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Specific Phobia

A specific phobia is an unrealistic or extreme fear of a specific situation, object, or setting. For example, one may have a fear of medical or dental visits, heights, flying, elevators, germs, or spiders.

The DSM-5 divides specifc phobias into five broad categories:

  • Animals, such as a fear of spiders, dogs, or bugs
  • The natural environment, such as 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 there is no real reason to be afraid and that their behavior is not logical. However, they may simply feel powerless when faced with the fear, and even the anticipation of it can cause intense anxiety.

Specific phobias can emerge at any age, but usually start in childhood or adolescence, and the symptoms can be lifelong. The condition affects 7 to 9 percent of Americans, according to the DSM-5, and occurs twice as often in women than in men. About 75 percent of individuals with a specific phobia have more than one; an average patient has three.

Symptoms

  • Deep fear or anxiety about a specific object or situation, which may result in crying, stiffening, clinging to another person, or escaping the situation.
  • 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 some cases, exposure to the feared object or situation (the phobic stimulus) can cause full or limited panic attacks.

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, agorophobia, post-traumatic stress disorder, or obsessive-compulsive disorder.

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Causes

While the exact cause is unknown, certain factors and personality traits appear to increase one's risk of developing specific phobia disorder. Neuroticism and frequent worries and negative thoughts may also increase the risk.

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.

Treatment

Cognitive-behavioral therapy (CBT) is a leading therapy approach for treating specific phobia disorder. CBT interventions help change the thinking and behaviors that cause distress in specific situations.

Exposure treatment is usually included with CBT. 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 beat-blockers are sometimes used to reduce anxiety, primarily in the short-term, such as when a feared situation is necessary or unavoidable.

References
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition        
Lieb R, Miche M, Gloster AT, Beesdo-Baum K, et al. Impact of Specific Phobia on the Risk of Mental Disorders: A 10-year prospective longitudinal community study of adolescents and young adults. Depression and Anxiety. July 2016;33:667-675.
McCabe RE and Swinson R. Psychotherapy for Specific Phobia in Adults. UpToDate. Last Updated: 11/06/15. Accessed July 5, 2017.
Anxiety and Depression Association of America. Specific Phobias. Accessed September 27, 2017.
Society of Clinical Psychology: Exposure Therapies for Specific Phobias. Accessed July 5, 2017.
Last updated: 07/05/2017