What Are Phobias?

Overview

A phobia is an overwhelming and debilitating fear of an object, situation, animal, place, or feeling, which can involve both fear and avoidance.^1,2 A phobia is considered to be an anxiety disorder, although people with a phobia might not experience any symptoms until they are in contact with what they are afraid of. However, in some cases, just thinking about the source of the phobia can trigger anxiety symptoms. This is referred to as anticipatory anxiety.¹ Phobias are really common and it’s likely you or someone close to you have a phobia to something such as to spiders (arachnophobia), which is a common type of phobia. If you want to learn more about phobias, their types, causes and treatments, keep reading!

Types of phobias

Phobias can be classified into two main types: specific and complex phobias.

Specific or simple phobias 

This subcategory of phobias has not been widely studied in contrast with other anxiety disorders.² Specific phobias imply a fear of a particular object, situation, animal, or activity. These often develop during childhood or adolescence and usually become less severe over time. Examples of these phobias include animal (e.g. arachnophobia), environmental (e.g. to heights, also known as acrophobia), and situational (e.g. to flying) phobias.¹ Specific phobias are very common, with 3-15% of people having them. The most common are animal phobias, in particular arachnophobia.²

Complex phobias

These phobias usually develop during adulthood and are more disabling than specific phobias.¹ The most common complex phobias are agoraphobia (fear of open spaces) and social phobia, which are considered to be two independent anxiety disorders different from specific phobias.²

Agoraphobia is also referred to as a fear of open spaces, but is much more complex than that. This complex phobia makes people feel anxious when they are in a space in which it would be difficult to escape if they had a panic attack. In this way, people suffering from agoraphobia will try to avoid being alone and in crowded places.¹ Agoraphobia affects 1.7% of the population and most commonly affects people older than 35.³

Social phobia, also known as social anxiety disorder, is defined as an intense and persistent fear of social situations.⁴ People suffering from this phobia try to avoid everyday interactions to prevent themselves from being negatively judged by others. Social phobia can have a huge impact on people’s lives. In fact, according to a study, people suffering from social phobia have a higher risk of leaving school early, 10% lower wages on average compared to the general population, and fewer friends. 

Furthermore, they are less likely to get married and have children and more likely to get divorced. Social phobia is estimated to affect approximately 12% of the population - making it a pretty common disorder.⁵

Causes and risk factors 

Phobias can be triggered by different factors, and indeed, they do not seem to have a single cause.¹ The factors that can be associated with the development of a phobia include:

• Going through a particular incident or trauma. This can be directly involved with the source of the phobia. For example, a traumatic experience related to heights might trigger acrophobia
• Learning early in life to be afraid of something from a close relative. For example, if your mother suffers from arachnophobia, you will be more likely to develop arachnophobia than the average person
• Genetics can also play a role in the development of a phobia. Studies have shown that some people are born with a higher tendency to be anxious than others, being thus more likely to have an anxiety disorder such as a social phobia

Symptoms and diagnosis 

The main symptom of phobias is an unreasonable and intense fear, anxiety or panic that cannot be controlled when the person is exposed to or even just thinks or speaks about the source of the phobia. As such, symptoms of phobias include different anxiety symptoms such as:^1,2,6 

• Dizziness and fainting
• Nausea and feeling like throwing up
• Excessive sweating
• Increased heart rate
• Heartburn
• Shortness of breath and trouble breathing
• Shaking
• Tight chest

In order to make a diagnosis, patients must suffer from an unreasonable fear and clinically significant distress or impairment associated with the source of the phobia.² 

Furthermore, mental health professionals, whilst making a diagnosis, also aim to determine the risk factors of patients (e.g. traumas or a relative with a phobia) by taking medical, mental health, and social history into account. Moreover, they will ask patients questions in order to find out more about their symptoms, and will talk with them about the impact that the fear is having on their life.⁶

Impact on daily life

As mentioned throughout this article, phobias can have a huge impact on people’s lives - to the point that they might stay home for as long as possible to try to avoid interacting with people (as seen in patients with social phobia). As another example, a person with arachnophobia will try to avoid going to places where he/she can find a spider (e.g. the mountain or a country with poisonous spiders), and a person with coulrophobia (fear of clowns) will avoid going to the circus. 

Thus, phobias can hugely limit your daily activities and, consequently, may lead to depression.¹ Luckily, there are different treatment options and coping strategies available that can help to manage these phobias. 

Treatment options

In general, people with phobias tend to refuse to seek professional help despite the fact that there are many effective treatments. This might be one of the factors that contribute to the high persistence of phobias, which last for several decades in 10-30% of cases.² But why do people refuse to get professional help? 

Well, first of all, it is remarkable that many people are not aware of the high number of available treatments and perceive phobias as untreatable. This can explain the low number of people who seek professional help. To avoid this and enhance the percentage of people who receive treatment, it is key to increase awareness of phobias and their treatments.

The most recommended and the first-line treatment for specific phobias such as coulrophobia, which is the fear of clowns, is exposure therapy. Exposure therapy is a form of cognitive behavioural therapy (CBT), that aims to change the reaction of the patient to the feared stimulus.⁷ To do this, patients are exposed gradually and repeatedly to the source of the phobia in order to help them manage their anxiety.⁶ Exposure therapy has extensively been studied as a treatment for arachnophobia and ophidiophobia (fear of snakes). 

However, 25% of people suffering from phobias refuse this type of treatment as they do not want to face the feared stimulus. Even though this type of therapy is the first-line treatment, pharmacological treatments are also useful, especially to help patients control anxiety symptoms. The main drugs used for managing phobias are sedatives (e.g. benzodiazepines) and beta-blockers (e.g. propranolol), which block the effects of adrenaline (a hormone secreted by the organism to prepare it for danger or stress).⁶

Coping strategies 

Together with psychological and pharmacological treatments, lifestyle changes can be useful for coping with phobias.⁶ Mental health professionals and doctors can assist you with this and give you information about the different strategies that can be helpful in reducing anxiety symptoms caused by phobias. Some of the main strategies are:

• Physical exercise and a balanced diet: studies have proved that being physically active and having a balanced and healthy diet is really effective for managing stress and anxiety and can thus be helpful for coping with phobias⁸
• Relaxation techniques (e.g. deep breathing or yoga) and mindfulness strategies 

Summary

Phobias are anxiety disorders characterised by an unreasonable and excessive fear of a particular stimulus (e.g. an animal, a situation, or a place). They can be classified into two main groups: specific phobias, such as arachnophobia and coulrophobia, and complex phobias, which include agoraphobia and social phobia. The symptoms of phobias, such as shortness of breath and dizziness, are related to the anxiety triggered by the source of the phobia and can thus be managed by treating and coping with these symptoms of anxiety. 

Luckily, there are effective treatments for anxiety, which include both psychological and drug-based treatments. However, increasing awareness and knowledge of these is essential to increase the number of people who seek professional help.