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Phobias

A phobia is an extreme form of anxiety or fear. If you have a phobia, your symptoms will occur when you’re exposed to a specific object or situation. The anxiety or fear will be out of proportion to the actual threat or danger the situation poses.

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Details

  • About What is a phobia?

    It’s normal and natural to fear or worry about particular situations, such as an exam or public speaking. But if you have a phobia, you’ll have an exaggerated or unrealistic idea about a situation or object. You may not realise that your fear is out of proportion to the true danger. Even if you do, you can't control or explain it.

    If you have a phobia and it’s affecting your life, it’s important to seek help from your GP. An untreated phobia may make you avoid whatever’s causing your fear. This can affect your ability to work, travel and socialise.

  • Types Types of phobias

    You can develop a phobia about any object or situation. Phobias are often divided into two main groups – specific (or simple) phobias and complex phobias.

    Specific (or simple) phobias

    If you have a specific (or simple) phobia, you’ll have an irrational fear of a specific situation or object. Specific phobias are the most common cause of anxiety symptoms. You may have a phobia of animals (eg dogs), the environment (eg dark places), blood, injections, injuries or certain situations (eg flying). Other common phobias include choking and clowns. Some of these triggers will be easier to avoid than others – it’s harder to avoid thunderstorms than snakes.

    For a list of some of the most common specific phobias, see the Common phobias section.

    Agoraphobia and social phobia

    These phobias can greatly interfere with your day-to-day life and may stop you doing certain things. The triggers are more difficult to avoid than with specific (simple) phobias.

    Agoraphobia is a fear of open spaces or being in places or situations where you feel you can’t escape. You may have a fear of leaving home, being in a crowd or travelling in a car, train or bus. You may panic in these situations and deliberately avoid them.

    Social phobia is a fear of being watched and judged in social situations. You may worry that you’ll do something embarrassing or that people are going to criticise you. You may panic in these situations and deliberately avoid them.

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  • Common phobias Common phobias

    There are over 500 specific (or simple) phobias. Each phobia has a medical name. Here are some of the most common ones:

    • animals (zoophobia)
    • birds (ornithophobia)
    • blood (haemophobia)
    • bridges (gephyrophobia)
    • confined spaces (claustrophobia)
    • darkness (nyctophobia, scotophobia)
    • dentists (dentophobia, odontiatophobia)
    • flying (aviophobia)
    • injections (trypanophobia)
    • injury (traumatophobia)
    • needles or other sharp objects (belonephobia)
    • heights (acrophobia)
    • snakes (ophidiophobia)
    • spiders (arachnophobia)
    • thunderstorms (astrophobia or brontophobia)
    • vomiting (emetophobia)

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  • Symptoms Symptoms of phobias

    If you have a phobia, you won't usually have any symptoms until you're faced with the situation or object that triggers your fear. But sometimes even thinking about that situation or object may trigger some or all of your symptoms too.

    Phobias can cause severe anxiety or a panic attack. Your physical symptoms may include:

    • feeling your heart racing (palpitations)
    • sweating
    • feeling dizzy or faint
    • finding it hard to swallow
    • trembling or shaking
    • pain or discomfort in your chest
    • struggling to breathe
    • numbness and pins and needles
  • Diagnosis Diagnosis of phobias

    If you think you have a phobia that’s affecting your daily life, see your GP.

    Your GP will ask about your symptoms. They may ask you about how long you’ve had them and when they occur. They may ask whether you’re avoiding certain animals, objects or situations because of your fear, and how much this affects your life.

    Your GP may also ask you about your medical history. If you have physical symptoms, such as palpitations (feeling your heart is racing), they may recommend you have some tests. These tests will check for any medical conditions that can cause similar symptoms to anxiety (eg angina, low blood sugar or thyroid problems). The GP will probably avoid these tests if you appear to be having a panic attack at the time.

    Your GP may refer you to another healthcare professional who specialises in treating mental health problems.

  • Treatment Treating phobias

    How easy it is to treat a phobia often depends on the type of phobia you have. If you have a specific phobia (eg to dogs), this is usually easier to overcome than a complex phobia, such as social phobia. Your response to treatment will also depend on how severe your phobia is and how much support you have from your family and friends.

    Most phobias can be treated with talking therapies. This is what the GP will recommend in most situations, especially if you don’t have an accompanying condition such as depression. Your GP may suggest you try several treatments together to help relieve your symptoms, especially if you have social phobia. In general, the GP will recommend medicines as a last resort, if other treatments haven’t worked or your symptoms are severe. The treatments work differently for everyone, but most people find that their symptoms get better over time. Some people are able to overcome their phobia completely.

  • Self-help Self-help for phobias

    The best way to overcome a phobia is to gradually expose yourself to your feared object or situation. This may seem like a scary thing to do, but it’ll eventually help to reduce your fear and anxiety. You can do this with the support of a healthcare professional, even if your phobia is only a mild one. Your GP may refer you to a counsellor who specialises in cognitive behavioural therapy (CBT) – see the Talking therapies for phobias section. In some situations, you may be able to refer yourself to a talking therapies service.

    If you would prefer to try CBT on your own, rather than see a counsellor, you could use a self-help manual. If possible, choose a book that’s been recommended by a professional organisation, such as the Royal College of Psychiatrists. You can also work through other self-help books or computer programmes at home.

    There’s plenty of help, guidance and support available for people with phobias. If you can, try to talk about your fear with someone you trust. They may have felt something similar to you and understand what you’re going through. You may also find a support group helpful, to see how others have coped with the same phobia as you. Some airlines run ‘fear of flying’ courses for passengers with this specific phobia.

    You may find that relaxation techniques can help you control your anxiety. Deep breathing may help during a panic attack.

    Too much caffeine may make your anxiety worse. Think about how much caffeine you’re having in one day. Caffeine is found in coffee, caffeinated teas and some fizzy drinks. If you can’t cut out caffeine completely, try to at least cut down.

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  • Talking therapies Talking therapies for phobias

    Your GP may suggest you try a talking therapy called cognitive behavioural therapy (CBT). CBT can help you change how you think, feel and behave when you’re exposed to the object or situation that you’re afraid of. Your GP may refer you to a suitable therapist if they think this is a suitable option.

    CBT involves one-to-one sessions with a therapist trained in treating phobias. During these sessions, your therapist will help you develop coping skills so that you can face your phobia. They may also teach you relaxation techniques. They may gradually expose you to the object or situation that you fear, to help you learn to cope with your anxiety. This is called exposure therapy.

    Sometimes, as a first step your therapist might only ask you to ‘imagine’ yourself in the scary position. They may then ask you to approach the object or situation you fear (eg a bridge). Once you can do this comfortably, keeping your symptoms under control, your therapist may ask you to touch the object (eg stand on the bridge). Your therapist will keep increasing your exposure to the object or situation until you build confidence and start to interact normally with it (eg cross the bridge). Your therapist will go at your pace, with as many, or as few, sessions as you need.

    Exposure therapy helps nine in every 10 people who try it. It’s often the only treatment needed for specific phobias.

  • Medicines Medicines for phobias

    Most phobias aren’t usually treated with medicines because talking therapies are so successful. But if your anxiety is so bad that it’s affecting your daily life, your GP may decide to prescribe some medicines in the short term.

    Your GP may prescribe medicines called beta-blockers. These may help to ease specific physical symptoms, such as palpitations (feeling your heart is racing) and sweating.

    Sometimes, your GP may prescribe medicines called benzodiazepines. These can help to relieve very severe anxiety, especially if it’s stopping you from trying exposure therapy. Benzodiazepines can make you drowsy though. They can also be addictive, so you shouldn’t take them for longer than four weeks. They’re best used for short periods, especially when you may have to confront your feared situation, eg catch a flight if you have fear of flying.

    If your anxiety lasts for a long while, your GP may recommend you try antidepressants called selective serotonin-reuptake inhibitors (SSRIs). Your GP may prescribe SSRIs if you have severe social phobia. These don’t work overnight; you will need to take them routinely for four to six weeks to experience any benefit.

    Always read the patient information leaflet that comes with your medicine. Ask a GP or pharmacist for advice if you have any questions about your medicines.

  • Causes Causes of phobias

    It’s not clear why some people develop phobias and others don’t.

    Sometimes the start of your phobia may be triggered by a frightening situation or place. This caused you to feel anxious at the time. But most people can’t remember any specific event or situation that led to their phobia.

    Most specific phobias begin in children aged between seven and 10 years. Social phobia may begin during the teenage years, following a traumatic social experience, such as extreme embarrassment. Phobias in adults are usually a continuation of these childhood phobias.

    Specific phobias, especially a fear of blood or injury, and complex phobias may run in families.

  • Complications Complications of phobias

    If you have a phobia, you’ll try to avoid whatever’s causing your fear. If you have social phobia, this can affect your work and relationships too. If you have severe agoraphobia, you may be unable to leave the house, which may stop you seeking help when you need it. If you have a fear of needles, this can stop you having vaccinations or taking necessary medicines, such as insulin for diabetes. Avoiding your feared situation means that the phobia is maintained.

    If you have a phobia that affects your daily life, this can affect your mood and lead to depression. You may then be more reluctant to try talking therapies, such as CBT. If you use alcohol or drugs to cope with your feelings, you may increase your risk of developing alcohol- and drug-related health problems.

  • FAQ: Multiple phobias Can I have more than one phobia at a time?

    If you already have one phobia, you may develop another one. Many people have several specific (simple) phobias, fearing more than one object or situation at the same time.

    Agoraphobia is a fear of open spaces or being in places or situations where you feel you can’t escape. If you have agoraphobia, you may also have social phobia (a fear of social situations).

    If you have a phobia, you may also develop a different type of anxiety, such as panic disorder (a fear of having further panic attacks).

  • FAQ: Helping friends How can I help my friend who has a phobia?

    If your friend has a phobia, offer your support. It may be helpful if you learn more about phobias and how they can be treated. If your friend hasn’t spoken to their GP, encourage them to do so, as there are many effective treatments available. Your friend can also try self-help books or join a local self-help group.

    Phobias are often treated more successfully if family and friends get involved. Help your friend as much as you can, either by reminding them to take their medicines or by taking them to appointments. Encourage them to confront their fears through small steps as much as possible, as long as they feel comfortable doing so. Being with them when they are exposed to whatever’s causing their anxiety can help too. Although it is out of proportion to the danger, it’s important to remember that the fear is very real to the person, and to acknowledge that.

    Sometimes your friend may want to do things on their own though. So remember to give them some space when they need it.

  • FAQ: Social phobia What is social phobia?

    Social phobia is one of the most common phobias. It’s also called social anxiety disorder.

    Everyone has some degree of social anxiety – before an interview or a public performance. But if you have social phobia, your fear and anxiety is so severe that it affects your normal life. You may worry that you’ll be criticised or laughed at when you’re around other people. This will happen during everyday activities, including speaking on the telephone, meeting unfamiliar people, working or even shopping.

    The main symptoms of social phobia are palpitations (feeling your heart racing), trembling, blushing and sweating. You may try to escape the situation that’s triggering your symptoms, or even avoid it completely. This can affect your work and relationships.

    Social phobia can be treated with talking therapies, such as cognitive behavioural therapy (CBT), and certain medicines. You may need to keep taking the medicines for at least 12 months to make sure the phobia doesn’t come back. It’s not uncommon to have a combination of medicines and CBT.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Phobias. BMJ Best Practice. bestpractice.bmj.com, last updated February 2016
    • Specific phobic disorders. The MSD Manuals. www.msdmanuals.com, last full review/revision May 2014
    • Social anxiety disorder. PatientPlus. patient.info, last checked August 2016
    • Phobic disorders. Medscape. emedicine.medscape.com, updated July 2014
    • Semple D, Smyth R. Chapter 9: Anxiety and stress-related disorders. Oxford Handbook of Psychiatry (online). 3rd ed. Oxford Medicine Online. oxfordmedicine.com, updated December 2015
    • Panic disorder. PatientPlus. patient.info, last checked December 2016
    • Anxiety Disorders. Medscape. emedicine.medscape.com, updated November 2016
    • Simon C, Everitt H, van Dorp F, et al. Chapter 27: Mental health. Oxford Handbook of General Practice (online). 4th ed. Oxford Medicine Online. oxfordmedicine.com, published online April 2014
    • Cognitive and behavioural therapy. PatientPlus. patient.info, last checked April 2014
    • Social Phobia. The MSD Manuals. www.msdmanuals.com, last full review/revision May 2014
    • Hypnotics and anxiolytics. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current/4-central-nervous-system/41-hypnotics-and-anxiolytics, reviewed February 2017
    • Antidepressant drugs. NICE British National Formulary. www.evidence.nhs.uk, reviewed February 2017
    • Exposure Therapies for Specific Phobias. Society of Clinical Psychology. www.div12.org,accessed 31 March 2017
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    Reviewed by Nick Ridgman, Head of Health Content, March 2017
    Expert reviewer Dr Rahul Bhattacharya, Consultant Psychiatrist
    Next review due March 2020

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