September 23, 2011

Phobias are irrational and excessive fears of specific things or situations. Phobias are categorized as a type of anxiety disorder. In modern psychiatry, phobias may be described as specific or simple phobias centered around clearly defined objects or circumstances, or fears around more general circumstances such as agoraphobia (fear of sudden, severe panic attacks) or social phobia (fear of social or performance situations in which extreme embarrassment may occur). There are many subtypes of specific phobias including fears of animals or insects (e.g., fear of spiders or snakes), fears of circumstances in the natural environment (e.g., fear of heights), fear of blood or injury, and fear of a variety of life circumstances (e.g., fear of enclosed spaces).

It is important to distinguish phobias from natural concern regarding potentially dangerous objects or circumstances. For example, a person who is concerned about snakebite if he or she is for some reason required to remove a venomous snake from the snake’s hiding place would not generally receive a diagnosis of phobia. If, on the other hand, a person lived in an environment relatively devoid of snakes, was distressed by her fear of snakes, and had some degree of functional incapacitation because of her fear of snakes, then she might qualify for a diagnosis of a phobic disorder. Individuals with phobias have a marked and persistent fear that is cued by the presence of the phobic situation. Exposure to the phobic stimulus nearly invariably provokes an immediate anxiety response; sometimes individuals will experience a panic attack with rapid heartbeat, sweating, shortness of breath, and feeling dizzy. In cases of blood/body injury phobia vasovagal fainting can occur, indeed approximately 75% of individuals with blood/ body injury phobia report a history of fainting in situations of blood drawing, injection, or body injury. Traumatic experiences such as being bitten by an animal or being trapped in a closet may predispose to the development of phobias as may informational transmission (e.g., repeated media coverage of airplane crashes may be associated with the development of phobia regarding air travel in some vulnerable individuals).

The content of phobia as well as their frequency of occurrence varies among cultures and ethic groups. For example, fear of magic or ancestral spirits is not uncommon in some cultures, and a diagnosis of phobia is only warranted in situations where the fear is excessive for a given culture and causes significant disability or distress. Phobias are relatively common in the populations with a community sample 1-year prevalence rate of 9% and a 10% lifetime rate. Gender ratios differ among phobia, with women being more likely to experience some specific types of phobias. Approximately 75-90% of individuals with animaland natural environment-type phobias (e.g., fear of spiders) are women. An exception to this is fear of heights where women make up 55-70% of individuals with fear of heights. Approximately 55-70% of individuals with blood/body injury phobias are women as well. Phobias generally have their onset in childhood or young adulthood, in some cases persisting into adulthood. Treatment may involve a variety of behavioral or cognitive interventions. In one approach, exposure therapy, individuals are exposed to the feared object/situations to varying degrees of intensity and the focus of therapy is on lessening fear and anxiety related to the phobic object or situation. With some types of phobias, such as social phobia and agoraphobia (when individuals are fearful of leaving their homes), medications may be helpful as well. Medications known to be useful in social phobia include selective serotonin reuptake inhibitors (SSRI), antidepressant medications, and betablockers, which reduce biologic anxiety symptoms.

SEE ALSO: Anxiety disorders, Cognitive-behavioral therapy, Depression

Suggested Reading

  • Heimberg, R. G., & Juster, H. R. (1994). Treatment of social phobia in cognitive behavioral groups. Journal of Clinical Psychiatry, 55(Suppl.), 38.

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