Department of Psychiatry
Penn Behavioral Health

Center for the Treatment and Study of Anxiety

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Specific Phobias




Symptoms

A specific phobia is an intense, persistent, irrational fear of a specific object, situation, or activity, or person. Usually, the fear is proportionally greater than the actual danger or threat. People with specific phobias are highly distressed about having the fear, and often will go to great lengths to avoid the object or situation in question. According to a study by the National Institute of Mental Health (NIMH), it is estimated that between 8.7% - 18.1% of Americans suffer from phobia.

Some examples of phobias:

  • A teenager with a dog phobia avoids going to the houses of friends and family who own dogs
  • A businessman with a fear of flying loses out on a promotion because he is unwilling to travel
  • A woman with a needle phobia avoids getting blood work her primary care physician deemed necessary for her physical health
  • A young man with a fear of enclosed spaces takes the stairs each day to his office on the 11th floor to avoid taking the elevator

Note that in the people in the above situations, the presence of the phobia is causing marked distress in their everyday lives.




Diagnostic Criteria

Based on criteria from the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000)

  1. A persistent fear that is excessive or unreasonable, that occurs by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
  2. Exposure to the feared item or situation almost always leads to an immediate anxiety response, which may take the form of a panic attack. In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
  3. The person recognizes that the fear is excessive or unreasonable. In children, this feature may be absent.
  4. The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
  5. The avoidance, anxious anticipation, or distress during the feared situation(s) interferes significantly with the person's normal routine, work (or school) functioning, or social activities or relationships, or there is marked distress about having the phobia.
  6. In individuals under age 18 years, the problem lasts at least 6 months.
  7. The anxiety, panic attacks, or avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia, Panic Disorder, etc.




Types of Specific Phobia

There are five different types of specific phobia.

  • Animal Type (e.g. dogs, snakes, or spiders)
  • Natural Environment Type (e.g., heights, storms, water)
  • Blood-Injection-Injury Type (e.g. fear of seeing blood, receiving a blood test or shot, watching television shows that display medical procedures)
  • Situational Type (e.g., airplanes, elevators, driving, enclosed places)
  • Other Types (e.g., phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds like balloons popping or costumed characters like clowns)


Specific Phobias versus Normal Childhood Fears

It is important to differentiate between specific phobias and normal childhood fears. According to the Child Anxiety Network (www.childanxiety.net), some research shows that 90% of children between the ages of 2-14 have at least one specific fear. Not all fears interfere with daily functioning, and do not necessarily merit psychological treatment. Below are some examples of typical childhood and early adolescent fears.

  • Infants/Toddlers (ages 0-2 years) loud noises, strangers, separation from parents, large objects

  • Preschoolers (3-6 years) imaginary figures (e.g., ghosts, monsters, supernatural beings, the dark, noises, sleeping alone, thunder, floods)

  • School Aged Children/Adolescents (7-16 years) more realistic fears (e.g., physical injury, health, school performance, death, thunderstorms, earthquakes, floods)




Etiology of Specific Phobia

As with any psychological disorder, the etiology of specific phobias are complex, and include a number of factors such a learned history, past experiences, and biology.

Learning History

  • Direct Learning Experiences: Specific phobias can sometimes begin following a traumatic experience in the feared situation. For example, a child who is bitten by a dog might develop a fear of dogs, or someone who has a car accident might develop a fear of driving.
  • Observational Learning Experiences: Some people may learn to fear certain situations by watching others show signs of fear in the same situation. For example, a child growing up with a father who is afraid of heights may learn to fear heights himself.
  • Informational Learning: Sometimes, people develop specific phobias after hearing about reading about a situation that may be dangerous. For example, a person learns to fear flying after watching news footage of 9/11.

However, it is important to remember that learning is not the sole cause of specific phobias. Many people are bitten by dogs or get into car accidents and do not go on to develop phobias.

Biological Factors

Not much is known about the biological factors that cause and maintain specific phobias. However, when a person encounters a feared stimulus, many biological changes occur in the body, including changes in brain activity, the release of cortisol, insulin, and growth hormone, and increases in blood pressure and heart rate.



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