Phobias

What is a phobia?

A phobia is a type of anxiety disorder involving an intense, overwhelming fear of a specific object, situation or activity, even though it poses little or no real danger. It's far stronger than ordinary fear, and merely picturing the thing you're afraid of can trigger it, not only encountering it directly.

What are the symptoms of a phobia?

Symptoms vary from person to person, but several patterns are common across most phobias:

• An overwhelming fear that feels difficult or impossible to control
• Physical symptoms such as a pounding pulse, shaking, dizziness or trouble breathing
• A strong urge to escape or avoid the situation altogether
• Trouble thinking about anything else once the fear is triggered
• Worrying in advance about situations where you might come across the thing you fear
• Recognising that the fear is out of proportion to any real danger, but being unable to talk yourself out of it
• Symptoms that don't fade after a few weeks, and can carry on for years without support.

Over time, avoiding the source of your fear can end up reinforcing it, and for some people this leads to broader disruption, such as turning down travel, medical appointments or social plans.

What causes phobias, and who is at risk?

There's rarely a single clear reason a phobia develops. Most seem to grow out of some combination of what you've been through, your underlying biology, and things you've learned along the way.

Examples include:

• A frightening or painful past experience: Such as a dog bite or a turbulent flight
• Learning fear from someone else: Such as a parent reacting with panic to the same trigger
• A family tendency towards anxiety: Or a naturally more sensitive temperament
• Differences in how the brain's threat-detection system responds: Sometimes reacting as if there's danger when there isn't
• Deep-rooted instincts: These may once have helped keep humans safe, such as a wariness of heights or certain animals
• Repeated avoidance itself: Since dodging a trigger teaches your brain that avoidance equals safety, which can deepen the fear over time

Phobias are thought to affect somewhere around 1 in 10 adults. Women are affected roughly twice as often as men. Symptoms usually start in childhood or the teenage years, sometimes as late as the early twenties, though they can develop at any age.

Are there different types of phobia?

Phobias are broadly grouped into specific (simple) phobias and more complex phobias.

Specific phobias

These involve a fixed fear of one clear trigger, and fall into a handful of broad categories:

• Animal: Such as spiders (arachnophobia), snakes (ophidiophobia) or dogs (cynophobia)
• Environmental: Such as heights (acrophobia), storms (astraphobia) or the dark (nyctophobia)
• Blood, injection or injury: Such as seeing blood, medical procedures, or injections (trypanophobia)
• Situational: Such as flying (aerophobia), driving, lifts or enclosed spaces (claustrophobia)
• Other: Such as choking, vomiting, or germs and contamination (mysophobia).

Complex phobias

• Agoraphobia: Commonly assumed to mean simply being scared of wide open areas, but it's really about dreading situations where getting away or finding help would be hard, such as crowds or public transport, which can lead to staying home for long stretches
• Social anxiety disorder, sometimes called social phobia: Intense worry about looking foolish or being criticised while around other people, often triggered by things like giving a speech, making small talk with strangers, or eating somewhere others can watch you.

How are phobias diagnosed?

It’s best to speak to your GP, who can refer you on to a mental health professional if needed. In general, a fear is more likely to be a diagnosable phobia if it feels extreme or uncontrollable, if avoiding the trigger is shaping your day-to-day choices, and if the reaction has lasted for months or years rather than settling down on its own.

How are phobias treated?

• Cognitive behavioural therapy (CBT): This helps you identify and challenge irrational thoughts about your trigger
• Exposure therapy or desensitisation: This involves gradually and safely facing the trigger, often alongside relaxation techniques, so the fear response weakens over time
• Flooding: This is a more intensive form of exposure involving prolonged contact with the feared situation
• Medicines for anxiety: These aren't usually the first treatment tried, and some can themselves cause anxiety-like side effects, so doctors tend to weigh them up carefully rather than starting with them alone
• Support groups or phobia clinics alongside self-help approaches: These include relaxation techniques, mindfulness, and looking after your sleep and general wellbeing.

When should I see a doctor?

You should see a doctor if:

• your fear is stopping you doing things you need or want to do, such as travelling, attending appointments, or getting to your job or studies
• you're going out of your way to avoid situations, and this is starting to limit your daily life
• the fear hasn't eased after several months, or seems to be getting worse
• you're relying on alcohol or other unhealthy coping habits to get through situations that trigger your fear.