I recently spoke about Phobias on Radio 702, South Africa. I have had some requests for further detail on phobias. Also to understand whether there is a link between childhood phobias and autism.


What are they?

A specific phobia is a type of anxiety disorder defined as an extreme or irrational fear of or aversion to something. With a  specific phobia, you are likely to experience a sense of dread or panic when faced with a specific situation or object. These irrational fears can interfere with personal relationships, work, and school, and prevent you from enjoying life.

Unlike Generalized Anxiety Disorder (GAD), specific phobias come in a variety of forms. When an individual is confronted with a specific situation or object, or even anticipates being confronted with it. Even though the situation or object poses little or no actual danger to the individual, they often cannot control their fear towards it and will actively avoid it at all costs. Although people with specific phobias recognize the irrationality of their fears, the thought of these fears alone is often enough to cause tremendous, debilitating anxiety.

While ordinary fears cause minor anxiety and can be more easily overcome, specific phobias physically and/or psychologically impair the affected individual to such an overwhelming extent that it is disabling to their daily life.

Who gets phobias?

Prevalence rates are approximately 5% in children, 16% in 13- to 17-year-olds, and around 3%-5% in older individuals. Females are more frequently affected than males. In most cases, specific phobias develop in early childhood between the ages of 7 and 11, though it is possible for a phobia to develop at any age.

Why do people get phobias?

Specific phobias can be caused by a variety of different factors: experiencing a traumatic event (e.g. being attacked by a dog); observing others going through a traumatic event (e.g. witnessing a car accident); an unexpected panic attack (e.g. while flying in an airplane); or informational transmission (e.g. extensive media coverage of a terrorist attack).

Often, those affected by a specific phobia are unable to identify the reason why their phobia developed

Risk factors for developing a specific phobia are temperamental, environmental, and genetic. For instance, negative affectivity (a propensity to feel negative emotions such as disgust, anger, fear or guilt) or behavioral inhibition are temperamental risk factors for a variety of anxiety disorders, including specific phobias.

Parental overprotectiveness, physical and sexual abuse, and traumatic encounters are examples of environmental risk factors that increase the likelihood of an individual developing a specific phobia.

There may also be a genetic susceptibility to a certain category of a specific phobia; for example, if an individual has an immediate relative with a specific situational phobia of flying, the individual is more likely to have the same specific phobia than any other category of phobia.

What are the symptoms?

  1. Racing heart
  2. Difficulty breathing
  3. Trembling or shaking
  4. Sweating
  5. Nausea
  6. Dry mouth
  7. Chest pain or tightness

Emotional Symptoms:

  1. Feeling overwhelming anxiety or fear
  2. Knowing that your fear is irrational, but feeling powerless to overcome it
  3. Fear of losing control
  4. Feeling an intense need to escape

Types of Specific Phobia

Specific Phobias are categorized into 5 types:

  1. Animal Phobias (e.g., dogs, snakes, or spiders)
  2. Natural Environment Phobias (e.g., heights, storms, water)
  3. Blood-Injection-Injury Phobias (e.g., fear of seeing blood, receiving a blood test or shot, watching television shows that display medical procedures)
  4. Situational Phobias (e.g., airplanes, elevators, driving, enclosed places)
  5. Other Phobias (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)

What is the treatment and prognosis

Treatment options for specific phobias can involve therapeutic technique, medication, or a combination of both.

Cognitive-behavioral therapy (CBT) as “a system of treatment involving a focus on thinking and its influence on both behavior and feelings.” CBT emphasizes the role of dysfunctional beliefs and their influence on emotional and behavioral outcomes. The therapy focuses on changing such negative thoughts and dysfunctional beliefs in order to change the reaction to the phobic stimulus.

Treatment of a specific phobia also involves gradual/graduated exposure to the fear stimulus.

MedicationIn some cases, medications should be used in conjunction with CBT. Anti-anxiety medications can also be effective in calming emotional and physical reactions to specific phobias.

DSM-5 Diagnostic Criteria

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines 7 diagnostic criteria for specific phobias:

  1. Marked fear or anxiety about a specific object or situation (In children fear or anxiety may be expressed by crying, tantrums, freezing, or clinging).
  2. The phobic object or situation almost always provokes immediate fear or anxiety.
  3. The phobic object or situation is avoided or endured with intense fear or anxiety.
  4. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
  5. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
  6. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  7. The disturbance is not better explained by symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms; objects or situations related to obsessions; reminders of traumatic events; separation from home or attachment figures; or social situations.

Please follow this link to research further regarding possible links between autism and phobias in children