Phobia

What is phobia?

A phobia is a persistent, excessive, unrealistic fear of an object, person, animal, activity, or situation. It is a type of anxiety disorder. A person with a phobia either tries to avoid the thing that triggers the fear, or endures it with great anxiety and distress.

Some phobias are very specific and limited. For example, a person may fear only spiders (arachnophobia) or cats (ailurophobia). In this case, the person lives relatively free of anxiety by avoiding the thing he or she fears. Some phobias cause trouble in a wider variety of places or situations. For example, symptoms of acrophobia (fear of heights) can be triggered by looking out the window of an office building or by driving over a high bridge. The fear of confined spaces (claustrophobia) can be triggered by riding in an elevator or by using a small restroom. People with these phobias may need to alter their lives drastically. In extreme cases, the phobia may dictate the person's employment, job location, driving route, recreational and social activities, or home environment.

The most common types of phobias include:

• Specific phobia (simple phobia). With this most common form of phobia, people may fear specific animals (such as dogs, cats, spiders, snakes), people (such as clowns, dentists, doctors), environments (such as dark places, thunderstorms, high places), or situations (such as flying in a plane, riding on a train, being in a confined space). These conditions are at least partly genetic (inherited) and seem to run in families.
• Social anxiety disorder (formerly called "social phobia"). People with social anxiety disorder fear social situations where they may be humiliated, embarrassed, or judged by others. They become particularly anxious when unfamiliar people are involved. The fear may be limited to performance, such as giving a lecture, concert, or business presentation. Or it may be more generalized, so that the phobic person avoids many social situations, such as eating in public or using a public restroom. Social phobia seems to run in families. People who have been shy or solitary as children, or who have a history of unhappy or negative social experiences in childhood, seem more likely to develop this disorder.
• Agoraphobia. Agoraphobia is a fear of being in public places where it would be difficult or embarrassing to make a sudden exit. A person with agoraphobia may avoid going to a movie or a concert, or traveling on a bus or a train. Many people with agoraphobia also have panic symptoms or panic disorder (which involves intense fear plus uncomfortable physical symptoms, such as trembling, heart palpitations, and sweating).

Childhood phobias occur most commonly between the ages of 5 and 9, and tend to last a short while. Most longer-lasting phobias begin later in life, especially in people in their 20s. Adult phobias tend to last for many years, and they are less likely to go away on their own, unless they are treated. Phobia can increase an adult's risk of other types of psychiatric illness, especially other anxiety disorders, depression, and substance abuse.

Symptoms of phobia

The symptoms of phobia are:

• Excessive, unreasonable, persistent feelings of fear or anxiety that are triggered by a particular object, activity, or situation.
• Feelings that are either irrational or out of proportion to any actual threat. For example, while anyone may be afraid of an unrestrained, menacing dog, most people do not run away from a calm, quiet animal on a leash.
• Avoidance of the object, activity, or situation that triggers the phobia. Because people who have phobias recognize that their fears are exaggerated, they are often ashamed or embarrassed about their symptoms. To prevent anxiety symptoms or embarrassment, they avoid the triggers for the phobia.
• Anxiety-related physical symptoms. These can include tremors, palpitations, sweating, shortness of breath, dizziness, nausea, or other symptoms that reflect the body's "fight or flight" response to danger. (Symptoms such as these may lead to a diagnosis of panic disorder.)

Diagnosing phobia

A mental health professional is likely to ask about current symptoms and family history, particularly whether other family members have had phobias. You may want to report any experience or trauma that may have set off the phobia – for example, a dog attack leading to a fear of dogs.

It may be helpful to discuss how you react – your thoughts, feelings, and physical symptoms – when you are confronted with the thing you fear. Also, describe what you do to avoid fearful situations, and how the phobia affects your daily life, including your job and your personal relationships.

Your doctor will ask about depression and substance use because many people with phobias have these problems as well.

Expected duration of phobia

In children, specific phobias can be short-term problems that disappear within a few months. In adults, about 80% of new phobias become chronic (long-term) conditions that do not go away without proper treatment.

Preventing phobia

There is no way to prevent a phobia from starting. However, treatment can reduce the negative impact of the disorder.

Treating phobia

Treatment usually includes some combination of psychotherapy and medication depending on the type of phobia:

• Specific phobia. Cognitive-behavioral therapy can help, especially a procedure called either desensitization therapy or exposure therapy. This technique involves gradually increasing your exposure to the thing you fear, at your own pace, under controlled circumstances. As you are exposed to the object, you are taught to master your fear through relaxation, breathing control, or other anxiety-reducing strategies. For short-term treatment of phobias, your doctor may prescribe an anti-anxiety medication. If the phobia is confronted only occasionally, as in a fear of flying, the use of medication can be limited.
• Social anxiety disorder. If your social phobia centers on one particular performance (for example, giving a lecture or playing in a concert), your doctor may prescribe a medication called a beta blocker, such as propranolol (Inderal). This medicine can be taken just prior to the performance. It dampens the physical effects of anxiety (pounding heart or trembling fingers), but usually does not affect the mental sharpness needed for speaking or the physical dexterity needed for playing an instrument. For more generalized or long-term forms of social phobia, your doctor may prescribe an antidepressant, usually an SSRI (selective serotonin reuptake inhibitor) such as sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), or fluoxetine (Prozac). If an SSRI is not effective, your doctor may prescribe an alternative antidepressant or anti-anxiety medication. Cognitive-behavioral therapy also works well for many people with social phobia, in both individual and group settings.
• Agoraphobia. The treatment for this disorder is similar to the treatment for panic disorder. Drug treatment includes SSRI antidepressants, and a variety of other types of antidepressants, such as mirtazapine (Remeron), venlafaxine (Effexor), clomipramine (Anafranil), and imipramine (Tofranil). Psychotherapy is also helpful, particularly cognitive-behavioral therapy.

When to call a professional

Make an appointment to see your doctor as soon as possible if you are troubled by fears or anxieties that are disturbing your peace of mind, interfering with your personal relationships, or preventing you from functioning normally at home, school, or work.

Prognosis

The outlook is very good for people with specific phobia or social phobia. According to the National Institute of Mental Health, about 75% of people with specific phobias overcome their fears through cognitive-behavioral therapy, while 80% of those with social phobia find relief from medication, cognitive-behavioral therapy, or a combination.

When agoraphobia occurs with panic disorder, the prognosis is also good. With appropriate treatment, 30% to 40% of patients become free of symptoms for extended periods, while another 50% continue to experience only mild symptoms that do not significantly affect daily life.

Additional info

American Psychiatric Association
https://www.psychiatry.org/

National Institute of Mental Health
https://www.nimh.nih.gov/

American Psychological Association
https://www.apa.org/

Anxiety and Depression Association of America
https://www.adaa.org/