New places, high bridges, old elevators may make all of us a bit uneasy or even frightened. We might try to avoid things that make us uncomfortable, but most people generally manage to control their fears and carry out daily activities without incident.
But people with specific phobias, or strong irrational fear reactions, work hard to avoid common places, situations, or objects even though they know there’s no threat or danger. The fear may not make any sense, but they feel powerless to stop it.
People who experience these seemingly excessive and unreasonable fears in the presence of or in anticipation of a specific object, place, or situation have a specific phobia.
Having phobias can disrupt daily routines, limit work efficiency, reduce self-esteem, and place a strain on relationships because people will do whatever they can to avoid the uncomfortable and often-terrifying feelings of phobic anxiety.
While some phobias develop in childhood, most seem to arise unexpectedly, usually during adolescence or early adulthood. Their onset is usually sudden, and they may occur in situations that previously did not cause any discomfort or anxiety.
Specific phobias commonly focus on animals, insects, heights, thunder, driving, public transportation, flying, dental or medical procedures, and elevators.
Although people with phobias realize that their fear is irrational, even thinking about it can often cause extreme anxiety.
Doctors don’t know what causes social anxiety disorder. They think it may run in families. But they are not sure if it’s because of genetics or a response to a traumatic situation.
While there is no one specific known cause for phobias, it is thought that phobias run in families, are influenced by culture and how one is parented, and can be triggered by life events. Immediate family members of people with phobias are about three times more likely to also suffer from a phobia than those who do not have such a family history.
The causes of specific phobias are complex, probably involving a history of negative experiences in the feared situation, other psychological factors, as well as biological factors.
• Specific phobias can sometimes begin following a traumatic experience in the feared situation. For example, someone who is bitten by a dog might develop a fear of dogs, or someone who has a car accident might develop a fear of driving.
• There is evidence that people can learn to fear particular situations by watching others show signs of fear in the same situation. For example, growing up with parents who fear heights could lead to a fear of heights in some children.
• This involves learning to fear a particular object or situation by hearing or reading that the situation is dangerous. Examples include learning to fear flying by hearing about plane crashes in the news, or learning to fear driving by continually receiving warnings from others that driving is dangerous.
• Note that only some individuals with specific phobias report that their fears began through direct learning, observational learning, or informational learning. Many individuals report that their fear started without any obvious trigger or cause. Some individuals report having had their fear for as long as they can remember. Also, note that most people are exposed to negative experiences (e.g., car accidents, being bitten by dogs) and do not develop phobias. So, the interesting question is, “who develops a phobia following one of these experiences and who doesn’t?” This question is still being answered by researchers.
• Several factors may contribute to any one individual developing a specific phobia after having a negative experience that involves a particular object or situation. One factor is the individual’s previous experience in the situation. For example, an individual who has grown up with dogs may be less likely to develop a fear of dogs after being bitten, compared to an individual who is bitten the first time he or she encounters a dog. A second factor is subsequent exposure to the situation (after the negative experience occurs). For example, an individual who gets right back behind the wheel following a car accident may be less likely to develop a phobia of driving than someone who avoids driving for a period of time after the accident.
Symptoms of having a specific phobia often include uncomfortable and terrifying feelings of anxiety:
1. A feeling of imminent danger or doom
2. The need to escape
3. Heart palpitations
6. Shortness of breath or a smothering feeling
7. A feeling of choking
8. Chest pain or discomfort
9. Nausea or abdominal discomfort
10. Feeling faint, dizzy or lightheaded
11. A sense of things being unreal, depersonalization
12. A fear of losing control or “going crazy”
13. A fear of dying
14. Tingling sensation
15. Chills or heat flush
Symptoms of specific phobias may include:
1. Excessive or irrational fear of a specific object or situation.
2. Avoiding the object or situation or enduring it with great distress.
3. Physical symptoms of anxiety or a panic attack, such as a pounding heart, nausea or diarrhea, sweating, trembling or shaking, numbness or tingling, problems with breathing (shortness of breath), feeling dizzy or lightheaded, feeling like you are choking.
4. Anticipatory anxiety, which involves becoming nervous ahead of time about being in certain situations or coming into contact with the object of your phobia. (For example, a person with a fear of dogs may become anxious about going for a walk because he or she may see a dog along the way.)
Children with a specific phobia may express their anxiety by crying, clinging to a parent, or throwing a tantrum
Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.
The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
The avoidance, anxious anticipation or distress in the feared situation(s) interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
In individuals under the age of 18, the duration is at least 6 months.
The anxiety, panic attack, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder.
Specific phobias are the only anxiety disorder for which psychological treatments are almost always considered to be the best approach to treatment. There are no controlled studies showing that medications are an effective treatment for specific phobias.
Effective psychological and pharmacological therapies do exist although there is a large body of evidence which suggests psychological interventions are more effective than credible alternatives. Cognitive Behaviour Therapy is particularly effective in the treatment of phobias. Treatment usually consists of anything between 10 to 20 weekly sessions. Techniques might involve a gradual approach to the problem so that people can learn that their fears as well as the physical symptoms of anxiety die away the longer they are in the feared situation. Unhelpful or mistaken beliefs about the dangerousness of the problem can also be disconfirmed by carefully designed behavioural tests.
Treatment for specific phobias may include one or a combination of:
Cognitive behavioral therapy : Treatment for specific phobias involves a type of cognitive behavioral therapy, either desensitization or exposure, in which patients are gradually exposed to what frightens them until their fear begins to fade.
Medication : May be prescribed temporarily to help reduce severe anxiety.
Relaxation techniques, such as deep breathing, may also help reduce anxiety symptoms.