Understanding Phobias

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More than 10% of Americans have a specific phobia. These phobias usually start in childhood, adolescence, or early adulthood. Although many childhood phobias disappear before adulthood, only a small percentage of phobias in adults go away without treatment.

Marion is so afraid of bugs that her social life has suffered drastically. Whenever friends invite her to go to on a picnic or even to a pool party, she finds a reason to say no. Recently, she stopped joining her co-workers for lunch in the cafeteria because one day there was a fly buzzing around their table. She's had this fear since she got a bee sting in fourth grade.

Brad can't remember when or why he became so afraid of riding in elevators. But last month he turned down an excellent job promotion because it would have required moving his office up to the tenth floor. Both Marion and Brad are too embarrassed to tell anyone about their fears. Unfortunately, they don't know they have a treatable disorder—specific phobia.

What Are Phobias?


  • is more intense and persistent
  • is irrational
  • usually leads to avoidance of the objects or situations that cause the fear
  • interferes with everyday routines, work, or relationships, and/or causes significant distress

Adults with phobias usually realize their fear is irrational; children, however, may not, which makes it even more difficult to control.

Let's say, for example, that you are horribly afraid of rats. For most of us, that's a normal fear. They're ugly and can carry disease. Who wouldn't be afraid of them? But if your fear of simply seeing a rat evolves into dreams about rats, or if you stop walking downtown because you might see one, or stay home every day to rat-proof your home for no apparent reason, your fear has evolved into a phobia.

Phobias are the most common type of anxiety disorder. The three main types of phobias are:

  • Specific phobia: fear of a specific object, such as insects or blood, or of a specific situation, such as flying in an airplane or riding in an elevator
  • Social phobia: fear of being judged by other people and acting in a way that could cause embarrassment or humiliation
  • Agoraphobia: fear of being "caught" or seen in a public place, especially when having a panic attack

This article focuses on specific phobias.

What Are Some Common Specific Phobias?

Phobias of certain types of animals, such as snakes, insects, and dogs, are especially common. They often begin in childhood and are frequently considered normal fears. If they continue into adulthood and cause significant distress, they are considered specific phobias.

There are several other common types of specific phobias. For example, the natural environment type includes a fear of environmental phenomena such as storms or heights. The blood-injection-injury type of phobia is the fear of seeing blood or an injury or having an injection or other invasive medical procedure. The situational type occurs in a specific type of situation such as flying or being in a tunnel, elevator, or other enclosed space. Phobias may also occur in situations that could lead to choking, vomiting, or acquiring a specific illness.

Specific phobia used to be called "simple phobia" or "single phobia" because it involves an intense fear and avoidance of a single specific object or situation. Direct exposure to the object or situation—and sometimes just imagining it—causes fear that is out of proportion to the actual level of danger. The intensity of the fear may vary from one exposure to another. And people can have more than one specific phobia.

Phobic fear usually involves physical symptoms that can range from a few mild panic-like symptoms to a full-blown panic attack. Common panic symptoms include heart palpitations, sweating, trembling, feelings of dizziness or choking, nausea, and fear of losing control or going crazy. Because these symptoms are so unpleasant, people with phobias do everything possible to avoid the trigger. If avoidance is fairly easy—like a fear of having blood drawn—the phobia may not cause much disruption in everyday life, and may not require any treatment. But when the object or situation is encountered often, maintaining a normal life may become difficult, if not impossible.

What Causes Specific Phobias?

Most researchers believe specific phobias are caused by a combination of biological factors and life events. Heredity and chemical disturbances in the brain may play a role. So too may traumatic events, such as a previous animal bite, accident, or childhood illness. Some phobias are learned over time, as in a child modeling a parent's phobia. But often, phobias occur without a specific trigger. Avoidance of the feared object or situation keeps the phobia securely in place.

Are They Treatable?

Behavior therapy is the most effective treatment for people whose phobias have become disruptive to a normal lifestyle. It involves changing and gaining control over unwanted behavior. The type of behavior therapy used with specific phobias is called desensitization, or exposure therapy. First you are slowly exposed to the feared object or situation. In some cases, exposure begins with your imagining coming into contact with whatever the trigger is. As your fear gradually diminishes, you slowly learn that avoidance is not necessary.

Cognitive-behavioral therapy (CBT) is a technique that combines an effort at changing the way people think about the objects of their phobia with specific ways to change the way people behave when confronted with the object of their phobia. Relaxation techniques may also be used with behavior therapy to help you face the fear that occurs with exposure. Although most people with specific phobias seem to benefit from professional help, some people with minor phobias can treat them on their own using self-help books.

Medication is generally used for specific phobias only if there is a very high level of anxiety at the beginning of exposure therapy and you need additional help to get started. The medication is usually an antidepressant or tranquilizer. As you gain confidence in dealing with the previously-avoided situation, the medication is slowly phased out.

Getting Help

Like Marion and Jack, many people with phobias do not get help. Perhaps they don't realize they have a treatable condition or they may be too embarrassed to seek help. Jane Connors, an attorney from Boston, had a phobia about being attacked on a subway. "How ridiculous is that? I'm a successful professional woman who's terrified to ride the streetcar. But I'm even more afraid of having someone find out."

Psychologist George Thorn, PhD, clinical program director at the Center for Anxiety and Related Disorders at Boston University says, "Specific phobia is a highly treatable disorder. The success rates with behavioral and cognitive therapy are very good, even with short-term treatment."

If you suspect you have a specific phobia, seek out diagnosis and treatment from a mental health professional. Support groups for people with phobias may also be available near you. If you know someone who may have a phobia and is not diagnosed or receiving treatment, encourage him or her to get professional help.


Anxiety Disorders Association of America

National Institute of Mental Health

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