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Phobias


Expert reviewer Dr Rahul Bhattacharya, Consultant Psychiatrist
Next review due March 2022

A phobia is an extreme form of anxiety or fear of a specific object or situation. This makes you worry about being faced with the situation, so you try to avoid it. The anxiety or fear is out of proportion to the actual threat or danger the situation poses.

If you have a phobia, especially if it’s severe, it can affect the way you live your life and cause a lot of distress. People of all ages can get phobias, and the good news is that they’re often treatable.

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What is a phobia?

It’s normal and natural to avoid things that might really harm you, and to 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 realise that your fear is out of proportion to the true danger, but you can't control it.

You may find yourself organising your life so that you avoid the thing that you’re fearful of and if you can’t avoid it, you may become very anxious. An untreated phobia can affect your ability to work, travel and socialise. If you have a phobia that’s affecting your life, it’s important to seek help from your GP.

If you need help now

This page is designed to provide general health information. If you need help now, please use the following services.

  • Samaritans
    116 123 (UK and ROI) This helpline is free for you to call and talk to someone.
    www.samaritans.org
  • NHS Services has a list of where to get urgent help for mental health.
  • Mind website. Click on the yellow ‘Get help now’ button at the top left of the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.

If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.

Types of phobia

You can develop a phobia about many different objects or situations, although some are much more common than others. These are the three main types of phobia.

  • Simple (or specific) phobias. Specific phobias are the most common cause of anxiety symptoms. Specific phobias include animals (dogs, snakes), situations (flying, enclosed spaces), natural environment (storms, heights) and phobias about blood and medical procedures such as injections. Obviously, some of these triggers are easier to avoid than others.
  • Agoraphobia. Agoraphobia is a fear of being in a place or situation where you feel you can’t escape or where help might not be available if you become anxious. You may have a fear of leaving home alone, of being in a crowd or of travelling in a car, train or bus. You may panic in these situations and deliberately avoid them, which can greatly interfere with your day-to-day life.
  • Social phobia (social anxiety disorder). Social phobia is a fear of being watched and judged in social or performance situations. This may happen during everyday activities, including speaking on the telephone, meeting unfamiliar people, working or even shopping. You may worry that you’ll do something embarrassing or that people are going to criticise you. You may try to avoid all such situations or feel very anxious and panic if you have to endure them. This can affect your work and relationships.
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Symptoms of phobias

If you have a phobia, you’ll probably feel fine until you approach or are faced with the situation or object that triggers your fear. But sometimes, even just thinking about that situation or object may trigger some or all of your symptoms.

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

  • feeling your heart racing (palpitations)
  • sweating
  • feeling dizzy or faint
  • a feeling of choking
  • feeling sick
  • trembling or shaking
  • pain or discomfort in your chest
  • struggling to breathe
  • numbness and pins and needles

An important symptom of a phobia is avoiding certain objects or situations or feeling very anxious and panicky if you can’t. You may fear that you’ll faint or that you’re losing control or dying. These feelings can be very distressing for you, and severely interfere with your day-to-day life.

If you think you have symptoms of a phobia that is affecting your everyday life, contact your GP. You may also be able to get help with anxiety by referring yourself directly to a psychological therapist without seeing your GP. Look online for IAPT services (IAPT stands for ‘Improving access to psychological therapies’). It’s a free NHS service.

Diagnosis of phobias

If you’re concerned and contact your GP or a therapist, they’ll 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. They may also want to know if anyone in your close family has phobias.

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 want to make sure these don’t have some other medical cause. This might involve a physical examination and perhaps some tests. These tests will check for medical conditions that can cause similar symptoms to anxiety (for example, angina, low blood sugar or thyroid problems). If you need any tests, your GP will explain these to you, and you’ll have the chance to ask questions about them.

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

Treatment of phobias

How easy it is to treat a phobia depends on the type of phobia. If you have a specific phobia (for example, dogs), this is usually easier to overcome than agoraphobia or social phobia. How well your treatment works 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. Your GP may suggest you try several treatments together to help relieve your symptoms, especially if you have social phobia. They may recommend that you use an IAPT psychological therapy service (see our section ‘Symptoms of phobias’). In general, medicines are 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.

Self-help for phobias

There isn’t just one specific self-help treatment that will work for everyone with a phobia, but you might find some of the following helpful.

  • Talk about your fear with someone you trust. They may have felt something similar to you and understand what you’re going through.
  • Find a support group. You’ll be able to talk with other people who’ve had similar experiences. It can help to hear how others have coped with their phobias.
  • Learn ways of coping with panic and anxiety. You may find that relaxation techniques can help you control your anxiety. Focussing on your breathing may help during a panic attack.
  • Make lifestyle changes such as being more active, which may help reduce symptoms of anxiety. You may also find it helps to reduce how much caffeine you drink. Caffeine is found in coffee, caffeinated teas and some fizzy drinks.
  • Try self-help resources such as books or online programmes. These are often based on cognitive behavioural therapy (CBT) – see our section on talking therapies. If possible, choose a book that’s been recommended by a professional organisation, such as the Royal College of Psychiatrists.
  • Take a course to help overcome a specific phobia. For instance, some airlines run ‘fear of flying’ courses.

You can get more tips and hints on self-help for phobias from the organisations listed in our section ‘Other helpful websites’. Some can also help you connect with other people dealing with phobias through support groups or online chat rooms.

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 CBT therapist if they think this is a suitable option. If you have social phobia, you may be offered CBT which has been specifically developed to treat this condition in adults and children.

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.

Exposure therapy for phobias

Your CBT therapist 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 (or desensitisation). Your therapist will only start this process if you give your permission.

As a first step, your therapist might ask you to imagine yourself in the scary situation. They may then ask you to approach the object or situation you fear (for example, a bridge). Once you can do this comfortably, keeping your symptoms under control, your therapist may ask you to touch the object (for example, 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 (for example, 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 for phobias

If your anxiety is so bad that it’s affecting your daily life, your GP may decide to prescribe some medicine. There are three main types of medicine which your GP may offer.

  • Antidepressants. If you have agoraphobia or social phobia, and your anxiety lasts for a long while, your GP may offer you antidepressants called selective serotonin-reuptake inhibitors (SSRIs). These don’t work overnight; you may need to take them routinely for four to six weeks before you feel any benefit.
  • Beta-blockers. These may help to ease specific physical symptoms, such as palpitations (feeling your heart is racing) and trembling hands.
  • Benzodiazepines (a type of tranquiliser). These can help to relieve very severe anxiety. They can be addictive, so they’re best used only for very short periods, such as when you have to face the situation you fear (for example, getting on a plane).

Always carefully read the patient information leaflet that comes with your medicine. If you have any questions about taking your medicines, you can ask a pharmacist for advice.

Causes of phobias

It’s not clear why some people develop phobias and others don’t. It may be due to many factors acting together. Sometimes, the start of your phobia may be related to a frightening situation or place. But many people can’t remember any specific event or situation that led to their phobia.

You can develop a phobia at any age, but most specific phobias begin in children aged between seven and 10 years. Sometimes phobias are learnt because the child sees other people around them acting fearfully (for instance, on seeing a spider). Social phobia may begin during the teenage years, perhaps following experiences of being embarrassed or humiliated. Agoraphobia can sometimes start after a panic attack, because you worry about having another one in a similar situation. Phobias in adults, especially specific phobias, are often a continuation of childhood phobias.

Some types of phobia, especially a fear of blood or injury, and social phobia may run in families.

Complications of phobias

If you have a phobia, you’ll try to avoid whatever’s causing your fear. Social phobia 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. A fear of needles can stop you having vaccinations or taking necessary medicines, such as insulin for diabetes. It’s natural to want to avoid the thing you fear, but avoidance keeps your fear alive.

You may find that your anxiety makes you turn to props such as alcohol or tranquilisers. If you’ve been trying to cope with your phobia (especially social phobia) with alcohol or tranquilisers, you’re not alone. You might feel more relaxed at first, but taking alcohol or tranquillisers is very risky because it might become a habit. You could end up having to deal with two problems – the original anxiety, and the effects of the alcohol or medicine you’re taking.

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.

Frequently asked questions

Expand all

  • Can I have more than one phobia at a time?

    Yes. If you already have one phobia, you can develop another one. Many people have several specific (simple) phobias, fearing more than one object or situation at the same time. It’s not unusual to have both agoraphobia and social phobia - more than half of people who have agoraphobia also have social phobia.

    If you have a phobia, you also have a greater risk of developing other mental health problems, such as panic disorder (a fear of having further panic attacks) and depression.

  • How can I help my friend who has a phobia?

    Phobias are often treated more successfully if family and friends get involved, so it’s good to offer your support . Here are some suggestions for how you can help.

    • Learn more about phobias and how they’re treated. Read about personal experiences to get an idea of what your friend is going through.
    • Be patient and listen to your friend. Ask what help they would like from you.
    • Don’t pressure them into facing their fears.
    • Gently encourage your friend to see their GP, get help from a therapist or try self-help remedies (see our section ‘Treatment of phobias’).
    • Offer practical help, such as arranging appointments or going to appointments with your friend.
    • Offer to be with your friend when they’re facing situations they fear and ask how you can help. For instance, they may want you to take them out of the situation if they get symptoms or help them become calmer.
    • Always remember that your friend’s fear is very real to them, even if the situation doesn’t seem dangerous to you. Let them know you understand that.
    • Sometimes your friend may want to do things on their own, so remember to give them some space when they need it.

    Remember that it’s important to look after yourself too. Don’t take too much on, and try and share your caring role with others if you can. By protecting your own mental health you’ll be in the best place to help your friend.



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Depression

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Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of talking therapy. It helps you change how you think, feel and behave.

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  • Other helpful websites

  • Sources

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    • Mental health. Oxford Handbook of General Practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2014
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    • Panic disorder. PatientPlus. patient.info/patientplus, last edited December 2016
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    • Cognitive and behavioural therapies. PatientPlus. patient.info/patientplus, last edited April 2014
    • Specific phobic disorders. The MSD Manuals. www.msdmanuals.com, last full review/revision July 2018
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    • Social anxiety disorder: recognition, assessment and treatment. National Institute for Health and Care Excellence (NICE), 2013. www.nice.org.uk
    • Antidepressant drugs. NICE British National Formulary. bnf.nice.org.uk, accessed May 2019
    • Beta-adrenoceptor blocking drugs. NICE British National Formulary. bnf.nice.org.uk, accessed May 2019
    • Anxiety, panic and phobias. Royal College of Psychiatrists. www.rcpsych.ac.uk, accessed May 2019
    • Phobias. Mind. www.mind.org.uk, published March 2017
    • How to access mental health services. NHS. www.nhs.uk, last reviewed April 2019
    • Personal communication, Dr Rahul Bhattacharya, Consultant Psychiatrist, May 2019

  • Author information

    Reviewed by Dr Kristina Routh, Freelance Health Editor, May 2019
    Expert reviewer Dr Rahul Bhattacharya, Consultant Psychiatrist
    Next review due May 2022

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