A specific phobia is an unrealistic or extreme fear of a specific discreet situation, object, or setting. These fears are persistent and cause those with the phobia to avoid situations in which exposure might occur. For example, one may have a phobia of medical or dental visits, heights, flying, elevators, or spiders. Specific phobias are anxiety disorders.
The DSM-5 divides specific phobias into five broad categories:
- Animals, such as a fear of spiders, dogs, or bugs.
- The natural environment, such as fear of heights or thunderstorms.
- Blood, injury, and injection, such as a fear of needles or medical procedures.
- Situational, such as a fear of flying or riding in elevators.
- Others, such as a fear of vomiting or choking.
People with specific phobias often know their anxiety is out of proportion to the danger posed by the object or situation. Nonetheless, specific phobias can cause intense anxiety and even panic attacks in a person confronted with a situation or object they fear.
Specific phobias can emerge at any age, but usually start in childhood or adolescence, and the symptoms can be lifelong. The condition occurs twice as often in women than in men, according to the DSM-5. About 75 percent of individuals with a specific phobia have more than one, and an average patient has three.
Globally, Asian, African, and Latin American countries report significantly lower rates of specific phobias, at between 2 to 4 percent, according to the DSM.
- Deep fear or anxiety about a specific object or situation, which may result in crying, stiffening, escaping the situation, or a panic attack.
- The object or situation always provokes almost immediate fear or anxiety.
- The individual actively avoids the object or situation.
- The danger posed by the object or situation is not proportional to the fear that is experienced.
- The phobia disrupts the person's daily life.
In children, a specific phobia generally prompts crying, tantrums, freezing, or clinging.
Many individuals with a specific phobia will change their lifestyles to avoid their fear as much as possible; for example, moving to a region where certain animals are rare or where there is no subway.
For a diagnosis of specific phobia to be made, the symptoms must persist for at least six months and not be due to social anxiety, separation anxiety, agoraphobia, post-traumatic stress disorder, or obsessive-compulsive disorder.
There are many specific phobias, some of which are widespread among the population, many of which are rare, and some of which are so idiosyncratic that no terminology describes them. Some of the most common phobias include:
Arachnophobia: the fear of spiders
Trypanophobia: the fear of injections
Agoraphobia: the fear of not being able to escape from a place
Nyctophobia: the fear of the dark
Ophidiophobia: the fear of snakes
Coulrophobia: the fear of clowns
Acrophobia: the fear of heights
Aerophobia: the fear of flying
Cynophobia: the fear of dogs
Astraphobia: the fear of thunder and lightning
Excessive fears are common in young children but rarely result in life-long phobias. It is a normal part of child development to learn about the world, and that entails becoming scared of some of what a child discovers. Most often, these fears recede over time. When a child’s specific fear remains for months or years, and if they exhibit considerable anxiety and avoidance of that which they fear, then a diagnosis of a specific phobia is possible, in consultation with a professional.
According to the DSM-5, the prevalence of specific phobias in the United States is between seven and nine percent of the population. Other research finds variations that span three to 15 percent of the population. One study found that environmental phobias are the most common, while animal phobias are less common, and blood-injection phobias are the least common.
Most phobias begin in childhood, but the age of onset can vary widely. Research has found that for animal phobias, the average age of onset is around 7 years old, and for blood-injection phobias around 9 years old, while the average age for onset of claustrophobia is 20 years old.
Certain specific experiences can elevate the risk as well, such as having overprotective parents, losing a parent, sexual or physical abuse, and trauma related to the specific fear.
Genetics may also play a role; individuals who have a first-degree relative with a specific phobia are more likely to have that same specific phobia.
Specific phobias sometimes develop following a traumatic event (such as being attacked by an animal), the observation of others going through a traumatic event (such as watching someone drown), or learning about a traumatic event (such as a plane crash). However, many individuals with specific phobias are unable to recall the reason for the onset of their phobias, and most people who experience traumatic events do not develop phobias around what happened to them.
Evidence for a genetic basis for phobias exists, however, but presents more often as neuroticism or anxiousness, rather than as a specific phobia, according to research. It is also possible that phobias are inherited, but not through genes. Family attitudes and fears can be taught through the generations.
Women are twice as likely to have specific phobias, compared to men, according to the DSM-5. Research shows that women are more likely than men to have animal phobias, situational phobias, and environmental phobias, while women and men have about the same rate of blood-injection phobias.
The role human evolution plays in causing specific phobias is a topic of debate in the academic world. While many phobias concern organisms that could kill us, such as snakes, spiders, and heights, other phobias do not fit this bill. Phobias of lions, which could have killed paleolithic humans are rare, while phobias of slugs, which present much less evolutionary pressure, are more common. Arachnophobia is one of the most common phobias, but only 0.1 percent of spiders are dangerous. Other phobias, like those of flying or driving, simply didn’t exist in the minds of our evolutionary forebears. Some call the desire to explain modern phenomena through evolution the “adaptive fallacy.”
Cognitive-behavioral therapy (CBT) combined with exposure therapy is the leading approach for treating specific phobias. CBT interventions help change the thinking and behaviors that cause distress in specific situations.
In exposure therapy, a therapist generally guides the patient toward gradual real or virtual exposure to the object or situation feared, sometimes paired with relaxation exercises. Virtual reality has shown promise as a delivery tool for exposure therapy, and may offer an opportunity to reach more people with accessible and affordable care.
Medications such as beta-blockers are sometimes used to reduce anxiety, primarily in the short-term, such as when a feared situation is necessary or unavoidable.
Individuals with specific phobias may have a decreased quality of life due to their condition, consistent with other anxiety disorders. Individuals with specific phobias are up to 60 percent more likely to make a suicide attempt than are individuals without the diagnosis. However, it is likely that these elevated rates are primarily due to comorbidity with personality disorders and other anxiety disorders.
One of the leading treatments for specific phobias is exposure therapy, in which a person is slowly and gradually exposed to that which they fear. If the patient is afraid of snakes, this therapy could begin by learning about snakes, advance to looking at pictures of snakes, holding a toy snake, going to a zoo to look at real snakes, and finally, holding a live snake.
This treatment does not necessarily “cure” a phobia, but it can help a patient to develop more rational responses in the face of fear. A successful patient still may not like snakes or clowns, but may no longer react with panic or a fight-or-flight response when they are exposed to triggers.