Specific Phobias

Nature

A specific phobia involves an intense, unreasonable, and persistent fear and avoidance of a specific object or situation to a degree that it interferes with one’s ability to function.  

The danger of the feared stimulus is over-estimated and one’s ability to cope with negative consequences is under-estimated. The anxiety and dread experienced is out of proportion to the danger which results in avoidance of the feared object or situation.  To be diagnosed with a specific phobia, the fear or avoidance needs to be distressing or impairing and constrain or limit a person’s life.

Specific phobias affect 19 million adults but often begin in childhood. Most cases start before age ten, however they can also develop well into the adolescent years. Fears can become increasingly severe and affect functioning as the child grows up. While young children generally become less afraid of things (such as strangers, the bath, etc.) as they mature, children with phobias typically become more afraid, and their fears do not decrease with reassurance or information. For example, a dog phobia persists despite the individual being told that a dog is kind, has no teeth to bite because it is old, and will not scratch. To be considered a phobia as opposed to a transient fear, the symptoms must be present for at least 6 months.

Females are twice as likely to experience a phobia than males. Phobias can be genetic and run in families and can also be influenced by environmental factors. Some teens develop a phobia after being exposed to a frightening event (such as a fear of water after nearly drowning, a fear of dogs after being bitten, claustrophobia developing after an unpleasant experience in a confined space). Some people develop phobias after witnessing the fearful response of family members to objects or situations when they are young. A child may also be exposed to something frightening or seemingly dangerous through reading, media exposure, the Internet, or hearing about it from someone they know. Although a combination of nature and nurture likely play a role in the emergence of a phobia, many people cannot explain how or why their phobia begun.

Specific phobias differ from social phobia or agoraphobia, as the former specifically refers to anxiety in social situations and the latter refers to fear and avoidance of places which may induce feelings of anxiety.

Experience

When a person with a phobia sees or is reminded of the feared object or situation, they experience intense distress and feel like they are in real danger.

Even if a person knows that their fear is irrational, they feel unable to control the feeling and the fear reaction.  To stop experiencing these feelings, the individual tries to avoid seeing or hearing about the feared object or situation, and has difficulty functioning when they are exposed to the trigger.

Common phobias include:

  • Animal Phobias- fear of snakes, dogs, rats, spiders, bees, etc.
  • Acrophobia- fear of heights such as high floors of buildings, top of mountains or high bridges. May result in dizziness.
  • Elevator Phobia- fear the cable will break and elevator will crash or that elevator will get stuck and you will be trapped inside.
  • Airplane phobia- fear the plane will crash, that cabin will depressurize resulting in suffocation, fear that plane will be hijacked or bombed.
  • Claustrophobia – fear of enclosed places such as elevators and tunnels.
  • Doctor/Dentist phobia- fear of painful procedures such as injections or teeth fillings.
  • Nomophobia – fear of being without one’s usual mode of technology such as a computer, phone, social media or gaming platforms.
  • Thunder/Lightning phobia- fear that usually begins in childhood but considered a phobia when the fear persists through adolescence.
  • Blood/injury Phobia- fear of being exposed to blood or pain through injections or injury despite being physically healthy. May result in fainting.
  • Illness Phobia- fear of contracting or succumbing to a specific illness. Sufferers may seek constant reassurance from others and avoid situations that reminds the individual of the feared disease. This is different from hypochondria in which the individual imagines may types of diseases rather than focusing on one.
  • Other types such as fear of natural disasters, death, situations that may lead to choking or vomiting, loud sounds like balloons popping or costumed characters like clowns.

There are other phobias, such as Agoraphobia and social phobia, which are distinct disorders and are not considered specific phobias. With a specific phobia (in contrast to agoraphobia and social phobia) panic is elicited by the feared object or situation (trigger) and does not involve spontaneous panic attacks, fear of panic attacks, or fear of embarrassment or humiliation in social situations.

Younger children may not realize their fear is excessive, but many teens recognize that their fear is irrational and disproportionate, feel embarrassed, and chose not to talk about it or seek help. Attention may be brought to the phobia due to the individual’s avoidant behaviors (e.g. constipation from fear and avoidance of public toilets or exhaustion due to fear of the dark) or if they engage in rituals and compulsions to deal with their fear.

Impact

The reactions and impacts of specific phobias can be broken down into three categories: behavioral, cognitive, and physical.

Each category comes with its own specific set of triggers and challenges.  

Behavioral Impact: Specific phobias can significantly limit a teenager’s activities.  The usual strategy for dealing with phobias is to avoid the feared object or situation, significantly altering the sufferer’s life. Phobias interfere with routines, work, family, school, and relationships. They can cause significant distress and can keep individuals from enjoying life.

Teenagers may avoid parks and outdoor spaces, refuse to attend medical appointments, or may miss field trips if the feared trigger will be present. Although avoidance helps reduce anxiety short-term, avoiding those situations perpetuates the cycle of fear as sufferers never discover how to successfully confront their fear.  

In addition to impinging on engagement in daily activities like school and recreation, specific phobias may also impact the individual’s family (for example someone refusing to go on a family vacation due to fear of flying). Family members often go to great lengths to accommodate the child’s phobias and help them avoid the distress. Teens may also seek frequent reassurance from parents or ask them to “check things” (such as making sure a room is free of bugs before going to bed) to alleviate anxiety.

Cognitive impact: This includes any fearful thoughts such as: “The snake is going to bite me!”, “I can’t handle it.” “It will be awful.” and “What if the plane goes down?”

Physical impact:

  • Increased heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Feeling of choking
  • Chest pain or discomfort
  • Upset stomach
  • Feeling dizzy or faint
  • Numbness
  • Chills or hot flashes
Prevalence of Specific Phobias

Specific phobias have a lifetime prevalence of 15% among adolescents, with the incidence highest at 16.7% between the ages of 13 and 14 years old. Between 18 and 29 years old, specific phobias have a lifetime prevalence of 13.2%. About 22% of annual cases are classified as severe. The average age of onset for specific phobias is 7 years old. Females have a 20% higher likelihood to be impacted than males.

Treatment

Most adolescents suffering from a specific phobia respond to treatment resulting in the relief of major symptoms.

Cognitive Behavioral Therapy (CBT) has shown evidence of being effective in the treatment of specific phobias.  CBT focuses on learning to challenge unhelpful thoughts and beliefs, and gradually making changes in behavior, which show that the feared consequences do not happen. Coping statements (such as “I’ve handled this before and I can handle it again”) are also utilized and rehearsed until they are internalized.  To break the cycle of anxiety when exposed to the phobia trigger, CBT focuses on changing what the individual thinks and does and gradually exposes the individual to the feared objects or situations. For some phobias, it is difficult to design real life exposure (for example fear of earthquakes). In these cases, exposures are done using imagery techniques and virtual reality technology.

Relaxation skills training (such as deep breathing and progressive muscle relaxation) can reduce symptoms by reducing muscle tension, slowing down breathing, and calming the nervous system when facing a specific fear or managing anticipatory anxiety. Parents also may be involved in treatment by modeling non-phobic behavior, managing avoidant behavior, and eliminating accommodations.

Resources

Anxiety BC;
https://www.anxietybc.com/parenting/my-anxiety-plan-specific-phobia

Anxiety and Depression Association of America (ADAA);
https://adaa.org/understanding-anxiety/specific-phobias

The Anxiety and Phobia Workbook
Edmund J.  Bourne, New Harbinger Publications. (2015)
Find it on Amazon

Beyond Blue;
https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/specific-phobias

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