Specific Phobia

Definition and common symptoms of Specific Phobia

According to the Diagnostic and Statistical Manual (1994, DSM-IV) of the American Psychiatric Society, a specific phobia disorder is a condition in which there occurs a “clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour”.

The DSM-IV criteria for specific phobia are:

  • A relatively enduring or persistent tendency to experience unreasonable or excessive fear in the presence or anticipation of being exposed to a rather specific object or situation e.g spiders
  • Exposure to the feared object results in the exceedingly fast anxiety response or even a panic attack (Larson et al 2006).
  • The person realizes that their fear is unreasonable or exaggerated.
  • The phobic situation is either endured with intense anxiety or avoided completely.
  • The anxiety invoked by the phobic situation must interfere significantly with the person’s usual routine example at work at home or in social interactions or the person is strongly distressed by having this phobia.
  • In children these symptoms must be present for at least six months.

Research subsequent to the formulation of the above criteria has suggested that the stipulation that the person realizes the fear is irrational or exaggerated is probably unnecessary since less than 1% of a sample of 4800 persons who otherwise fulfilled criteria for specific phobia were unaware that it was unreasonable or exaggerated (Zimmerman et al 2010).

Lifetime prevalence of Specific Phobia

Specific phobia is much more common than most people imagine perhaps because the person with a specific phobia disorder may feel embarrassed about it and hide it from others.

Research has shown that at least one in ten persons have a specific phobia disorder. For example, a recent study by Zimmerman et al (2010) found that the lifetime rate of specific phobia was 11.8% in psychiatric patients and 10.2% in bariatric surgery candidates, respectively.

These results are consistent with lifetime prevalence of 12.5% for specific phobia obtained in an older but much larger sample by Kessler et al (2005). And according to this same study, specific phobia ranked as the third most prevalent psychiatric disorder being outranked only by major depression at 16.6% and alcohol abuse at 13.2%.

Common Phobic objects and subtypes of Specific Phobias

There are a wide variety of possible phobic objects or situations and the DSM-IV divides them into the following four subtypes listed in order of their relative frequency of occurrence (as indicated in the DSM-IV):

  • Situational type. One of the most common types here is fear of flying. Other specific situations include elevators, driving, or enclosed places. Hence fear of flying and fear of enclosed spaces are two of the most common specific phobias.
  • Natural environmental type in which the fear is invoked by objects in the natural environment such as storms, heights, or water.
  • Blood injection type in which the stimulus is observing blood or a severe wound or actually receiving an injection or other intrusive medical procedure e.g. donating blood.
  • Animal type in which the fear is of animals or insects e.g. cockroaches, mice, rats.

Treatments for Specific Phobia

There are a wide variety of treatment approaches for specific phobias and these have been reviewed recently (Choy, Fyer & Lipsitz, 2007). Treatment strategies include the following:

  • In vivo exposure in which the person with the specific phobia is gradually exposed to the phobic object or situation. This is generally thought to be of the most effective kind of treatment but still is usually combined with other strategies e.g. relaxation skills.
  • Exposure using virtual reality to expose subject to the phobic object or situation (Price et al 2008). This is a relatively new treatment approach and preliminary results are promising.

    However, the best results, as indicated by a reduction in self reported anxiety and fear experienced during an actual flight, were obtained when virtual reality exposure is combined with cognitive interventions.”(Choy et 2007).
  • Systematic desensitization in which the client imagines the phobic object in a graded manner and generally using relaxation techniques which they have learned in therapy.
  • Cognitive behavioural therapy in which the goal is to alter maladaptive beliefs e.g. that flying is more dangerous than other forms of transport (Paquette et al 2003), and improve self talk and emotional regulation skills (Schienle et al, 2005; Straube et , 2006).
  • Self-help books. There is considerable research evidence that self-help books can be very effective for some people. Fortunately two excellent self help books are available (Antony, M.M., & McCabe, R.E. (2005).

    Overcoming animal and insect phobias: How to conquer fear of dogs, snakes, rodents, bees, spiders, and more. Oakland, CA: New Harbinger Publications and Antony, M.M., & Watling, M.A. (2006).

    Overcoming medical phobias: How to conquer fear of blood, needles, doctors, and dentists. Oakland, CA: New Harbinger Publications.) Both are available free as PDF downloads from: http://www.martinantony.com/downloads

Choy et al (2007) emphasize that much more research is needed to investigate the long term effectiveness of therapies for specific phobias because “animal extinction studies suggest that relapse is a common phenomenon” and “little is known about long-term outcome”.

Sometimes clients get better in therapy but may still avoid the phobic object or situation to varying degrees e.g. not taking flights unless absolutely necessary.

Do you have a specific phobia?

If you suffer from a troublesome phobia, there are a variety of effective treatment approaches available. For severe debilitating phobia, treatment should be obtained from a properly trained mental health professional who has had some experience in treating anxiety disorders generally and phobias in particular.

For milder cases self-help books may suffice perhaps with additional professional guidance. The main conclusion from this brief review is that there are a variety of effective treatments for specific phobia disorder, and no one today need go through life with a painful restricting specific phobia.

References

(1994). Diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: American Psychiatric Association

Choy , Y., Fyer , A. J. Lipsitz , J. D. (2007). Treatment of specific phobia in adults. Clinical Psychology Review, 27, 266-286.

Kessler, Ronald C., Berglund, Patricia, Demler, Olga, Jin, Robert, Merikangas, K. R., Walters, Ellen E., (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, Vol. 62(6), 593-602, doi:10.1001/archpsyc.62.6.593

Larson , C. L. Schaefer , H. S. Siegle , G. J. Jackson , C. A. Anderle , M. J. Davidson , R. J. (2006). Fear is fast in phobic individuals: amygdala activation in response to fear-relevant stimuli. Biological Psychiatry, 60, 410-417.

Paquette , V. Lévesque , J. Mensour , B. Leroux , J. M. Beaudoin , G. Bourgouin , P. Beauregard , M. (2003). Change the mind and you change the brain: effects of cognitive behavioral therapy on the neural correlates of spider phobia. Neuroimage, 18, 401-409.

Price, M., Anderson, P., Rothbaum, B.O. (2008). Virtual reality as treatment for fear of flying: A review of recent research. International Journal of Behavioral Consultation and Therapy, Vol 4(4), 340-347.

Schienle , A. Schäfer , A. Stark , R. Vaitl , D. (2005). Effects of cognitive behavior therapy in spider phobics measured with fMRI. Psychophysiology, 42, 8-9.

Straube , T. Glauer , M. Dilger , S. Mentzel , H. J. Miltner , W. H. (2006). Effects of cognitive-behavioral therapy on brain activation in specific phobia. Neuroimage, 29, 125-135.

Zimmerman, M., Dalyrymple, K., Chelminski, I., Young, D., & Galione, J.N. (2010). Recognition of irrationality of fear and the diagnosis of social anxiety disorder and specific phobia in adults: Implications for criteria revision in DSM-5. Depression and Anxiety, 27, 1044-1049


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