Phobias

Topic Overview

What is a phobia?

Having a phobia means you are extremely afraid of a specific object, situation, or activity. Having a phobia about something is very different from everyday worry or stress. For example, most people feel worry and stress at some time, such as when speaking in front of a large group of people. People with phobias have so much fear that it is hard to do normal activities, such as going to work.

Having a phobia includes feeling stressed about being near the object, being in the situation, or doing the activity. It also includes being afraid of the object, situation, or activity itself. People with phobias avoid what they are afraid of so they won't feel worried and stressed.

There are five types of phobias:

• Natural environment phobias, such as being afraid of storms or lightning.
• Animal phobias, such as being afraid of spiders or dogs.
• Blood-injection-injury phobias, such as being afraid of blood or getting a shot (injection).
• Situational phobias, such as being afraid of elevators or bridges.
• Other phobias, such as being afraid of choking or throwing up. Other phobias in children include being afraid of loud noises or characters in costumes, such as clowns.

About 10% of people have had a phobia at some time.¹ Women are twice as likely as men to have a phobia. Many people who have phobias also have another problem such as an anxiety disorder, depression, or substance abuse.

What causes phobias?

The cause of phobias is unknown. If you have a family member with a phobia, you are more likely to have a phobia. Sometimes a person might have a phobia because he or she:

• Had something bad happen, such as being bitten by a dog.
• Had a panic attack in a specific situation, such as being in an elevator.
• Saw something bad happen to someone else, such as seeing a person fall off of a building.
• Saw someone else who was very scared of something, such as sitting in an airplane near a person who is afraid of flying.
• Learned about something bad happening, such as a plane crash.

Phobias usually start when a person is a child or a teenager. Children have more animal phobias, natural environment phobias, and blood-injection-injury phobias than teenagers or adults. Situational phobias usually start when a person is an adult. Women often have phobias at a younger age than men do. If a person has one phobia, he or she is likely to have another phobia as well.

What are the symptoms?

The main symptom of a phobia is being more afraid than most people of being around an object, being in a situation, or doing an activity. A person with a phobia might also be stressed about the possibility of being around the object, being in the situation, or doing the activity. Children show their stress by crying, throwing tantrums, freezing, or clinging to someone else.

Adults with phobias know that the amount of fear and worry they feel is more than the danger of being hurt by the object, situation, or activity. Children do not understand this about their phobias.

Many people with phobias are more afraid of being hurt by the object or situation than they are afraid of the object or situation itself. For example, a person might be afraid of travelling in an airplane because he or she is worried that the plane will crash. People with phobias might be worried about the following things happening when they are around the object or situation they are afraid of:

• Losing control
• Panicking
• Feeling physically stressed or afraid, including having a faster heartbeat or having a hard time breathing
• Fainting. Many people who have a blood-injection-injury phobia faint when they are around the object of their phobia. For example, a person might faint when he or she has to get a shot.

The amount of worry or fear a person has depends on how close they are to the object, situation, or activity they are afraid of. For example, a person is more afraid of a spider that is on the table in front of him or her than of a spider that is outside a window. The worry and fear a person has also depend on how easily the person can get away. For example, a person might feel more afraid when he or she is in an elevator when the doors are shut than when the doors are open.

How are phobias diagnosed?

To find out if you have a phobia, your doctor will ask questions about your symptoms, including how long you have had them. Your doctor will also do a physical examination, ask questions about your medical history, and ask questions about medicines you are taking. This information will help your doctor find out whether or not you have some other condition.

To be diagnosed with a phobia, you must have most of the following symptoms:

• You are more afraid than most people of a specific object, situation, or activity.
• You feel stressed or have a panic attack when you are near the object or situation.
• If you are a teenager or adult, you understand that the amount of fear you have about the object or situation is not reasonable.
• You avoid the object, situation, or activity that you are afraid of.
• The fear and stress that you feel make it hard for you to do normal activities such as going to work every day or doing grocery shopping.
• If you are under age 18, you have had symptoms for at least 6 months.
• Your symptoms don't fit another problem, such as panic disorder.

How are phobias treated?

Phobias are treated with cognitive-behavioural therapy. This therapy includes imagining or actually being close to the object, situation, or activity that you are afraid of. This is called exposure. Cognitive-behavioural therapy can be done with one person or in a group.

One type of exposure involves a series of steps to get closer to the object, situation, or activity. This is called systematic desensitization. For example, if you have a phobia of heights, you might first imagine yourself in a high place, such as a balcony on the 10th floor of a building. Then you would do an exercise to help you relax until your worry and fear about heights are less. Next, you would try going onto a balcony on a lower floor and do the exercise to help you relax. Finally, over time, you might be able to go onto the 10th floor balcony without being afraid.

Sometimes your doctor might prescribe medicine. Medicine may help with the symptoms of anxiety that you experience because of your phobia. Medicine for phobias is most useful if it is combined with cognitive-behavioural therapy.

The type or class of medicines called benzodiazepines (such as Xanax or Valium) is sometimes used to treat the stress and worry of specific phobias. Beta-blockers (such as atenolol or propranolol) are sometimes used to treat the physical symptoms of being stressed and worried about a phobia, such as having a faster heartbeat. Beta-blockers are used for blood-injection-injury phobias. They might also be used for performance anxiety, such as fear of speaking in front of a group of people.

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Author:	Carrie Henley Sabra L. Katz-Wise	Last Updated: August 15, 2006
Medical Review:	Patrice Burgess, MD - Family Medicine Tom Bailey, MD - Family Medicine Lisa S. Weinstock, MD - Psychiatry
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