Defining Phobias

A person diagnosed with a specific phobia (formerly known as a "simple phobia") experiences excessive, distressing, and persistent fear or anxiety about a specific object or situation (such as animals, enclosed spaces, elevators, or flying) (APA, 2013). Even though people realize their level of fear and anxiety in relation to the phobic stimulus is irrational, some people with a specific phobia may go to great lengths to avoid the phobic stimulus (the object or situation that triggers the fear and anxiety). Typically, the fear and anxiety a phobic stimulus elicits is disruptive to the person’s life. For example, a man with a phobia of flying might refuse to accept a job that requires frequent air travel, thus negatively affecting his career. Between 5% and 12% of the population worldwide suffer from phobic disorders, making it the single largest category of anxiety disorders.

When confronted with the object of their phobia, a person will generally enter a state of panic and experience a wide variety of physical symptoms, such as nausea, increased heartbeat, dizziness, and sweaty palms. For this reason, many people with phobias simply avoid the object of their phobia. Such avoidance can range from not wanting to be outside in a lightning storm to being unable to even look at a picture of lightning.

There are five general categories of phobias:

• Environment phobias (e.g., fear of lightning, fear of tornadoes)
• Animal phobias (e.g., fear of snakes, fear of bears)
• Blood-injury phobias, (e.g., fear of getting a shot, fear of the sight of blood)
• Situational phobias (e.g., fear of heights, fear of public speaking)
• Other phobias not otherwise specified (e.g., fear of vomiting)

Spider phobia

Specific phobias can produce a wide variety of physical symptoms, such as nausea, increased heartbeat, dizziness, and sweaty palms. (Hope you don't have a phobia of spiders!)

DSM-5 Diagnostic Criteria

In order to be diagnosed with a specific phobia, a person must experience a marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). These symptoms must last for at least six months. Exposure to the object of the phobia nearly always elicits extremely distressing symptoms of anxiety, either immediately ("situationally bound") or after some time delay ("situationally predisposed"). The person either avoids the phobic situation(s) or else endures it with extreme distress. 

The avoidance and/or distress associated with the phobia must interfere significantly with the person's academic or social functioning. Like all anxiety disorders, the symptoms must not be better accounted for by another mental disorder or by substance use.

Etiology

At a low level, fear and anxiety are not bad things. In fact, the hormonal response to anxiety has evolved as a benefit, since it helps humans react to dangers. Researchers in evolutionary medicine believe this adaptation allows humans to recognize a potential threat and act accordingly in order to ensure safety. 

The fact that specific phobias tend to be directed disproportionately at certain objects (such as snakes and spiders) may have evolutionary explanations as well. In this view, phobias are adaptations that may have been useful in the ancestral environment. On the savanna, dangers such as large predators, snakes, and spiders tend to be hidden from view until very close and may be a particular danger to infants and small children, favoring the development of an instinctive fearful response. Agoraphobia (fear of open spaces) may have been advantageous to our ancestors if it compelled them to avoid large open spaces without cover or concealment where they could be harmed. Thus, there may be a genetic predisposition to learn to fear certain things more easily than others. 

Though the specific cause of phobias is unknown, they could be inherited; research has shown that if a person has a family member with a phobia, they are more likely to have one themselves. Phobias can also develop because of certain circumstances or occurrences, such as having been bitten by a snake, having seen someone else be bitten by a snake, having witnessed someone else being afraid of snakes, or having learned about someone being bitten by snake.

Treatment

There are various methods used to treat phobias. Systematic desensitization is a process in which patients seeking help slowly become accustomed to their phobia, and ultimately overcome it. Similar to this, virtual reality therapy helps patients imagine encounters with the phobic object by simulating scenes that may not be possible or easy to find in the physical world. Cognitive behavioral therapy (CBT) allows the patient to challenge dysfunctional thoughts or beliefs by being mindful of their own feelings, with the aim that the patient will realize that their fear is irrational. Mainly used to treat post-traumatic stress disorder, eye-movement desensitization and reprocessing (EMDR) has been demonstrated as effective in easing phobia symptoms following a specific trauma, such as a fear of dogs following a dog bite. Hypnotherapy can be used alone and in conjunction with systematic desensitization to treat phobias. Finally, antidepressant medications such as SSRIs or MAOIs may be helpful in some cases of phobia.