrophobia

Claustrophobia – Describes symptoms of claustrophobia and provides an overview of available treatments. (Better Health Channel, Australia)

Dental Phobia

Dental Phobia – Discusses dental phobia and what you can do about it. Provides a dental anxiety self-test. (floss.com)

Fear of Flying

Airfraid – Offers fear of flying information and links to airline-sponsored courses in the UK and US for people afraid to fly. (Airfraid.com)

Fear of Flying – Fear of flying resource covers symptoms medical issues, and cognitive coping strategies. (A Guide to Psychology and its Practice)

Fear of Flying: Introduction (commercial site) – A thorough article on the fear of flying. Includes descriptions of common causes and solutions. (HealthyPlace.com)

Specific Phobia: Fear of Flying – Provides treatment information, a personal story on fear of flying, book recommendations, and tips for getting help. (Anxiety Disorders Association of America)

Fear of Heights

Acrophobia – Article on the fear of heights. Includes information on causes and solutions. (Wikipedia)

Fear of Snakes

Ophidiophobia – Article on the fear of snakes. Includes a list of famous people with this phobia. (Wikipedia)

Fear of Spiders

Fear of Spiders – Overview of arachnophobia, including a historical look at spider phobia.

Fear of Water

Fear of Water – A photo essay provides an overview of one approach to overcoming a fear of water. (Enjoythewater.com)

Needle Phobia or Blood-Injection-Injury Phobia

Needle Phobia Page – In-depth look at needle phobia, including treatments.

The Needle Phobia Information Site – Resource for those with needle phobia. Includes a discussion forum, treatment strategies, links to journal articles, and personal stories.

When Health Fears Hurt Health – Article by the American Psychological Association on health phobias, including dental phobia, blood phobia, needle phobia, and disease phobia. (APA Online)

Phobias in Children and Teens

The Child Anxiety Network – Provides information about child anxiety, including how to help your child cope. Features a section on childhood phobias.

Fears and Phobias – Information geared to teenagers about fears, phobias, and treatment. (TeenHealth)

Phobias – Easy-to-understand phobia information for children. (KidsHealth)

Phobia Treatments

Systematic Desensitization – Detailed look at systematic desensitization and how to do it on your own. Includes instructions on relaxation, constructing an anxiety hierarchy, and confronting phobias in vivo. (A Guide to Psychology and Its Practice)

A Virtual Cure – Article by the American Psychological Association on the use of virtual reality in combination with cognitive-behavioral therapy as a tool to help people overcome phobias. (APA Online)

What is Cognitive-Behavioral Therapy? – Describes several treatment approaches and provides referrals. (National Association of Cognitive-Behavioral Therapists (NACBT))

Cognitive-Behavioral Therapy – Overview of cognitive-behavioral therapy, including its use in the treatment of phobias. (National Alliance on Mental Illness)

How Hypnosis Helps Phobias – Learn how hypnosis is used to treat phobias. Includes advice on finding a qualified hypnotherapist. (Natural Bloom)

Relaxation Techniques – Describes relaxation techniques in general, how they help, how to learn on your own, and how to find a qualified practitioner. (University of Maryland Medical Center)

Phobia Support and Self-Help

Overcoming Particular Fears (Phobias) (PDF) – Provides a list of suggestions for overcoming different types of phobias and a sample worksheet for you track your progress. (World Health Organization)

Helping Someone Else Overcome a Phobia – Provides guidance and tips for helping a friend or family member overcome a phobia. (Gloucestershire Primary Mental Health Service, reprinted from The World Health Organisation Division of Mental Health & Substance Misuse)

US:

Anxiety Disorders Association of America (ADAA) – Non-profit organization dedicated to the diagnosis, treatment, and cure of anxiety disorders. Provides a newsletter, a national network of self-help groups, and a search tool for finding a therapist.

Freedom From Fear – National non-profit mental health advocacy association dedicated to helping depression and anxiety sufferers, including those with phobic disorders. Includes information on finding help and a bookstore. 

Anxieties.com – Free self-help site for people with anxieties, including phobias and panic attacks. Features a self-assessment questionnaire, weekend treatment groups, and a “Don’t Panic Self-Help Kit.”
 
AnxietyPanic.com – Site dedicated to educating patients, families, caregivers, and the community about anxiety and panic disorders. Features a phobia treatment section.

UK:

National Phobics Society – UK charity for suffers and ex-sufferers of anxiety disorders and phobias. Includes treatment information, advice, and support.

First Steps to Freedom – Support resource for people who suffer from phobias and other anxiety problems. Offers factual information, self-help books, one-on-one telephone counseling, and a confidential help line. 

No Panic – Provides self-help information for people with phobias, panic attacks, obsessive-compulsive disorder, and other anxiety disorders.

Triumph over Phobia – National UK network of self-help groups dedicated to helping phobia sufferers overcome their fear.

Delving Deeper into Phobias

Anxiety Disorder: Specific Phobia – Article geared toward medical professionals provides a thorough look at specific phobias, including clinical history, treatment, and medication. (eMedicine)

Fears and Phobias: Are They Normal or Abnormal? – Results of a research study investigating the incidence of animal phobia in the adult population. The study found that almost 50% are fearful of at least one animal or insect. (Bombay Hospital Journal)

Fear of Snakes, Spiders Rooted in Evolution, Study Finds – News article on the evolutionary development of snake phobia and spider phobia. (National Geographic News)

What is a Specific Phobia? – Learn more about specific phobias, including causes and interesting facts. (PsychDirect)

Melinda Smith created this article with contributions from Jeanne Segal, Ph.D. Last modified on: 8/2/06.