[Download the NAMI specific phobias fact sheet.]
What are specific phobias?
A specific phobia is a common mental illness characterized by an irrational fear of a particular object or situation. Specific phobias have two main components, the first of which is a strong and consistent fear of an object or situation that the individual realizes poses no actual threat. Secondly, this response results in the intentional avoidance of the feared object or situation, causing difficulties within the individual’s life as decisions are made in order to steer clear of the feared stimulus.
In many cases, the phobic object is something that might be dangerous or unsafe in certain situations (e.g., snakes, insects, high places or blood). Many people without specific phobias may also avoid these objects to some degree. For example, many people do not look forward to flying on airplanes or would not want to touch a spider. The difference between these normal reactions and those experienced by a person with a specific phobia is the intensity of the fear response and the level of dysfunction that it causes in a person’s life. A person with a phobia of flying might choose to drive from Boston to Houston even when a plane would save days of travel and lots of gas money. A person with phobia of spiders might refrain from going into the garage for months at a time in order to avoid a spider’s web that was seen the previous summer.
Furthermore, while many people may experience some anxiety or disgust when seeing a spider, the spider-phobic person experiences physical symptoms of this fear that can include shortness of breath, nausea or heart palpitations. In severe cases, people with phobias can experience panic attacks that can leave them feeling embarrassed, worthless or incapacitated. People with specific phobia may also experience significant difficulties at work, school or in their social lives as required activities are stopped in order to avoid the fear-inducing object or situation.
Who gets a specific phobia?
Specific phobias often begin in childhood and can last throughout one’s lifetime unless properly treated. Some estimates suggest that up to 15 to 20 percent of people will experience symptoms of specific phobia over the course of their life. Specific phobias affect people of all ages, races, genders, cultures and socioeconomic status, although it is thought that younger people with less income are more likely to experience this mental illness. Many studies suggest that women are more likely to experience specific phobias, although men may be more likely to seek treatment for this illness.
Specific phobias often occur in people with other mental illnesses including anxiety disorders (e.g., social phobia, panic disorder, generalized anxiety disorder, posttraumatic stress disorder) and mood disorders (e.g., depression, bipolar disorder). As drugs and alcohol can often be used as a “self-medication” to decrease the fear or anxiety associated with their illness, people with specific phobias are at increased risk of substance abuse and substance dependency.
Scientists have not identified a single gene that causes specific phobia; however, it is generally accepted that individuals with a parent or close relative who experienced this illness are more likely to develop it themselves. The neurological basis for this illness is further supported by scientific studies demonstrating that people with specific phobias have changes in their brain functioning. The amygdala, a specific region of the brain associated with the fight-or-flight response, has been studied in people with specific phobia and may be a key to further understanding this illness.
What are most common specific phobias?
The DSM-IV-TR describes five subtypes of specific phobias as listed below:
- Fear of animals—this can include pets, wild animals and insects (e.g., arachnophobia—fear of spiders).
- Fear of natural environment—this can include natural disasters (e.g., storms and earthquakes) as well as fear of being in unstable places within the environment (e.g., hydrophobia—fear of water and acrophobia—fear of heights).
- Fear of blood/injections/injury—this can include fear of seeing the blood of other people (e.g., witnessing surgeries or injuries) as well as fear of experiencing this stimuli oneself (e.g., fear of having one’s blood drawn for laboratory tests).
- Fear of situations—this can include fear of traveling by different means (e.g., fear of driving on a highway or pteromerhanophobia—fear of flying) as well as claustrophobia (fear of being in enclosed places such as elevators, tunnels or bridges).
- Other Fears—this can include fear of dying by illness, fear of incontinence and fear of other bodily sensations (e.g., coughing, palpitations or pain).
What treatments are available for people with specific phobias?
Psychiatrists, psychologists, social workers and other mental health professionals all agree that the primary treatment for specific phobias is behavioral therapy.
Exposure therapy is a specific kind of behavioral therapy where a person is brought into contact with the feared object of situation. By increasing the level of exposure to the source of fear, a person experiences fewer symptoms in a process that is called extinction. For example, a person with a specific phobia of spiders may first be exposed to photos of spiders. Initially, this may cause an intense fear response with symptoms of shortness of breath, dizziness, heart palpitations and a desire to flee. However, with continued exposure to the pictures, an individual’s body will eventually stop producing such a response. When this occurs, the intensity of the stimulus is increased. This same person may then sit in a room in which a spider is in a plastic cage and be encouraged to touch the cage. Again, this may cause tremendous distress, but this response too will lessen with time. In a final stage, a person may be encouraged to hold a tarantula—something which was previously unthinkable! Even this experience will become tolerable as the symptoms of specific phobia are treated properly through this technique.
Another common treatment is called systematic desensitization. This treatment has many overlaps with traditional exposure therapy, although it also focuses on using relaxation techniques such as deep breathing and progressive muscle relaxation. These skills can be useful in helping a person cope with the anxiety and stress of the therapeutic process.
In general, medications are not used to treat specific phobias as behavioral therapy is so successful in treating this illness. In some cases of extreme symptoms or during the initial stages of treatment, certain medications such as benzodiazapines (e.g., diazepam [Valium], clonazepam [Klonopin], lorazepam [Ativan]) or beta-blockers (e.g., propranolol [Inderal]) may be used. It should be clearly noted that these medications are not long-term or curative treatments for specific phobias. As with any medical condition, all medication decisions should be discussed with a doctor.
Will people with specific phobia get better?
Unfortunately, many people with specific phobia will not seek treatment for their illness. For people who do not seek treatment, many will continue to experience the disabling symptoms of their illness. In spite of this, a significant percentage of people with this illness will experience a decrease in the severity of their symptoms over time, and up to 20 percent will experience full recovery.
For people seeking treatment, the majority will experience a significant decrease in their symptoms. A sizable percentage of people who engage in proper treatment will experience a near complete resolution of their symptoms.
Family and friends can be most helpful in encouraging their loved one to seek treatment for this troubling illness. With proper treatment and the support of their loved ones, most people with specific phobias can expect to live meaningful and productive lives and see a significant decrease in the severity of their symptoms.
Reviewed by Ken Duckworth, M.D., Jacob Freedman, M.D., and Frederick Kahn, B.S.,