Phobia: definition, causes, symptoms, and treatment

Phobia is defined as an intense and unexplainable fear of some situation, animal, object, and environment. Being afraid of something doesn’t mean a person has a phobia. As a type of anxiety disorder, phobia tends to be illogical and irrational. 

The exact cause of the phobia is unclear. Various factors pave the way to the development of a phobia. These include stressful or negative experiences, traumatic events, or having a parent or sibling with a phobia, in which case it’s a learned behavior. Some types of phobias are most common in childhood and develop by the age of 10. Other types of phobias are more complicated, and they develop in adulthood.

Phobia manifests itself through various symptoms that include intense anxiety, shaking, trembling, rapid heart rate, shortness of breath, and a feeling of dread. When exposed to the subject of phobia, a person goes through a wide spectrum of emotions. However, people usually know their phobia is irrational. But they can’t control their emotions.

Fortunately, phobias are manageable. The most effective treatment approach is cognitive-behavioral therapy. Sometimes doctors may prescribe medications to treat the effects of phobia, such as severe anxiety. For some people combination of these treatment approaches may yield the best effects in the treatment or management of their phobia.

What is phobia?

Phobia is a type of anxiety disorder indicated by exaggerated, inexplicable, and usually illogical or irrational fear of a specific object, situation, animal, or something else. 

The term phobia was coined by ancient Greeks. They used the word phobia with a Greek or Latin prefix to refer to different kinds of fear. That practice is still used today, e.g., arachnophobia (fear of spiders) constitutes from the Greek word arakhne, meaning spider, and phobia meaning fear.

While it’s easy to think phobia is a modern-day problem when people are afraid of different things, it has been around for centuries. For example, Hippocrates described social anxiety disorder phobia as shyness back in 400 BC. This category also included people who think everyone observes them.

According to the National Institute of Mental Health, around 9.1% of Americans, or over 19 million people, have a specific phobia. Many people have more than one phobia. It ranges from mild to severe.

Phobia is included in the Diagnostic and Statistical Manual, 5^th Edition (DSM-5), published by the American Psychiatric Association. That means there are specific criteria for diagnosis of DSM-5; not everyone is afraid of something that has a phobia. As per the criteria, the duration of phobia symptoms must last for at least six months.

In previous versions of DSM, adult patients with anxiety phobia had to recognize their fear is irrational in order to be diagnosed with this disorder. Children didn’t have to do that. However, DSM-5 changed that criterion. Today, adults aren’t required to acknowledge their fear is out of proportion to reality.

1. Stressful experience

Some phobias are associated with a stressful or negative experience, especially in childhood. Stress produces feelings of depression and anxiety. When not processed or managed adequately, stress can decrease the ability to cope in specific situations. As a result, a person becomes more anxious or fearful about being exposed to those situations or objects again. Eventually, this can lead to a phobia. 

A paper from the Psychiatric Clinics of North America reported that stress, in response to a possible threat, amplifies the possibility of forming trauma-related memories. This can lead to PTSD, but some people may react by developing a phobia. 

Additionally, the journal Chronic Stress published a review that showed that chronic stress led to heightened glutamatergic activity i.e., the excitability of specific amygdala neurons and anxiety-related behaviors. More precisely, chronic stress causes neuroplasticity changes in the amygdala and other fear network structures, thus predisposing a person to develop chronic anxiety. Since phobia is a form of anxiety disorder, it explains how stressful experiences can pave the way to intense fear.

2. Frightening event

Experiencing a traumatic event is among the most common causes of phobia. Good examples are being trapped in an elevator or attacked by an animal. These situations have a lasting effect on people. Frightening events lead to a fear reaction that is expressed excessively. It happens due to changes in psychological arousal and reactivity.

For example, being attacked by an animal can leave a person scared of dealing with the same event again. Even months after the attack, they may still be frightened or believe it’s going to happen again sooner or later. That means their fear is excessively emphasized because the structures in the brain change the way they process it. A person keeps focusing on fear and other emotions they feel during a traumatic event. Every time they are exposed to situations that are similar to the frightening event, these emotions reappear even if the event itself is missing. 

For instance, the idea of being in an elevator or standing inside it can cause symptoms of phobia even if a person isn’t trapped anymore. Or being near the animal causes symptoms of phobia even if the animal isn’t attacking them at the moment and the attack itself happened in the past. A paper from the Social Psychiatry and Psychiatric Epidemiology confirmed that unpredictable and uncontrollable events that threaten a person or result in physical harm could influence the onset of phobia.

3. A family member from whom a child can “learn” to fear

A parent or other household member may have a phobia that a child can “learn” and thereby adopt a fear of something specific too. Although most people don’t think about it this way, a phobia can be a learned response from early life. It may develop from factors in the childhood environment. For instance, parents with anxiety or phobia can affect how a child copes with stress and anxiety later in life. 

Also, if parents or siblings have strong reactions to the subject of their phobia, it may influence how you feel about that specific situation or thing. So, you may become frightened as well. Eventually, this could lead to a phobia. Even though a person’s life isn’t in danger and the subject of phobia didn’t do anything to them specifically, they can still develop this anxiety disorder. That’s why phobia isn’t just a reaction to something stressful or frightening; in some cases, it’s a behavior that people learn.

1. Feeling of uncontrollable anxiety when the source of the fear is present

When exposed to fear or even when thinking about it, a person with phobia experiences uncontrollable anxiety. As a result, they may experience both physical and psychological symptoms. Uncontrollable anxiety may manifest itself as trembling, sweating, chills or hot flashes, difficulty breathing or shortness of breath, rapid heartbeat, choking sensation, tightness in the chest, and stomach discomfort. 

Other symptoms present at this point include headache, dizziness, nausea, dry mouth, pins and needles, confusion, disorientation, and ringing in the ears. The biggest psychological symptom of uncontrollable anxiety is a feeling of dread and fear of dying. A person strongly believes the subject of their phobia will put them in great danger. Being exposed to that fear results in symptoms that show the body and mind are in panic mode. 

2. Feel that it is imperative to avoid the source of the fear at all costs

One of the most prominent signs of phobia is the strong need to avoid the source of phobia no matter what. Avoidance results from a fear of being unable to escape, care for yourself, get help, or deal with anxiety-like symptoms of phobia. Depending on the object of fear, a person may feel like something is going to happen to them unless they find a way to avoid it. 

For that reason, they may strive to avoid places, situations, or even people that are close to their fear in one way or another. For example, a claustrophobic individual may avoid places where they need to use elevators. This can prevent them from visiting friends and family, or taking job opportunities in tall buildings. 

Basically, a person organizes their life around phobia. Avoidance is particularly expressed in persons with severe phobias. Evidence, however, shows avoidance behavior amplifies anxiety effects.

3. Being unable to perform as intended when exposed to the trigger

Being exposed to the trigger or even worrying about such a scenario can take its toll on performance. That happens due to racing thoughts that prevent a person from focusing on a task at hand. The mind is scattered and chooses to amplify fear-related thoughts that induce anxiety symptoms. 

Impaired focus and concentration make it difficult for a person to perform their tasks properly. Intense fear reduces problem-solving and decision-making skills cause memory problems and doesn’t allow a person to process information properly in their mind. For that reason, a phobia can interfere with productivity at work or school. Anxiety disorders are associated with cognitive impairment, studies confirm.

4. Acknowledgment of the irrationality of the fear and an inability to control the emotions

Most people with a phobia do know their fear is irrational. But, being aware of the irrationality of phobia doesn’t help them overcome their fear. Instead, it makes them feel even worse. The reason it makes them feel worse is that they become aware of a lack of control over their phobia. Since they know their fear is irrational and can’t do anything about their emotional response, a person feels humiliated and disappointed.

Under normal circumstances, acknowledging the irrationality of fear involves confronting the subject or situation. For a person with a phobia doing so is impossible without professional help and guidance. That’s why despite understanding the irrational aspect of their fear, a person can’t prevent or stop their reaction and symptoms of anxiety that occur due to exposure to the subject of phobia. They don’t want to deal with symptoms such as shortness of breath, feelings of dread, and others, but they can’t control them. 

What are the common effects of phobia?

Phobias tend to have devastating effects on a person’s psychological and physical health and well-being. Common emotional effects of phobia include life-limiting severe anxiety, embarrassment, isolation, helplessness, and loss of control. Phobia can also contribute to mental disorders and substance use disorders. The latter may occur due to the stress of living with a severe phobia, Mayo Clinic explains.

A person with a phobia may find it incredibly difficult to do simple everyday tasks. Phobia can affect every aspect of their life including education, social life, and career, depending on the type of fear.

The presence of phobia may create a mental burden where a person keeps wondering why they aren’t like other people. Their fear may make it difficult to have a functioning social circle. As a result, a person with a phobia may start spending less and less time with other people. Since phobia can create uncomfortable situations, it makes a person feel embarrassed. This is particularly the case with social phobia, where the underlying fear is humiliation.

One of the worst and most intense effects of phobia is feeling out of control. Despite being aware of the irrational side of fear, a person still realizes they can’t control it. Being aware of a lack of control can be overwhelming and further affect the mental health of an individual. 

What are the different types of phobia?

The two types of phobia are specific phobia and complex phobia. Their differences and examples are outlined in the table below.

How does a phobia affect the brain’s function?

Phobia affects the brain’s function through significant changes in brain activity. Men and women who suffer from phobias display enhanced activity of the amygdala when they are exposed to phobia-producing stimuli. Amygdala is the brain area that serves as a center for emotional behavior, emotions, and motivation. It also participates in decision-making, memory processing, and emotional responses, including anxiety, fear, and aggression. 

The right amygdala is linked to negative emotions such as sadness and fear. The left amygdala is more involved in pleasant reactions. The higher the activation of the right amygdala, the more intense the sense of distress caused by phobia disorder. 

In an experimental setting, phobia-inducing images increase the activity of the stria terminalis, the anterior cingulated cortex, and the insula. Hyperactivation of these areas of the brain indicates prolonged exposure to phobia-causing stimuli engages more areas of the brain rather than calming them down.

To understand how phobic disorder affects the brain, it’s important to keep in mind that fear creates a distraction. As a result, our focus is on the source of the fear and nothing else. The more intense the fear so is the focus on it. The human mind becomes preoccupied with that fear, which explains why it’s tricky for a person to calm down. Even an irrational fear may appear realistic at that point. If a person perceives their experience as real, an extreme fear response overcomes the sense of control over the specific situation.

What are the phobia treatments?

Phobia treatments are medications and psychotherapy, such as cognitive-behavioral therapy. Most phobias are curable, NHS UK confirms. However, no single treatment works for different phobias equally. A combination of medications and therapy may be necessary alongside self-help techniques.

1. Medications

Medications are mainly prescribed to manage the effects of phobias such as anxiety. That means not all patients with phobias need to take medicines. The doctor prescribes medications for the specific needs of patients. Examples of medications that doctors may prescribe include antidepressants, beta-blockers, and tranquilizers.

In the treatment of phobia, the main role of medications is to reduce the intensity of emotions a patient is experiencing. For example, beta blockers are usually prescribed for cardiovascular conditions such as high blood pressure, but in this case, they can lower anxiety. Beta-blockers can decrease the severity of heart palpitations in persons with phobia.

Tranquilizers have the same purpose as beta-blockers, but they are only prescribed for severe anxiety and at the lowest doses. Antidepressants also work to produce calmness and reduce the severity of intense fear and anxiety. 

2. Cognitive behavioral therapy

Cognitive-behavioral therapy (CBT) is a type of psychotherapy that focuses on identifying irrational thoughts that lead to negative emotions and behaviors. The therapist then works with the patient to overcome these irrational beliefs and adopt healthier coping mechanisms. Since many phobias are irrational, CBT can help.

An important aspect of CBT for the treatment of phobia is gradual exposure to fear. That way, a person becomes less anxious about the subject of their phobia. This approach is called desensitization or exposure therapy. For instance, when a person is afraid of snakes, the therapist may start asking them to read about them. After a while, a therapist may show a picture or a video featuring a snake. As the treatment keeps progressing, the therapist may arrange for a patient to visit the local zoo or a reptile house. The final step of exposure therapy would be to hold a snake in a controlled and supervised environment.

Cognitive-behavioral therapy works by allowing patients to gain control over their phobia. A review from Dialogues in Clinical Neuroscience confirmed that CBT is effective for the treatment of anxiety disorders. Other studies show that CBT and exposure therapy can help with social phobia and other types of phobias.

In phobia treatment, CBT is often structured and time-limited. Some patients need four to 14 sessions with a therapist, but others need more than that. The number of sessions depends on the severity of the phobia. The therapist determines the most suitable protocol for the specific needs of each patient. The typical length of a session is 30 to 45 minutes, but the initial session may last up to 60 minutes.