Specific phobias

Overview

Specific phobias are an extreme fear of objects or situations that pose little or no danger but make you highly anxious. So you try to stay away from these things. Unlike the brief anxiety you may feel when giving a speech or taking a test, specific phobias are long-lasting. Without treatment, specific phobias tend to last a lifetime.

Phobias can cause strong physical, mental and emotional responses. They also can affect how you act at work or school, or in social situations.

Specific phobias are common anxiety disorders. Overall, they happen more often in females. Not all phobias need to be treated. But if a specific phobia affects your daily life, several types of therapies are available to help you work through and conquer your fears — often forever.

Symptoms

A specific phobia involves a strong, lasting fear of a certain object or situation that's much greater than the actual risk. There are many types of phobias. It's common to have a specific phobia about more than one object or situation. Specific phobias also can happen along with other types of anxiety disorders.

Common types of specific phobias are fears of:

• Situations, such as airplanes, driving, enclosed spaces or going to school.
• Nature, such as thunderstorms, heights or the dark.
• Animals or insects, such as dogs, snakes or spiders.
• Blood, shots or injuries, such as needles, accidents or medical procedures.
• Others, such as choking, throwing up, loud noises or clowns.

Each specific phobia has a name. Phobia comes from the Greek word "phobos," which means fear. Examples of more common names include acrophobia for the fear of heights and claustrophobia for the fear of confined spaces.

No matter what specific phobia you have, you may:

• Feel intense fear, anxiety and panic right away when exposed to or even thinking about what causes your fear.
• Know that your fears are not reasonable or not as big as you think they are, but you cannot control them.
• Have anxiety that gets worse as the situation or object gets closer to you physically or in time.
• Do everything possible to stay away from an object or situation or face it with extreme anxiety or fear.
• Have trouble with daily activities because of your fear.
• Have physical reactions and feelings, including sweating, rapid heartbeat, tight chest or trouble breathing.
• Feel like throwing up, or you get dizzy or faint, especially around blood or injuries.

Children may have tantrums, or they may cling, cry or refuse to leave a parent's side or approach their fear.

When to see a doctor

An extreme fear can make life hard — for example, taking long flights of stairs instead of an elevator. But it is not a specific phobia unless it seriously disrupts your life. If anxiety negatively affects the way you act at work or school, or in social situations, talk with your doctor or another health care professional, or a mental health professional.

Childhood fears, such as fear of the dark, monsters or of being left alone, are common. Most children outgrow them. But if your child has an ongoing, strong fear that interferes with how they act at school or work daily, talk to your child's doctor.

The right therapy can help most people. And the sooner you ask for help, the more likely that therapy will be effective.

Causes

Much is still not known about what causes specific phobias. Causes may include:

• Bad experiences. Many phobias start because of a bad experience or panic attack related to a specific object or situation. Sometimes even seeing or hearing about a bad experience can be enough to trigger a phobia.
• Genetics or learned behavior. There may be a link between your specific phobia and the phobia or anxiety of your parents. This could be due to a blend of genetics and learned behaviors.
• Brain function and structure. Those with specific phobias trigger certain parts of the brain, while a person without these phobias does not have the same response in the brain. Also, a person with a specific phobia can have a different brain structure than a person without that specific phobia.

Risk factors

These factors may increase your risk of specific phobias:

• Age. Specific phobias can first appear when you're a child, typically by age 10. But they can occur later in life too.
• Your relatives. If a family member has a specific phobia or anxiety, you're more likely to develop it too. This could be something passed down to you from a blood relative. Or children may learn specific phobias by watching how a family member reacts to an object or a situation.
• Your temperament. Your risk may increase if you're more sensitive to anxiety or you're more reserved or negative than what's typical.
• A bad experience. A specific phobia can start when something distressing happens to you, such as being trapped in an elevator or attacked by an animal.
• Learning about bad experiences. Hearing about bad experiences, such as a plane crash, can cause a specific phobia to start.
• Changing your behavior. Avoidance is the most common way people cope with phobias. By doing so, their anxiety typically gets worse.

Complications

Although specific phobias may seem silly to others, they can be distressing and damaging to the people who have them. These phobias can cause problems that affect many areas of life.

They can result in:

• Social isolation. Staying away from places and things that are feared can cause problems at work or school, or in connections with others. Children with these disorders are at risk of problems at school and loneliness. They also may have trouble in social situations if their behaviors are very different from their peers.
• Mood disorders. Many people with specific phobias have depression and other anxiety disorders.
• Substance misuse. The stress of living with a severe specific phobia may lead to misuse of drugs or alcohol.
• Suicide. Some people with specific phobias may be at risk of suicide.
• Strain on loved ones. To try to keep from feeling anxious, people often rely too much on being reassured by others. Sometimes this leads to others becoming too protective over the person with anxiety. For example, a parent may become too protective of a child, resulting in more stress for the parent.

Diagnosis

You may start by seeing your primary care provider. You also may need to see a mental health professional, such as a psychiatrist or psychologist. They can diagnose and treat specific phobias.

To diagnose a specific phobia, your health care professional or mental health care professional may:

• Talk with you to see what risk factors you might have.
• Ask questions about your symptoms, and take a medical, mental health and social history.
• Talk about what you're avoiding because of your fear.

Treatment

The best treatment for specific phobias is a form of therapy called exposure therapy. Sometimes your health care professional also may recommend other therapies or medicine. Knowing the cause of a phobia is less important than focusing on how to treat the avoidance behavior that has developed over time.

The goal of treatment is to improve your quality of life so that you're no longer limited by your phobias. As you learn how to better manage your responses, thoughts and feelings, your anxiety and fear will get lower and no longer control your life. Typically, one specific phobia is treated at a time.

Talk therapy

Talking with a mental health professional can help you manage your specific phobia. The most effective treatments are:

• Exposure therapy. This therapy focuses on changing your response to the object or situation that you fear. Gradual, repeated exposure to the source of your specific phobia, and the related thoughts, feelings and sensations, may help you learn to manage 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 (CBT). CBT involves gradual exposure combined with other ways to learn how to view and cope with the feared object or situation differently. You learn how to challenge your worries and put up with uncomfortable feelings. CBT helps you learn how to create a sense of mastery and confidence with your thoughts and feelings rather than feeling overcome by them.

Medicines

Generally, exposure therapy successfully treats specific phobias. But sometimes medicines can reduce the anxiety and panic symptoms you feel from thinking about or being exposed to the object or situation you fear.

Medicines may be used during treatment at first or for short-term use in specific, occasionally encountered situations, such as flying on an airplane, public speaking or going through an MRI procedure.

These medicines include:

• Beta blockers. These drugs block the stimulating effects of adrenaline, such as increased heart rate, high blood pressure, pounding heart, and shaking voice and limbs that anxiety causes.
• Sedatives. Medicines called benzodiazepines help you relax by lowering your anxiety. Sedatives are used with caution because they can be addictive. They should not be used if you have a history of alcohol or drug dependence.

Lifestyle and home remedies

Ask your doctor or other health care professional to suggest lifestyle and other strategies to help you manage the anxiety caused by specific phobias. For example:

• Mindfulness strategies may help you learn how to manage anxiety and reduce avoidance behaviors.
• Relaxation techniques, such as deep breathing, progressive muscle relaxation or yoga, may help you cope with physical symptoms of anxiety and stress.
• Physical activity and exercise may help manage anxiety related to specific phobias.

Coping and support

Professional treatment can help you overcome your specific phobia or manage it effectively so you do not become a prisoner to your fears. You also can take some steps on your own:

• Try not to stay away from feared situations. Practice staying near feared objects or situations as much as you can rather than staying away from them completely. Family, friends and your therapist can help you work on this. Practice what you learn in therapy and work with your therapist to create a plan if symptoms get worse.
• Reach out. Think about joining a self-help or support group where you can connect with others who know what you're going through.
• Take care of yourself. Get enough rest, eat healthy and try to be physically active every day. Reduce or avoid caffeine, as it can make anxiety worse. And do not forget to celebrate successes as things get better.

Helping your child cope with fears

As a parent, there's a lot you can do to help your child cope with fears. For example:

• Talk openly about fears. Let your child know that everyone has scary thoughts and feelings sometimes, but some do more than others. Do not reduce the importance of the problem or criticize your child for being afraid. Instead, talk to your child about their thoughts and feelings and explain that you're there to listen and help.
• Do not reinforce specific phobias. Take advantage of times that can help your child overcome fears. If your child is afraid of the neighbor's friendly dog, for example, do not go out of your way to stay away from the animal. Instead, help your child cope when faced with the dog and show ways to be brave. 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, urge your child to keep closing the distance.
• Model positive behavior. Because children learn by watching, you can show how to respond when faced with something your child fears or that you fear. You can first show fear and then show how to work through the fear.

If your child's fears continue, seem to be extreme and get in the way of daily life, talk with your child's doctor or other health care professional for advice.

Prevention

If you have a specific phobia, consider getting help, especially if you have children. Although genetics likely plays a role in how specific phobias start, seeing someone else's phobic response over and over again can trigger a specific phobia in children.

By dealing with your own fears, you can teach your child how to face fears and inspire them to take brave actions just like you did.

Preparing for an appointment

If you've made the choice to seek help for a specific phobia, you've taken a huge first step. You may start by talking to your doctor or other primary care provider. Depending on your situation, you may be referred to a mental health professional to identify the problem and get proper treatment.

What you can do

Before your appointment, make a list of:

• Your symptoms, even if they do not seem to be related to your anxiety. Specific phobias may cause physical, emotional and mental distress.
• Triggers, such as places or things you're staying away from because of your anxiety and fears. Include how you've tried to deal with these triggers and what makes the situation better or worse.
• Key personal information, including any major stresses or recent life changes.
• All medicines, vitamins, herbal products or other supplements that you take, and the doses. Include alcohol or other drugs you may be using to ease your anxiety.
• Questions to ask your doctor to make the most of your time together.

Questions to ask might include:

• Why did I develop this fear?
• Will this fear go away on its own?
• What can I do to make my symptoms better?
• What treatments do you recommend?
• Would exposure therapy or CBT help me?
• What are the side effects of medicines commonly used for this condition?
• If I decide to take medicines, how long will it take for my symptoms to get better?
• How much improvement can I expect if I follow the treatment plan?
• I have other health conditions. How can I best manage them together?
• Are there brochures or other printed material that I can have?
• What websites do you recommend?

Do not hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor may ask:

• Do you avoid any situations or places because you fear they'll trigger your symptoms?
• 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?
• Have you recently had an attack when you felt scared or anxious all of a sudden?
• During these attacks of fear or anxiety, have you ever felt like you could not breathe or like you were having a heart attack?
• Have you recently been feeling nervous, anxious or on edge?
• What other symptoms do you have?
• How do your symptoms affect your life and the people closest to you?
• Do you have any medical conditions?
• Have you been treated for other mental health issues in the past? If yes, what type of therapy helped the most?
• How often do you drink beverages that have caffeine? How many caffeinated beverages do you drink?
• How often do you drink alcohol or use street drugs?
• Have you ever thought about harming yourself?

Be ready to answer questions to make sure you have time to go over points you want to spend more time on.