What Is a Phobia?

A phobia is an excessive, persistent, and irrational fear of something, and is a type of anxiety disorder. It can be directed toward objects, places, activities, situations, animals, or people. We all try to avoid things that make us feel uncomfortable, but people with phobias work hard to avoid what scares them, so much so that it disrupts their daily activities. Symptoms can range from mildly inconvenient (like sweating) to disabling (like avoidance behaviors that make someone miss out on important opportunities).

What Is a Phobia?

A phobia is a type of anxiety disorder that magnifies perceived threats and trigger exaggerated stress responses.

The American Psychiatric Association identifies three major categories of phobias:

• Social phobia, now called social anxiety disorder, is where people unreasonably fear being humiliated, embarrassed, or judged by others in social situations. Unfamiliar people and groups can be particularly distressing
• Agoraphobia refers to an intense and debilitating fear of public places and situations where it is difficult to escape or embarrassing to exit. This may include enclosed and/or open spaces. Many people with agoraphobia also have panic symptoms or panic disorder, which involves intense fear plus uncomfortable physical symptoms, such as trembling, heart palpitations, and sweating
• Specific phobias, known as simple phobias, are the most common type of phobias. These phobias can be of animals (such as dogs and cats), people (such as clowns and healthcare providers), environments (such as dark or high places), and situations (such as flying or taking a train)

Symptoms

Symptoms often overlap across different types of phobias. Commonly experienced psychosocial and physical reactions related to phobias include: 

• Uncontrollable and severe feelings of panic and anxiety: Anxiety-associated physical effects, such as nausea, sweating, blushing, heart palpitations, and trembling. Other physical symptoms include increased heart rate, shortness of breath, a choking feeling, chest pain or discomfort, upset stomach, feeling dizzy or faint, a feeling of losing control or “going crazy” numbness, and chills or hot flashes
• Intentional avoidance: People with phobias may try to avoid the things that cause them intense fear and anxiety. Depending on the exact phobia, this can look like avoiding everything from meeting new people to going into elevators to avoiding flying on a plane or even leaving the house.
• Understanding the fear is irrational but unable to control the exposure response: When someone has a phobia, they are aware that their reaction is exaggerated but unable to remedy it without help. Untreated phobias are life-limiting in that they cause significant interference with daily activities and interpersonal relationships

Diagnosis

Diagnosis of phobias is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5) and requires the response to be disproportionate to any actual threat.

Necessary elements of a phobia diagnosis include:

• Exposure to the phobia almost always triggers an exaggerated stress response
• The fear, anxiety, or aversion is persistent, typically lasting six or more months
• It results in avoidance or enduring with extreme distress
• Everyday functioning is impaired, impacting relationships and opportunities
• The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder)

A mental health professional may ask about current symptoms and family history, particularly whether other family members have had phobias. You may also be asked about any experience or trauma that may have set off the phobia, such as a dog attack leading to a fear of dogs.

Childhood phobias typically present between ages 5 and 9, and go way beyond the typical fears of childhood and can be life-disrupting. They are often short-lived, however, and disappear within a few months. While children with phobias can fear the same things as children without phobias, the key difference is that for a phobic child, there is no on-off switch for the fear. It’s ever-present and so extreme that it interferes with their ability to relax, concentrate, and enjoy activities.

In adults, about 80% of new phobias become chronic conditions that do not go away without proper treatment.

Types

Social Anxiety Disorder

Social anxiety disorder is more than shyness or introversion. It is characterized by extreme fear and distress in social situations.

Men and women are affected equally with this disorder. This condition affects about 7% of Americans. People with social phobia can experience extreme difficulty in social activities, from dating and meeting new people to answering questions in school and interviewing for jobs. People with social phobia can lost out on opportunities as a result of aversion and avoidance. 

People with social phobia are at high risk for alcohol or other drug use because they may come to rely on these substances to relax in social situations.

Agoraphobia

The fear and aversion in agoraphobia comes from feeling unable to easily escape or get help. Diagnosis requires a marked fear or anxiety about two (or more) of the following five situations: Using public transportation, being in open spaces, being in enclosed spaces (e.g., shops, theaters, cinemas), standing in line or being in a crowd, and being outside the home alone.

Agoraphobia sometimes occurs when a person has had a panic attack and begins to fear situations that might lead to another panic attack.

Specific Phobias 

Having a specific phobia means responding unfavorably to a specific trigger that is generally not threatening to or distressing for others. It could be an environmental trigger like a lightning or rain storm, an animal trigger like snakes or spiders, or a situational trigger such as entering an airport or flying in a plane. Other common specific phobias include extreme fears of and aversions to heights, needles, and seeing blood. 

Prevention

There is no way to prevent a phobia, but early treatment of panic disorders may help prevent agoraphobia.

Treatment 

Phobias in general are highly treatable because people are typically aware of their trigger. Psychotherapy, medication, or a combination of both can be used, but the exact treatment plan depends upon the type of phobia.

Psychotherapy

Healthcare providers will usually recommend talk therapy first, which includes:

• Cognitive behavioral therapy: It is used to change specific thoughts that cause fear
• Exposure-based treatment: It involves tackling parts of the phobia, working from the least fearful to the most fearful. You may also be gradually exposed to your real-life fear to help you overcome it
• Phobia clinics and group therapy: They help people deal with common phobias such as a fear of flying
• Social skills training: This may be recommended for people with social phobia, and involves social contact in a group therapy situation to practice social skills. Role playing and modeling are techniques used to help you become more comfortable relating to others in a social situation
• Support groups: Sharing with others who have common experiences and problems can help alleviate the stress and anxiety that come with phobias. Support groups are usually not a good substitute for talk therapy or taking medicine, but can be a helpful addition. The Anxiety and Depression of America has a list of support groups for people with phobias on its website

Medication

Typically medications work best when combined with psychotherapy. Some drugs used to treat phobias include:

• Beta-blockers like propranolol (Inderal) can be prescribed to dull the physical effects of anxiety before exposure to a trigger like public speaking. This is particularly useful in cases of social phobia
• SSRI antidepressants, and other types of antidepressants, such as mirtazapine (Remeron), venlafaxine (Effexor), clomipramine (Anafranil), and imipramine (Tofranil) can be used in the treatment of agoraphobia
• Benzodiazepine and anti-anxiety medications, such as clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) may also be administered to treat social anxiety (phobia) or agoraphobia. Do not drink alcohol while on these medications 

A Word From Verywell

Phobias become less powerful and more manageable with adequate treatment. Even if you have a phobia, through the right interventions, you can prevent it from taking over your life. The most distressing step is probably reaching out and seeking help, but remember that proper treatment with a professional can drastically improve outcomes.