What Is Coulrophobia?

  • Saba AmberMedicinal and Biological Chemistry- BSc, Manchester Metropolitan University
  • Olga GabrielMaster's degree, Forensic Science, Uppsala University, Sweden
  • Regina LopesSenior Nursing Assistant, Health and Social Care, The Open University


Coulrophobia may best be defined as an extreme or irrational fear of clowns. The term was first coined in the 1980s on the internet in the midst of the multiple ‘killer clown’ sightings following the arrest of John Wayne Gacy in 1978 and the publication of Stephen King’s novel ‘IT’ in 1986.

Criteria for diagnosis

According to the American Psychiatric Association (APA), a phobia is a “marked fear or anxiety about a specific object or situation” as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).1 In the current edition of the DSM, Coulrophobia is not classed as a diagnosis on its own, instead, it would be classed as a ‘specific phobia’ if the individual meets the following criteria:1

  • A fear response to the stimuli that is excessive or unreasonable
  • Exposure to the stimuli almost always leads to an immediate anxiety response (this may include panic attacks)
  • The stimuli is avoided or endured under extreme distress
  • Fear of the stimuli causes significant interference with the individual’s life (their social life, daily routine, school/work, or relationships)
  • The fear of the stimuli has lasted longer than six months
  • The anxiety symptoms are not caused by any other mental disorder

Without meeting all of the criteria, the individual cannot be diagnosed with a specific phobia.

Characteristics of coulrophobia

Specific triggers and stimuli

Generally, an individual suffering from coulrophobia can be expected to react with anxiety or fear upon seeing a clown or an image of a clown. This may lead the individual to avoid situations such as birthday parties where a clown is expected to attend, movies that are known to include clowns and places like the circus where the individual may expect to come across a clown.

Emotional and physical responses

Upon coming into contact with a clown or viewing an image of a clown, the individual may experience a number of symptoms that could include nausea, trembling, profuse sweating, paleness, fast breathing, an increase in heart rate, and an intense feeling of terror.2

Causes and origins of coulrophobia

Evolutionary explanations and the uncanny valley effect

There are a number of different explanations for why someone may develop coulrophobia. One possible explanation could be linked to the uncanny valley effect- the feeling of unease or repulsion in response to viewing a near human image.3 The exaggerated facial features of a clown such as their smiles, eyes, and noses create an eerie near-human appearance that the brain categorises as ‘near human but not quite’ creating a sense of unease or fear.

This sense of unease may be increased by the exaggerated smiles painted onto the faces of clowns which may not match the expression actually being expressed by the person under all the paint. This visual clash may confuse the brain, contributing to a feeling of unease.

Another evolutionary explanation to explain coulrophobia, could be that the unnatural appearance of clowns may evoke a disgust response as the brain recognises it as an infectious threat.3 The brightly painted white face may resemble the pallor of an ill person or that of a corpse and the red paint which is commonly seen on the nose and around the eyes and mouth may resemble that of a sick person. This may cause an aversion to clowns.

Childhood experiences and traumas

Furthermore, studies have shown children who have had a negative experience with a clown at some point in their childhood, are more likely to go on to develop coulrophobia.3 This may include a negative experience when meeting a clown at a party or a reaction to an expected ‘party trick’ that may have shocked or scared the child.

Children who have been visited by a clown during their stay in the hospital may also go on to develop coulrophobia as they may associate the clown with the negative experience. Clowns are also known for their unexpected behaviour that may go against societal norms. The threat of unfamiliar or unknown actions may contribute to the feeling of fear felt by individuals with coulrophobia.

Media portrayal and its influence

The media portrayal of clowns has had a significant impact on how clowns are viewed by the general public. From the first portrayal of a ‘killer clown’ in the opera Pagliacci in 1893 to the more recent portrayals in the 2018 Stephen King adaptation of IT Part 1, clowns have had a decidedly negative image. In the 1960s, clowns were more commonly associated with comedy and children’s entertainment with the invention of Ronald McDonald and the popularisation of birthday party clowns.4

But this change in image did not last for very long with the 1980s seeing a disturbing trend of ‘killer clown’ sightings across the United States by school children. The ‘killer clown’ trend followed periods of decline and rapid reemergence in the decades that followed but there is not much of an explanation as to why these sightings would suddenly increase before rapidly disappearing.

Nonetheless, these negative media portrayals have certainly not helped in cases of coulrophobia. In fact, following the release of the 2018 film, IT Part 1, there was an increased number of coulrophobia cases observed by mental health professionals.4

Impact on individuals

Daily life challenges and avoidance behaviours

Unlike many other phobias, in the case of coulrophobia, it is pretty easy for the individual to avoid triggers relating to clowns. For example, the individual may choose to stay away from places such as the circus or birthday parties when they know that clowns are expected to be present. They can also avoid media such as films that focus on clowns.

However, that may be easier said than done as clowns are fairly common in the media with many more negative portrayals (Pennywise - IT, the Joker – Batman, and many other horror movies that have a clown as the main antagonist) than positive portrayals (Krusty - The Simpsons). The avoidance behaviour on the individual’s part may lead to feelings of isolation as they may feel unable to share their anxieties due to fear of ridicule.

Coping strategies and treatment

Self-help techniques for managing fear

Coulrophobia, like many other phobias, can be managed with the use of various therapies and other professional interventions. Some suggested forms of self-help include relaxation techniques that focus on deep breathing to help with feelings of anxiety.5 It may also be helpful to view someone apply their clown makeup in preparation for a performance to help recognise the fact that it is a regular person underneath the unnatural makeup and bright clothing.4

Therapeutic interventions

There are also many therapeutic interventions that may prove beneficial to an individual with coulrophobia such as Exposure Therapy or Cognitive Behavioural Therapy (CBT). Exposure Therapy involves the gradual exposure of the feared stimulus to the individual to reduce the fear felt in response. This practice is best carried out by a professional, as they are trained to carry out such treatment without causing undue distress and anxiety.

CBT is another common treatment for phobias but instead of gradual exposure to the stimulus, it focuses more on the background leading to the development of the phobia and/or the thought process around the feared stimuli. This may be particularly effective for some people as being able to rationalise their fear may allow them to overcome it, however, not all forms of therapy are suited for everyone, and the best form of therapy in individual cases should be suggested by a professional.

Medications and their role

If other methods of treatment are found to be ineffective or the physical response to the phobia is very severe, then medications may be considered in an attempt to treat coulrophobia. While medications cannot directly target the fear of clowns, they may be used to treat the physical symptoms of anxiety. This includes a range of antidepressant and anti-anxiety medication.5

However, these medications can only aid in relieving the physical symptoms experienced in an anxiety disorder and further treatment (such as Exposure Therapy and Cognitive Behavioural Therapy) may be required to address the underlying issue of coulrophobia.

Overcoming coulrophobia

Importance of seeking professional help

It is important to note that help is available, especially if the phobia is having a severe impact on your quality of life and interfering with your daily routine. There are a number of treatment options. Speaking to your GP is a good place to start seeking treatment for coulrophobia.


Coulrophobia, the extreme or irrational fear of clowns, is just one of many phobias an individual could suffer from. There are many possible causes for coulrophobia ranging from the Uncanny Valley effect, childhood trauma and negative media portrayals. However, help is available, especially for phobias that have a significant impact on an individual’s quality of life.

These include self-help methods like breathing techniques, and therapeutic interventions (Exposure Therapy and CBT) and in particularly severe cases there is even the option of taking medication to help manage the physical anxiety symptoms caused by Coulrophobia.


  1. Specific phobias (Symptoms) | center for the treatment and study of anxiety | perelman school of medicine at the university of pennsylvania [Internet]. [cited 2023 Aug 24]. Available from: https://www.med.upenn.edu/ctsa/phobias_symptoms.html#diagnostic
  2. Coulrophobia (Fear of clowns): causes and treatment. Cleveland Clinic [Internet]. [cited 2023 Aug 23]. Available from: https://my.clevelandclinic.org/health/diseases/21835-coulrophobia-fear-of-clowns
  3. Tyson PJ, Davies SK, Scorey S, Greville WJ. Fear of clowns: An investigation into the aetiology of coulrophobia. Front Psychol. 2023;14:1109466.
  4. BBC Bitesize [Internet]. [cited 2023 Aug 24]. Why are we scared of clowns and how can coulrophobia be overcome? Available from: https://www.bbc.co.uk/bitesize/articles/zjsf6v45.      
  5. Verywell Mind [Internet]. [cited 2023 Aug 24]. Coping with coulrophobia or the fear of clowns. Available from: https://www.verywellmind.com/clown-phobia-2671682
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Saba Amber

Medicinal and Biological Chemistry- BSc, Manchester Metropolitan University

Saba is a recent graduate in Medicinal Biochemistry with a particular interest in pharmacology.

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