A phobia is an overwhelming and unreasonable fear of an object or situation that poses little real danger but provokes anxiety and avoidance. Unlike the brief anxiety most people feel when they give a speech or take a test, a phobia is long lasting, causes intense physical and psychological reactions, and can affect your ability to function normally at work or in social settings.

Several types of phobias exist. Some people fear large, open spaces. Others are unable to tolerate certain social situations. And still others have a specific phobia, such as a fear of snakes, elevators or flying.

Not all phobias need treatment. But if a phobia affects your daily life, several therapies are available that can help you overcome your fears — often permanently.

Phobias are divided into three main categories:

  • Specific phobias. A specific phobia involves an irrational, persistent fear of a specific object or situation that's out of proportion to the actual risk. This includes a fear of situations (such as airplanes or enclosed spaces); nature (such as thunderstorms or heights); animals or insects (such as dogs or spiders); blood, injection or injury (such as knives or medical procedures); or other phobias (such as loud noises or clowns). There are many other types of specific phobias. It's not unusual to experience phobias about more than one object or situation.
  • Social phobia. More than just shyness, social phobia involves a combination of excessive self-consciousness and a fear of public scrutiny or humiliation in common social situations. In social situations, the person fears being rejected or negatively evaluated or fears offending others.
  • Fear of open spaces (agoraphobia). This is a fear of an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line or being in a crowd, or being outside the home alone. The anxiety is caused by fearing no easy means of escape or help if intense anxiety develops. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to fear another attack and avoid the place where it occurred. For some people, agoraphobia may be so severe that they're unable to leave home.

No matter what type of phobia you have, it's likely to produce the following reactions:

  • A feeling of uncontrollable panic, terror or dread when you're exposed to the source of your fear
  • The feeling that you must do everything possible to avoid what you fear
  • The inability to function normally because of your anxiety
  • Physical as well as psychological reactions, including sweating, rapid heartbeat, difficulty breathing, a feeling of panic and intense anxiety
  • Often, the knowledge that your fears are unreasonable or exaggerated but feeling powerless to control them
  • In some cases, anxiety just thinking about what you fear
  • In children, possibly tantrums, clinging or crying

When to see a doctor

An unreasonable fear can be an annoyance — having to take the stairs instead of an elevator, for instance — but it isn't considered a phobia unless it seriously disrupts your life. If anxiety affects your ability to function at work or socially, consider seeking medical or psychological treatment. Most people can be helped with the right therapy.

Much is still unknown about the actual cause of phobias. However, there does appear to be a link between your own phobias and the phobias of your parents. This could be due to genetics or learned behavior.

These factors may increase your risk of phobias:

  • Your age. Social phobia typically develops early in life, usually by age 13. Specific phobias first appear in childhood, usually by age 10. Agoraphobia occurs most frequently in the late teens and early adulthood, usually before the age of 35.
  • Your relatives. If someone in your family has a specific phobia, such as a fear of spiders or snakes, you're more likely to develop it, too. This could be an inherited tendency, or children may learn phobias by observing a family member's phobic reaction to an object or a situation.
  • Your temperament. Your risk may increase if you're more sensitive, more inhibited or more negative than the norm.
  • A traumatic event. Experiencing a traumatic event, such as being trapped in an elevator or attacked by an animal, may trigger the development of a phobia.

Although phobias may seem silly to others, they can be devastating to the people who have them, causing problems that affect many aspects of life.

  • Social isolation. Avoiding places and things you fear can cause academic, professional and relationship problems. Children with these disorders are at risk of academic problems and loneliness, and they may not develop good social skills.
  • Depression. Many people with phobias have depression as well as other anxiety disorders.
  • Substance abuse. The stress of living with a severe phobia may lead to substance abuse.
  • Suicide. Some individuals with specific phobias may be at risk of suicide.

If you've made the choice to seek help for a phobia, you've taken a huge first step. Start by talking to your primary care doctor. Depending on your situation, you may be referred to a mental health provider for evaluation and treatment.

What you can do

These suggestions can help you get the most from your appointment.

  • Make a list of the symptoms you're experiencing, even if they seem unrelated to your anxiety. Phobias generally cause both physical and psychological distress. Note what triggers your anxiety, how you've tried to deal with it, and factors that make it better or worse.
  • List key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins, herbal products or other supplements that you're taking, as well as the dosages.

Prepare questions to ask your doctor ahead of time, such as:

  • What might have caused me to develop this fear?
  • Is this something that will go away on its own? Or is there anything I can do on my own to improve my symptoms? For instance, if I'm afraid to fly, should I force myself to fly anyway?
  • What treatments do you recommend for this disorder?
  • What are the side effects of medications commonly used for this condition?
  • If I decide to take medications, how long will it take for my symptoms to improve?
  • If the first medication I try isn't effective, what will you recommend next?
  • Would talk therapy help me?
  • How much improvement can I expect if I follow your recommended treatment plan?
  • I have other health conditions. How can I best manage them together?

Don't hesitate to ask questions at any time during your appointment.

What to expect from your doctor

Be ready to answer your doctor's questions so you have time to focus on points you want to talk about in-depth. Your doctor may ask these questions:

  • Have you recently had a spell or an attack when all of a sudden you felt frightened, anxious or very uneasy?
  • Would you say that you have recently been feeling nervous, anxious or on edge?
  • During these attacks of fear and anxiety, have you ever felt like you couldn't breathe or like you were having a heart attack?
  • What other symptoms do you have?
  • When did you first notice these symptoms?
  • When are your symptoms most likely to occur?
  • Does anything seem to make your symptoms better or worse?
  • Do you avoid any situations or places because you fear they'll trigger your symptoms?
  • How are your symptoms affecting your life and the people closest to you?
  • What else concerns you that we haven't yet talked about?
  • Have you been diagnosed with any medical conditions?
  • Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most beneficial?
  • Have you ever thought about harming yourself?
  • Do you drink alcohol or use illegal drugs? How often?

There are no lab tests for phobias. Instead, the diagnosis is based on a thorough clinical interview and diagnostic guidelines. Your doctor will ask questions about your symptoms and take a medical, psychiatric and social history.

To be diagnosed with a phobia, you must meet certain criteria in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. This manual is used by mental health providers to diagnose conditions and by insurance companies to reimburse for treatment.

Specific phobias

Diagnostic criteria for specific phobias include:

  • An intense fear or anxiety triggered by an object or situation, such as snakes, flying or storms
  • An immediate anxiety response when you confront the source of your fear
  • Fear or anxiety that is irrational or out of proportion to the risk posed by the object or situation
  • Avoidance of the object or situation you fear, or endurance of it with extreme distress
  • Significant distress or problems with social activities, work or other areas of your life due to the fear, anxiety and avoidance
  • Persistent phobia and avoidance, usually lasting six months or longer

Social phobia (social anxiety disorder)

Diagnostic criteria for social phobia include:

  • An intense fear or anxiety in one or more social situations where there is the possibility of scrutiny by others
  • Fear that you'll embarrass or humiliate yourself or be viewed negatively by others with the possibility of rejection or offending others
  • Intense anxiety, which may take the form of a panic attack, that almost always results from exposure to social situations
  • Avoidance of social or performance situations you fear, or endurance of them with extreme distress
  • Fear and anxiety that are out of proportion to any real risk of being viewed negatively in the situation
  • Problems or distress caused by the phobia that severely affect your life, including your job, social activities and relationships
  • Persistent phobia and avoidance, usually lasting six months or longer

Agoraphobia

Diagnostic criteria for agoraphobia include a severe fear or anxiety about two or more of the following situations:

  • Using public transportation, such as a bus, plane or car
  • Being in an open space, such as a parking lot, bridge or large mall
  • Being in an enclosed space, such as a movie theater, meeting room or small store
  • Waiting in a line or being in a crowd
  • Being out of the home alone

These situations cause anxiety because you fear you won't be able to escape or find help if you develop panic-like symptoms or other incapacitating or embarrassing symptoms.

In addition, diagnostic criteria for agoraphobia include:

  • Fear or anxiety that almost always results from exposure to the situation
  • Avoidance of the situations, required assistance of a companion or endurance of situations with extreme distress
  • Fear or anxiety that is out of proportion to the actual danger posed by the situations
  • Significant distress or problems with social situations, work or other areas in your life caused by the fear, anxiety or avoidance
  • Persistent phobia and avoidance, usually lasting six months or longer

Your doctor or a mental health provider may suggest medications or behavior therapy or both to treat phobias. Most adults don't get better on their own and may require some type of treatment. The goal of phobia treatment is to reduce your anxiety and fear and to help you better manage your reactions to the object or situation that causes them.

Medications

Medications can help control the anxiety and panic from thinking about or being exposed to the object or situation you fear.

  • Beta blockers. These medications work by blocking the stimulating effects of adrenaline on your body, such as increased heart rate, elevated blood pressure, pounding heart, and shaking voice and limbs that are caused by anxiety. Short-term use of beta blockers can be effective in decreasing symptoms when taken before an anticipated event, for example, before a performance for people who have severe stage fright.
  • Antidepressants. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are commonly used in the treatment of phobias. These medications act on the chemical serotonin, a neurotransmitter in your brain that's believed to influence mood. As an alternative, your doctor may prescribe another type of antidepressant, depending on your situation.
  • Sedatives. Medications called benzodiazepines help you relax by reducing the amount of anxiety you feel. Sedatives need to be used with caution because they can be addictive and should be avoided if you have a history of alcohol or drug dependence.

Psychotherapy

Talking with a trained mental health professional can help you deal with your phobias.Several types of psychotherapy, also called talk therapy, may be effective.

  • Desensitization or exposure therapy focuses on changing your response to the object or situation that you fear and may be helpful for phobias. Gradual, repeated exposure to the cause of your phobia may help you learn to conquer your anxiety. For example, if you're afraid of elevators, your therapy may progress from simply thinking about getting into an elevator, to looking at pictures of elevators, to going near an elevator, to stepping into an elevator. Next, you may take a one-floor ride, then ride several floors and then ride in a crowded elevator.
  • Cognitive behavioral therapy involves exposure combined with other techniques to learn ways to view and cope with the feared object or situation differently.You learn alternative beliefs about your fears and the impact they have on your life. There's special emphasis on learning to develop a sense of mastery and control of your thoughts and feelings.

Treatment choices

Treatment depends on the type of phobia you have:

  • Specific phobias usually are treated with exposure therapy.
  • Social phobias may be treated with exposure therapy or with antidepressants or beta blockers.
  • Agoraphobia, especially when it's accompanied by a panic disorder, is usually treated with exposure therapy or with SSRIs.

Professional treatment can help you overcome your phobia or manage it effectively so you don't become a prisoner to your fears. You can also take some steps on your own to cope and care for yourself:

  • Try not to avoid feared situations.Family, friends and your therapist can help you work on this.
  • Reach out. Consider joining a self-help or support group where you can connect with others who understand what you're going through.
  • Take medication as directed. Don't stop a medication without first talking with your health care professional, as some medications can cause withdrawal-like symptoms.
  • Take care of yourself. Get enough rest, eat healthy and try to be physically active every day.

Helping your child cope with fears

Childhood fears, such as fear of the dark, of monsters or of being left alone, are common, and most children outgrow them. But if your child has a persistent, excessive fear that's limiting his or her ability to function in daily life, talk to your doctor.

To help your child cope with fears:

  • Talk openly about fears. Don't trivialize the problem or belittle your child for being afraid. Instead, let your child know that you're there to listen and to help.
  • Don't reinforce phobias. Instead, take advantage of opportunities to help children overcome their fears. If your child is afraid of the neighbor's friendly dog, for example, don't go out of your way to avoid the animal. Instead, help your child cope when confronted with the dog. For example, you might offer to be your child's home base, waiting and offering support while your child steps a little closer to the dog and then returns to you for safety. Over time, encourage your child to keep closing the distance.
  • Model positive behavior. Because children learn by watching, you can demonstrate how to respond when confronted by something your child fears. You can first demonstrate fear and then show how to overcome the fear.

If you have unreasonable fears, consider getting psychological help, especially if you have children. Although genetics likely play a role in the development of phobias, repeatedly seeing someone else's phobic reaction can trigger a phobia in children. By dealing with your own fears, you might not pass them on to your children.

Feb. 08, 2014