Phobias: Definition, Symptoms, And Treatments

At some point, you may have experienced a fear of physical, emotional, real, or imagined stimuli. Feeling afraid can be a healthy response to uncertainties and dangers you might face, and it may be the body's method of preventing you from harm. 

However, when fear of an object, situation, place, or other stimuli negatively disrupts your life or functioning, it might signify a phobia or another anxiety disorder. If you question the intensity and frequency of your fears, learning the definition of a phobia could be beneficial in identifying what you're experiencing.  

What is a phobia?

You may wonder about the difference between a common fear and a phobia. The American Psychological Association defines a phobia as a persistent and irrational fear of a specific situation, object, or activity that is strenuously avoided or causes significant distress. 

If you have a phobia, your fear may feel overwhelming and impact your daily functioning. Whether the stimuli you are afraid of is a threat may not have an impact on your fear level. For example, someone may fear heights regardless of the safety or risk factors of various high-up locations.

Symptoms of a specific phobia diagnosis 

In the DSM-5: (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), specific phobia is a subcategory diagnosis in the anxiety disorders category of the diagnostic manual. The condition's symptoms can include physical, psychological, and behavioral occurrences often related to the fight-or-flight response. With a specific phobia, you may have one or more phobic triggers that cause symptoms. A specific phobia might include an object like glass, an animal like bugs, or a situation like flying. These may all be considered triggers for those with a phobia of them. 

Within the DSM-5, a specific phobia can be named within the diagnosis. Common types of specific phobias that can be diagnosed include animal, natural environment, blood injection injury, situational type, or "other." Below are some of the symptoms of specific phobia disorder. 

Psychological symptoms

Anxiety often associated with phobias may include psychological symptoms. If a phobia is triggered, you might feel a sense of dread, immediate fear, or an urge to fight, flee, or freeze. You could feel a fear of losing control or fainting. In some cases, individuals might experience confusion or disorientation. Often, people might believe that the trigger of their phobia could pose a real threat or harm to them, even if that threat is perceived or not based on reality. 

Behavioral symptoms

The behavioral symptoms of phobias could include avoiding the fear associated with phobic triggers. Those with phobias might alter their habits to live peacefully without fear. If you have a phobia, you may avoid situations where a phobic response could be triggered. 

For example, if you have a social phobia, you may avoid places where you might run into people you know. You may feel so afraid to face specific triggers that you don't leave your home or practice extreme avoidance, as in agoraphobia, which often includes a fear of having a panic attack or feeling the effects of a fear or phobia in a public or crowded area. 

Physical symptoms

In the absence of your phobic trigger, your symptoms may not occur. You may feel calm and relaxed, happy, or absent of fear. However, if the phobia is triggered, you might experience physical symptoms often associated with panic attacks or panic disorder. Although panic attacks can occur with a specific phobia, they are not part of the diagnostic criteria for phobias in the DSM-5 and may occur as a separate cause of the phobia or anxiety felt. 

Physical symptoms of a panic attack may include:

• A choking sensation
• Chills or hot flashes
• Gastrointestinal issues such as gassiness or an urge to use the bathroom 
• Pain or tightness in the chest
• Nausea
• Headaches
• Dizziness
• Sweating
• Trembling
• Numbness
• A rapid heartbeat
• Feeling faint
• Dry mouth
• Ringing in your ears

Specific techniques such as mindfulness, fidgeting, changing your body's temperature, or coloring a mandala can decrease the severity of panic attacks in some cases. 

Understanding phobias 

Phobias often involve the emotion of fear. Fear is often a part of the fight-or-flight response, a physiological response to a perceived threat. If this response happens when there's a real threat, it can be adaptive in that it prepares you to manage it. Your body prepares to flee the danger or stay and fight it.

The fight-or-flight response is also called the acute stress response, referring to a type of hyperarousal that happens when you're terrified of a mental or physical threat. This response changes the activity of your nervous system, alters your hormone levels, and increases your heart rate, muscle tension, and the intensity of your sensory abilities. 

Anxiety differs from fear and can involve a feeling of worry, nervousness, or unease, especially about an upcoming event or an uncertain outcome. If anxiety is recurrent and impacts your functioning in one or more ways, you may be experiencing an anxiety disorder. Specific phobias are anxiety disorders, but there are others as well, including: 

• Generalized anxiety disorder (GAD) 
• Social phobia or social anxiety disorder 
• Obsessive-compulsive disorder (OCD) 
• Panic disorder
• Separation anxiety disorder
• Agoraphobia
• Other specified or unspecified anxiety disorder 

Fear can be a natural response to a real and imminent threat, but a phobia may not have a basis in reality in every case. When you experience fear of a perceived threat that may not harm you or others, your fight or flight response can still occur. Therefore, a phobia can cause the same impacts as fear and may cause chronic stress associated with adverse physical health conditions. 

Is a specific phobia the same as anxiety? 

A specific phobia is a type of anxiety disorder that involves more than the emotion of fear. Specific phobias are considered anxiety disorders because they are characterized by feelings of apprehension and dread that cause avoidance and interfere with one's quality of life, like other anxiety disorders. 

Phobias are thought to be caused by classical conditioning. For example, someone may not be afraid of trains (the neutral stimulus), but they are afraid of loud noises (the unconditioned stimulus). Since trains are loud, they might learn to associate the train with the noise, causing fear (a conditioned response). Once an association has been formed, which can happen immediately or after several exposures, the train (now the conditioned stimulus) causes fear (the conditioned response), and a phobia may result.

Because phobias can be conditioned responses, they might not disappear independently. In some cases, therapy can help extinguish or replace the conditioned response using counterconditioning.

Types of phobias

Phobias are divided into three types: specific phobia, social phobia, and agoraphobia. 

Specific phobia

A specific phobia is a persistent and often irrational fear of a single specific object, event, situation, or living creature. In other words, one stimulus triggers the fear. If you have a phobia of snakes, you might be afraid when you see a snake in the wild, at a zoo, or in a video on social media. However, when you don't see a snake (or anything resembling a snake), you may not experience fear. Someone may have more than one specific phobia. 

Social phobia

Social phobia is a fear of social situations, socializing, and sometimes people. Those with social phobias may avoid such situations, even if it means missing out on fun activities, friendships, or career opportunities. They may have differing reasons for the fear, such as a fear of being publicly judged or humiliated. As opposed to feeling awkward or shy, those with social phobia might feel scared, vulnerable, and anxious when thinking about or participating in social situations.

Agoraphobia

Agoraphobia is a phobia centered around being in situations you can't escape. Those with agoraphobia could experience several fears related to being in public, such as:

• Fear of open spaces
• Fear of elevators
• Fear of being in a crowd

If you have agoraphobia, these fears may cause you to withdraw. You may stay in your home as much as possible to avoid a panic response or avoid certain areas in public, such as a store. 

What causes phobias?

Specific phobias could be formed anytime from early childhood to adulthood. In the case of conditioned responses, you might experience the following: 

• You face a terrifying experience. 
• Your reaction is so profound that you fear ever facing that situation again. 
• Eventually, when you even think of being confronted with your phobic trigger, your body shifts into fight-or-flight mode, and you avoid the situation.

You might also develop a specific phobia if you were present when someone else displayed panic symptoms in response to a phobic trigger. Additionally, some specific phobias may have a genetic component. Genetics, brain chemistry, and life experience may equally or partially contribute to a phobia's development. 

Treatments for phobias

Several treatments have proven effective in supporting those living with phobias. Medications can provide relief, but long-term therapy treatments may be beneficial. 

Systematic desensitization

Systematic desensitization is a type of exposure therapy that works as follows: 

• The client is exposed to a mild example of what they fear while being prompted to relax (for example, using deep breathing). 
• When that experience feels more familiar and less frightening, the client is guided to move on to more frightening examples of the feared object or situation.
• During the practice, they may mark their fear levels on a scale of one through 100 with the guidance of a therapist. 

For example, if you are afraid of snakes, you and your therapist might start by looking at pictures of snakes while you focus on your breathing and listen to relaxing music. Next, your therapist might accompany you to see snakes in a zoo. At the end of the practice, in your therapist's office, you might hold a non-venomous snake. Over time, your fear response may lessen, although it may increase at first. 

Exposure therapy can be done with a licensed practitioner in a safe location and with safe stimuli. An exposure therapist should not put you in real danger. 

Virtual reality therapy

Virtual reality therapy is another type of exposure therapy that is done similarly to desensitization but consists of viewing an image or landscape of your phobic trigger on a computer screen, in a virtual reality headset, or a specially designed "cave." A virtual reality cave may look like a small room with a large-screen projector and powerful audio speakers. 

Virtual reality therapy may allow you to control the amount of exposure to the feared stimuli, so therapists can help clients work at their rate. Because clients learn that no harm comes from the exposures, their fear response may disappear or lessen over time. 

Counterconditioning

Counterconditioning can mean replacing your fear response with a neutral or positive response. For example, you might counter-condition a response to snakes by doing deep breathing exercises while you view a snake. The goal could be to replace your fear response with a relaxation response. Counterconditioning is a component of systematic desensitization.

Biofeedback

Biofeedback can work by teaching you to reduce your physiological response to fears. A doctor or therapist may place electronic sensors to record your heart rate, blood pressure, pulse, and other vital signs. The results are displayed on a screen. As you're exposed to the object of your fear, you watch the screen, and images or sounds give you feedback as you focus on relaxing and lowering your stress response.

Cognitive-behavioral therapy (CBT) 

Cognitive-behavioral therapy (CBT) involves identifying the thoughts behind feelings and behaviors. Once you know the thoughts that may be causing the frightening feelings and avoidant behaviors associated with your phobia, you can work with a therapist to change the thought. CBT may result in changing feelings and behaviors as well. 

Medications

Several categories of medications are used to ease phobias' physical and emotional symptoms. These include SSRI antidepressants (such as Paxil and Zoloft), beta-blockers (such as Inderal), and benzodiazepines (such as Ativan and Klonopin). Your doctor may prescribe SSRIs for steady relief and beta blockers or anti-anxiety medications to help when you feel panicked.

While medications may help you face a phobia in an unavoidable situation (for example, flying in a plane for a business trip), they may not work long-term. Therapy could allow you not to experience the side effects of many medications. Exposure therapies may also be more effective than medication in the long run. One study on exposure therapy found it was more cost-effective and offered more life-quality adjustments than medication for those experiencing post-traumatic stress disorder (PTSD), which may sometimes be associated with phobias.

Counseling 

Confronting your fears in therapy may be beneficial if you have a phobia. However, social phobia and agoraphobia can make it challenging to attend in-person therapy sessions. In these cases, online therapy might be beneficial. Your therapist can work with you through a chat feature, phone calls, or video calls to help you address your fears. Additionally, recent studies show that online CBT (iCBT) can treat anxiety disorders as effectively as in-person therapy. CBT has also been found to be cost-effective, with treatment effects maintained at one-year follow-up.

If you're interested in trying exposure therapy, CBT, or another online treatment form, consider reaching out to a counselor through a platform like BetterHelp. BetterHelp offers a database of over 30,000 licensed therapy providers. 

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