Specific Phobias

A specific phobia is an overwhelming fear of an object or situation that is out of proportion to the actual danger posed, and that you go to great lengths to avoid. Examples of specific phobias are fear of snakes, spiders, flying, heights, or seeing blood. Specific phobias affect up to 12 percent of adults at some point in their life.[1]

Social phobias are treatable. A good place to begin is with an overview of anxiety including the symptoms, causes, and treatment.

Six Symptoms of Phobias

If you have a specific phobia, you go to great lengths to avoid your fear. But when you cannot avoid it, the symptoms of a phobia are similar to a panic attack.

  • Heart: Racing heart, skipped beats
  • Chest: Chest tightness, difficulty breathing
  • Autonomic: Sweating, nausea, abdominal pain
  • Muscles: Tremors, shakes
  • Dizziness: Unsteady, lightheaded, faint
  • Fear: Fear of impending doom or dying

Definition and Diagnosis of Specific Phobias (DSM-F40.2)

Specific phobia diagnostic criteria based on the DSM-5.[2]

  • Do you have significant fear or anxiety about a specific object or situation, such as, animals, flying, heights, or seeing blood?
  • Are you fearful or anxious almost every time you are exposed to the object or situation?
  • Do you try to avoid the object or situation? If you cannot avoid it, do you endure the experience with intense fear?
  • Do other people consider your fear to be out of proportion to the actual danger posed?
  • Have your symptoms lasted for at least 6 months?
  • Has your fear had a significant negative impact on your life (relationships, work, social, or emotional life)?
  • Your symptoms are not due to medication, substance abuse, or any other medical condition (e.g., hyperthyroidism).
  • Your symptoms are not due to another mental health condition such as agoraphobia, panic disorder, obsessive-compulsive disorder, or post-traumatic stress disorder.

If you answered yes to all of the above criteria, you may meet the DSM definition of specific phobia.

Related Conditions

Agoraphobia is fear about specific situations, for example flying or being in enclosed spaces. If you are afraid of only one situation, then you may have a specific phobia. But if you are afraid of more than one situation, then agoraphobia is the more likely diagnosis.

Panic disorder is episodes of intense fear or a feeling of impending doom that happen suddenly, and often with no clear trigger. In a specific phobia, you may have panic attacks, but they are always triggered by a specific object or situation.

Obsessive-compulsive disorder isuncomfortable, intrusive and recurrent thoughts and/or the urge to relieve anxiety symptoms by carrying out rituals or behaviors. But in a specific phobia, you do not have rituals that are temporarily effective.

Post-traumatic stress disorder can often trigger phobias after a traumatic event. But these phobias are usually general and apply to a number of situations, for example, standing in line, being in a crowd, using public transportation, and being in enclosed spaces. Whereas, if you have a specific phobia it is always triggered by a specific object or situation.

Tests

Medical Tests

Your health care provider can determine if your specific phobia disorder is caused by an underlying medical condition, such as heart disease or thyroid problems. This may require blood tests and an electrocardiogram (ECG). A complete assessment should also include questions about your caffeine and alcohol consumption, and any substance use, which can contribute to an anxiety disorder.

Standardized Screening Test for Specific Phobias

There is no generally recognized screening test for specific phobias. But there are a number of screening tests for anxiety, including Generalized Anxiety Disorder Test (GAD-7) (pdf), Yale-Brown Obsessive-Compulsive Scale (YBOCS) (pdf), and Social Phobia Inventory (SPIN) (pdf).[3]

Causes of Specific Phobias

Before looking at the treatment of specific phobias, it helps to understand the causes because they can help guide the treatment. Specific phobias usually develop during childhood but can begin later in life.

Negative Experiences

Many phobias develop as a result of a negative experience, such as being attacked by an animal or trapped in a small space.

Phobias can also begin after you have heard about a negative experience. For example, hearing about a plane crash, without receiving the necessary reassurance, can lead to a specific phobia.

Family Environment

Fears can be learned. If one of your parents was overly afraid of an object or situation, you may also have learned to be afraid of something similar.

You learn fears not just from what parents say, but from what they show. Suppose you were startled by a spider as a child. If you ran to one of your parents, and they rushed you away from the spider, you learned that it’s normal to be afraid of spiders. The next time you saw a spider you might feel anxious. If your parent continued to be overprotective, you might gradually develop and irrational fear of spiders. Your fear would not be based on facts, but on your parent’s emotional response. It would be based on what they show not on what they say.

Substance Use

Adulthood phobias can be caused by substance abuse. Tobacco, caffeine, drugs, and alcohol can all increase anxiety and the risk of developing an anxiety disorder.

Medical Causes

A number of medical conditions can cause anxiety symptoms. These include an overactive thyroid, hypoglycemia, mitral valve prolapse, anemia, asthma, COPD, inflammatory bowel disease, Parkinson's disease, and dementia among others. Your physician may perform certain tests to rule out these conditions. But it is important to remember that anxiety is more often due to poor coping skills or substance abuse than any medical condition.

Treatment of Specific Phobias

The three main treatments for specific phobias are cognitive behavioral therapy, mind-body relaxation, and anti-anxiety medications.

Five Things You Can Do About Your Phobias

  • Quit smoking, reduce your alcohol and caffeine use. These can all cause or worsen anxiety symptoms.
  • Review your over-the-counter medications such as diet pills and cold medications that can contain stimulants, which may trigger anxiety.
  • Learn relaxation and stress-management techniques and make them part of your life. Develop healthy coping skills.
  • Rule out any medical causes for your symptoms.
  • Ask for help. Talk with a health professional about your anxiety. Review your thought patterns, and identify any negative thinking that can contribute to your anxiety.

Cognitive Behavioral Therapy for Specific Phobias

Cognitive behavioral therapy (CBT) helps you learn healthier ways of thinking, behaving, and reacting to the objects or situations you fear. MRI studies have shown that cognitive behavioral therapy changes brain pathways and results in a more permanent change in thinking and behavior.[4, 5]

Cognitive behavioral therapy also has a behavioral component. The idea is to gently take small steps into your anxiety-provoking situations. In this way you see that your phobias are exaggerated fears. You gradually get to exercise your new coping skills and see that you can safely negotiate situations that were previously anxiety-provoking.

Find Help

Specific phobias are treatable. Visit www.IWantToChangeMyLife.org/findhelp for a list of resources, including crisis phonelines, counselors, therapists, psychologists, psychiatrists, and support groups. You can change your life.

References

  1. National Comorbidity Survey, Lifetime Prevalence of DSM-IV Disorders.  https://www.hcp.med.harvard.edu/ncs/ftpdir/NCS-R_Lifetime_Prevalence_Estimates.pdf.
  2. American Psychiatric Association, DSM-5 The Diagnostic and Statistical Manual of Mental Disorders. 5 ed, ed. D. Kupfer: American Psychiatric Association.
  3. Beidas, R. S., Stewart, R. E., Walsh, L., Lucas, S., et al., Free, brief, and validated: Standardized instruments for low-resource mental health settings. Cogn Behav Pract, 2015. 22(1): p. 5-19. PMC4310476.
  4. Beutel, M. E., Stark, R., Pan, H., Silbersweig, D., et al., Changes of brain activation pre- post short-term psychodynamic inpatient psychotherapy: an fMRI study of panic disorder patients. Psychiatry Res, 2010. 184(2): p. 96-104.
  5. Linden, D. E., How psychotherapy changes the brain--the contribution of functional neuroimaging. Mol Psychiatry, 2006. 11(6): p. 528-38.
Last Modified: August 6, 2018