Understanding Phobias

Marion is so afraid of bugs that her social life has suffered drastically. Whenever friends invite her to go on a picnic or even to a pool party, she finds a reason to say no. Recently, she stopped joining her co-workers for lunch in the cafeteria because one day there was a fly buzzing around their table. She has had this fear since she got a bee sting in fourth grade.

Brad cannot remember when or why he became so afraid of riding in elevators. But, last month he turned down an excellent job promotion because it would have required moving his office up to the tenth floor. Both Marion and Brad are too embarrassed to tell anyone about their fears. Unfortunately, they do not know they have a treatable disorder—specific phobia.

What Are Phobias?

Everyone has at least some fears and situations they try to avoid. What distinguishes phobias from ordinary fears is that the anxiety:

• Is irrational
• Is more intense and persistent
• Usually leads to aggressive avoidance of the objects or situations that cause the fear
• Interferes with everyday routines, work, or relationships, and causes significant distress

Adults with phobias usually realize their fear is irrational. Children however, may not, which makes it even more difficult to control.

Consider the fear of flying. Many people have some apprehension about flying, but it does not keep them permanently grounded. Perhaps a bad experience or news coverage of a plane crash scared you. Over time, that fear manifested itself in your thoughts and dreams to a point where you miss job interviews or family vacations. Whatever the reason, if you avoid flying to the point it affects your quality of life, you have a phobia.

Phobias are a common type of anxiety disorder. Three types of phobias are:

• Specific phobia—fear of a specific object or situation that causes avoidance of normal activities
• Social anxiety disorder—fear of being judged by other people and acting in a way that could cause embarrassment or humiliation
• Agoraphobia—fear of being in a public place, especially when anticipating it you may have a panic attack

This article focuses on specific phobias.

Common Specific Phobias

Specific phobia involves an intense fear and avoidance of a single specific object or situation. Direct exposure to the object or situation—and sometimes just imagining it—causes fear that is out of proportion to the actual level of danger. The intensity of the fear may vary from one exposure to another. And people can have more than one specific phobia.

Phobias of certain types of animals such as snakes, insects, and dogs, are especially common. In many cases, phobias can begin in childhood and continue into adulthood.

There are several other common types of specific phobias. For example, fear of the natural environment includes being afraid of storms or heights.

The blood-injection-injury type of phobia is the fear of seeing blood or an injury or having an injection or other invasive medical procedure. The situational type occurs in a specific type of situation, such as flying or being in a tunnel, elevator, or other enclosed space. Phobias may also occur in situations that could lead to choking, vomiting, or getting a specific illness.

Phobic fear usually involves physical symptoms that can range from mild panic-like symptoms to a panic attack. Common panic symptoms include:

• Heart palpitations
• Difficulty breathing
• Sweating
• Trembling
• Feelings of lightheadedness or choking
• Nausea
• Fear of losing control or going crazy

Because these symptoms are so unpleasant, people with phobias do everything possible to avoid the trigger. If avoidance is fairly easy, the phobia may not cause a lot of problems and may not require treatment. But, when the object or situation is encountered often, maintaining a normal life may become difficult.

Causes of Specific Phobias

It is not known what specifically causes phobias, but most researchers believe they are caused by a combination of biological factors and life events. Heredity and chemical imbalances in the brain may play a role. So too may traumatic events, such as a previous animal bite, accident, or childhood illness. Some phobias are learned over time, as in a child modeling a parent's phobia. But often, phobias occur without a specific trigger. Avoidance of the feared object or situation keeps the phobia securely in place.

Common Treatments

Behavioral therapy is one of the most effective treatments for people whose phobias have become disruptive to a normal lifestyle. It involves changing and gaining control over unwanted behavior. The type of behavior therapy used with specific phobias is called desensitization, or exposure therapy. First, you are slowly exposed to the feared object or situation. In some cases, exposure begins with you imaging that you are coming into contact with whatever the trigger is. As your fear gradually diminishes, you slowly learn that avoidance is not necessary.

Cognitive-behavioral therapy (CBT) is a technique that combines changing the way people think about their phobia by changing the way they behave around it.

Relaxation techniques may also be used with behavior therapy to help people face their fears.

Most people with specific phobias benefit from these kinds of professional help. But, some people with minor phobias may find self-help books useful. Keep in mind that most studies show that people usually do not improve without therapy.

Medication is generally used for specific phobias only if there is a high level of anxiety at the beginning of exposure therapy. The medication, usually an antidepressant or tranquilizer, is slowly stopped as the person gains confidence.

Getting Help

Like Marion and Brad, many people with phobias do not get help. Perhaps they do not realize they have a treatable condition or are too embarrassed to get help. Jane, an attorney from Boston, had a phobia about being attacked on a subway. "How ridiculous is that? I am a successful professional woman who is terrified to ride the train. But I am even more afraid of having someone find out."

Specific phobia is a highly treatable disorder. The success rates with behavioral and cognitive therapy are very good, even with short-term treatment.

If you suspect you have a specific phobia, get help from a mental health professional. Support groups for people with phobias may also be available. If you know someone who may have a phobia and is not diagnosed or receiving treatment, encourage him to get professional help.

Revision Information

• Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
• Review Date: 11/2017
• Update Date: 01/31/2014