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Phobia

Phobia refers to an intense, unreasonable, abnormal and uncontrolled fear about a specific living being, object, activity, place or situation which the sufferer avoids desperately. It is one of the most common psychiatric disorders.

What Is A Phobia?

Phobias are a form of anxiety disorder which results in unrealistic, extreme and lasting fear of an animal, individual, object or event. The individual may go to great lengths to avoid the object of their fear or they may reluctantly face it with excessive stress and anxiety. Although avoiding the trigger for their fear may help to avoid anxiety temporarily, it can often reinforce and strengthen their anxiety and fear. Believed to be a learned emotional response to fear, the individual may experience panic attacks, severe distress and feelings of dread when in the presence of the source of their fear. In some cases, an adult sufferer may be aware that their fear is irrational and extreme but they are typically unable to control or manage it. When left untreated, it can adversely affect a person’s quality of life by impairing their ability to function in daily life. It can also impact their education, career, relationships and other aspects of personal life. Researchers 1 explain that “phobias may develop due to an association of an object or situation with emotions such as fear and panic.”

A person living with a phobia may experience an almost immediate onset of intense fear and typically experiences such episodes for a period of at least 6 months 2 . Their perceived threat is often much greater to the actual threat and they can take exceptional measures to avoid it. They will change and modify their life and lifestyle drastically to avoid the cause of fear like changing jobs, moving to a new place, driving through a new route etc. In case they are unable to avoid it, they will experience significant nervousness, anxiety, distress and panic attacks leading to rapid heartbeat, trembling, nausea and fainting.These symptoms can often last for minutes even in the absence of any real threat or danger.

A person may develop multiple phobias. Phobias are very common and women have an increased likelihood of developing them than men. However, with effective therapy one can overcome this mental illness and live a healthier life.

Understanding Phobia

A 2018 study explains “Phobias involve both fear and avoidance. For people who have specific phobias, avoidance can reduce the constancy and severity of distress and impairment.” But these can have a significant impact due to their “onset and strong persistence,” with time. The term phobia is derived from the Greek word ‘phobos’ which literally translates to fear. Although considered as a type of anxiety disorder, several terms containing the suffix phobia have been coined to identify the specific nature and type of fear. However, it should be noted that phobias are different from normal fears. Phobias involve higher degrees of anxiety which can persist for longer amounts of time which is usually not observed in feelings of fear. Studies 3 show that specific phobias are highly common in the general population “with lifetime and 12-month prevalence estimates in representative population surveys ranging from 7.7% to 12.5% and from 2.0% to 8.8%, respectively.” Moreover, occurrence is observed more in women (7.7%) than in men (3.3%).

According to research 4 , the amygdala is associated with the development and expression of the fear system in the human body. A part of the brain’s limbic system, the amygdala regulates our fight-or-flight response which causes us to become highly stressed, anxious and alert so that we can better respond to a threat or danger. When a person has a phobia, this region of the brain inappropriately copes with the anxiety, stress and fear associated with an event. Typically, these irrational fears tend to develop when an individual is young and the median age of onset is around 8-10 years of age.

Classification Of Phobias

According to the American Psychiatric Association (APA), phobias can be classified 3 distinct categories:

1. Specific phobias

This classification 5 includes fear of specific objects, creatures or natural situations like needles, spiders, snakes heights etc. This is often caused by adverse childhood experiences associated with the source of fear. According to a 2009 study 6 , “a specific phobia is defined as a persistent fear that is excessive or unreasonable and that is cued by the presence of a specific object or situation.” It was observed that around 50% of cases involve comorbidity with other specific phobias, while 25% of cases have other psychiatric disorders.

2. Social phobias

Also known as social anxiety disorder (SAD), it involves fear of a situation involving social interactions where the sufferer is afraid of judgment, criticism or humiliation by others. Unlike shyness, sufferers have a disabling fear of social gatherings, such as meeting new people, interacting with authority figures, public speaking etc. It “is characterized by excessive fear of embarrassment, humiliation, or rejection when exposed to possible negative evaluation by others when engaged in a public performance or social interactions,” explain researchers 7 .

3. Agoraphobia

It includes fear of situations where there is a lack of opportunities to escape or where help is not readily available. Although popularly believed to be a fear of open spaces, it can also involve small, confined spaces like elevators. It may lead to a panic disorder. Some forms of agoraphobia are being home alone or outside home alone, being in a crowded place etc. As per a recent 2021 study 8 , “It is characterized by the fear that a panic attack or panic-like symptoms may occur in these situations. Individuals with agoraphobia, therefore, strive to avoid such situations or locations.”

While specific phobias are related to recognizable and specific triggers, social anxiety & agoraphobia are regarded as complex 9 phobias as the triggers are harder to identify. Regardless, these are diagnosable mental conditions that can be treated successfully under the supervision of a mental health professional.

Symptoms Of Phobia

Symptoms Of Phobia
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An individual with one or multiple phobias may experience the following common symptoms:

  • Uncontrollable and excessive anxiety upon exposure to the trigger
  • A strong and desperate need to avoid the source of fear
  • Inability to think clearly or function properly when exposed to the source
  • Being aware that the fear is inappropriate and unreasonable but unable to control it
  • Anticipatory anxiety before exposure to the trigger
  • Severe panic attacks upon exposure to the source of fear

Panic attacks 10 are the most common and prominent symptoms of this condition. Here are some of characteristics of a panic attack:

  • High blood pressure
  • Increased heart beat
  • Chest pain
  • Nausea
  • Upset stomach
  • Shortness of breath
  • Shaking or trembling
  • Hot flashes or chills
  • Rapid, incoherent speech
  • Headache
  • Dry mouth
  • Numbness
  • Severe perspiration
  • Lightheadedness or dizziness
  • Disorientation & confusion
  • Feelings of being choked
  • A strong feeling of threat or danger
  • A feeling of loss of control
  • Uncontrollable crying
  • Being clingy to a loved one nearby

Types Of Phobia

Types Of Phobia
Phobia
Types Of Phobia
Phobia


According to American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), specific phobias can be further classified into 4 categories:

  • Fear of animals
  • Fear of natural environment
  • Fear of blood, injuries or medical conditions & treatments
  • Fear of specific situations

It should be noted that an individual can develop a phobia of virtually anything that leads to anxiety in them. As there is an array of terms to identify specific phobias, the DSM-5 does not have any official list that involves all types of fears. Due to the infinite number of fear-inducing situations, creatures and objects, experts and healthcare professionals often create terms and names by using the phobia suffix and a Greek or Latin prefix for the specific object of fear depending on the requirement. For instance, hydrophobia or the fear of water merges the Greek term hydro with phobia.

Regardless, here is a quick list of some of the most common and unique phobias experienced by people around the world:

  • Acrophobia – Fear of heights
  • Aerophobia – Fear of flying
  • Alektorophobia 11 – Fear of chickens
  • Arachnophobia – Fear of spiders
  • Astraphobia – Fear of thunder and lightning
  • Claustrophobia 12 – Fear of confined or tight spaces
  • Cryophobia – Fear of ice or cold
  • Cynophobia – Fear of dogs
  • Dentophobia – Fear of dental procedures or the dentist
  • Escalaphobia – Fear of escalators
  • Glossophobia – Fear of public speaking
  • Hemophobia – Fear of blood
  • Hydrophobia – Fear of water
  • Hippopotomonstrosesquippedaliophobia or Sesquipedalophobia – fear of long words
  • Monophobia or Autophobia – Fear of being alone
  • Mysophobia – Fear of germs
  • Necrophobia – Fear of dead things
  • Nephophobia – Fear of clouds
  • Nomophobia 13 – Fear of being without a working phone
  • Nyctophobia – Fear of darkness or the nighttime
  • Ophidiophobia – Fear of snakes
  • Onomatophobia – Fear of names
  • Pogonophobia – Fear of beards
  • Phobophobia – Fear of fears
  • Thanatophobia – Fear of death
  • Trypanophobia – Fear of medical procedures
  • Trypophobia – Fear of repetitive patterns of small holes or protrusions
  • Xenophobia 14 – Fear and hatred of strangers or foreigners
  • Zoophobia – Fear of animals

Read More About Acrophobia Here

Causes Of Phobia

Although the exact cause for the onset of phobias is still not fully understood, there are certain factors that can influence the development. Here are some risk factors that may contribute to the onset of a phobia:

1. Genetics

The condition may run in families 15 . Individuals with a first degree relative with an anxiety disorder are more likely to develop phobias. “Genetic epidemiologic studies have documented that these disorders are familial and moderately heritable,” states a 2008 study 16 .

2. Trauma

Adverse childhood experiences 17 , such as experiencing or witnessing a distressing or traumatic event, especially during childhood, can also lead to onset of this condition. If a child was attacked or traumatized 18 by an animal or insect during their childhood, they may develop an intense and irrational fear of the animal as an adult. Studies 19 have found that certain irrational fears tend to develop after “large-scale traumatic events, such as natural disasters and terrorist attacks.”

3. Learned responses & reactions

A child can also develop excessive fear if they have overly cautious and overprotective parents or caregivers. In such cases, phobias can develop as a learned response by observing their caregivers strongly reacting to something they are afraid of. The child may also have severe reactions to the same triggers as adults and experience panic attacks. “Classical fear conditioning has been used as a model paradigm to explain fear learning across species. In this paradigm, the amygdala is known to play a critical role,” states a 2007 study 20 .

4. Prolonged stress

Experiencing severe stress over a long period of time can lead to anxiety and depression. It can affect our ability to cope with negative emotions and difficult situations. As a result, an individual can become increasingly anxious and develop unreasonable fears 21 .

Apart from these, there can be many other probable risk factors that may contribute towards the onset of a phobia, such as –

  • Changes in brain functioning 22
  • Traumatic brain injuries
  • Depression
  • Substance abuse 23
  • Age
  • Female gender
  • Personality & temperament
  • Socioeconomic status
  • Ongoing medical conditions
  • Other psychiatric disorders, like paranoia 24 & schizophrenia 25

Read More About Depression Here

Complications

When left untreated, a phobia can significantly impair a person’s ability to perform daily functions. According to a 2016 study 26, phobias are “the most prevalent anxiety disorder in the community and is associated with substantial impairment. Comorbidity with physical diseases is assumed.” It can also result in severe problems in many other aspects of the individual’s life, such as –

1. Social withdrawal and isolation

As people with such extreme fears go to great lengths to avoid triggers, they may socially 27 isolate themselves to avoid anxiety. This can not only affect their social and personal relationships, but can also result in loneliness.

2. Depression

Individuals suffering from specific phobias often tend to develop depressive disorders 28 , anxiety disorders, panic disorders and other forms of mood disorders.

3. Substance and alcohol use

Sufferers can also become addicted to recreational drugs, alcohol and certain medications in an attempt to self-medicate 29 . These act as unhealthy coping mechanisms.

4. Suicidality

In extreme cases, a person with a phobia can become suicidal 30 , frequently talk about death and have suicidal ideation. Researchers 31 have found that anxiety disorders, panic disorder and post-traumatic stress disorder (PTSD) “are independently associated with suicide attempts.”

Diagnosis Of Phobia

A diagnosis may be conducted by a certified and licensed primary-care medical professional or a mental health specialist, such as a psychologist, a psychiatrist, a therapist or a social worker. The healthcare professional may conduct a psychological evaluation and medical interview by asking different questions to the patient to understand the symptoms and determine the severity of the condition. Moreover, they may assess the patient’s medical history and family history. The doctor may also conduct certain physical exams and lab tests to rule out any underlying conditions that may cause the symptoms. However, it should be noted that there are no specific lab tests for the diagnosis of the condition.

If any co-occurring disorders, such as depression, schizophrenia, anxiety disorders, substance use disorders, post-traumatic stress disorder (PTSD) or obsessive compulsive disorder (OCD), are identified, then treatment will be directed at the condition along with the phobia.

Treatment Of Phobia

Treatment Of Phobia
Phobia


Regardless of the severity of the symptoms, phobia is a treatable condition. As patients are typically aware that their irrational fears are unreasonable, seeking medical attention 32 and consulting a mental health professional can be helpful. Although most individuals with this condition do not necessarily seek treatment, if the symptoms cause severe functional impairments and affect their quality of life then medical treatment may become necessary.

There is no particular treatment for treating this condition. However, medications, psychotherapies of a combination of both can relieve the symptoms for both specific and complex phobias. The doctor or therapist may modify the treatment approaches to suit the needs of the patient.

Here are some of the most effective treatment options for this mental condition:

1. Psychotherapy

Therapy can be highly effective in enabling the patient develop coping strategies for symptoms associated with fear, anxiety and panic attacks. It can also teach the sufferer how to better manage their thoughts, emotions and reactions when exposed to triggers. A 2014 study 33 found that “Exposure-based therapies are the treatment of choice and empirically validated protocols are available that promise rapid and effective results.” A doctor may recommend the following psychotherapy approaches for treating phobia:

A. Cognitive behavioral therapy (CBT)

CBT 34 is widely recommended 35 for the treatment of different irrational fears. It is a therapeutic approach that aims to help the sufferer identify and replace negative and dysfunctional thoughts, beliefs and emotions with positive ones. This can enable them to manage their phobic reactions and express their emotions in a healthier way. According to a 2015 study 36 , “A large amount of research has accumulated on the efficacy and effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders,” like specific phobia.

Cognitive behavioral therapy for phobias may involve exposure and response prevention (ERP 37 ) therapy or systematic desensitization 38 where the patient is slowly exposed to the trigger of their fear in a controlled setting, such as using virtual reality (VR) technology. With repeated sessions, their fears eventually become weaker and less disabling. CBT also helps to reduce stress, anxiety and depression. Studies 39 have also found that a “developmentally informed, intensive, single session of cognitive-behavioral therapy (CBT) termed One-Session Treatment” can be especially effective in treating children and adolescents.

Read More About Cognitive behavioral therapy Here

B. Exposure therapy

According to research 40 , it is “a form of therapy based on exposing the patient continually to the stimuli that evoke symptoms until they can be tolerated and the phobic or compulsive behavior dissipates.” In this therapy 41 , the patient is gradually exposed to the source of the fear in increasing levels under the supervision of a trained mental health professional. It may require several sessions to desensitize the individual but exposure therapy tends to be highly effective. The therapy sessions also include relaxation exercises which teaches the patient to remain calm in stressful situations.

Apart from these, hypnotherapy 42 can also help in reducing symptoms of intense, irrational fears.

2. Medications

Although there are now specific medications for phobias, medications 43 can help to relieve symptoms and reduce functional impairments. A doctor may prescribe certain anti-anxiety medications & antidepressants for treating a phobia. As irrational fears are mainly anxiety disorders, anti-anxiety medications can help the sufferer to calm down & better manage their physical & emotional reactions to the triggers. The doctor may also occasionally prescribe benzodiazepines and beta-blockers to decrease anticipatory anxiety, if needed. However, research 44 shows that “exposure therapy is considered the first-line treatment,” the efficacy of medications of specific phobia “have rarely been studied or used clinically.” Moreover, as these medicines can have certain side effects and lead to dependence, it is crucial to always consult a doctor before taking any medications.

If comorbid conditions or co-occurring disorders are present, such as schizophrenia, PTSD or OCD, then the doctor may prescribe medications for treating those conditions as well.

3. Coping strategies

Educating the patient and their loved ones about their condition can be an efficient prevention tool. Moreover, talking to trusted loved ones about their thoughts and emotions, using visualization to face their fears, using positive affirmations and withholding from avoiding their fears can help in making substantial improvements. Moreover, certain relaxation techniques, such as mindfulness meditation 45 , deep breathing 46 , yoga, massages and progressive muscle relaxation 47 can also help in reducing symptoms associated with fear and anxiety.

Caring For Loved Ones With Phobia

If a family member or friend suffers from irrational fears and you need to care for them, then the following tips can prove to be beneficial:

  • Educate yourself about their condition and learn about the triggers, symptoms, causes and treatment
  • Be empathic and try to understand how their fear affects their thoughts, beliefs, emotions and behaviors.
  • Don’t try to minimize their fears. Be respectful and take their feelings seriously
  • Avoid forcing them to face their fears without any expert supervision as it can make the symptoms worse
  • Ask how exactly you can help them cope with their condition and encourage them to talk openly
  • Encourage your loved ones to seek medical help and accompany them during doctor’s appointments and therapy sessions
  • Practice self-care, do not avoid your own needs and set healthy boundaries

Takeaway

Living with a phobia, whether specific or complex, can be undoubtedly challenging. Such intense, unrealistic and lasting fears can disrupt our lives, careers and relationships. However, consulting with a doctor and seeking treatment can help us manage our fears, overcome the symptoms and improve our mental, emotional and physical well-being. So if you think you have a disabling fear that is affecting your life, then make sure to talk to a healthcare professional immediately.

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