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Phobia: Definition, Types, Causes, Symptoms, Treatments, Prognosis and Daily Life

Phobia: Definition, Types, Causes, Symptoms, Treatments, Prognosis and Daily Life

Medically reviewed by Jeevika Yu, written by Carl Lee. Reading Time: 13 minutes

This article will give you a more comprehensive understanding of phobias in the following aspects:

Let's dive in!

Overview

  • Unusual fear of external things or situations.
  • Manifestations of anxiety, nervousness, avoidance, fear.
  • The higher incidence rate in women than men.
  • The combination of psychological and pharmacological treatment is effective.

 A video about phobias:

 Video sources: Osmosis

 

Definition of phobia

Phobia, also known as phobia and phobic neurosis, is a neurological disorder characterized by an excessive and unreasonable fear of something external or a situation.


The attacks are often accompanied by significant anxiety, autonomic disturbances, and avoidance reactions. The patient has difficulty in self-control. 


The symptoms recur so that they interfere with their normal activities. There are three types of phobias: agoraphobia, social phobia, and specific phobia.


Types of phobias

Agoraphobia

Agoraphobia, also known as place phobia, is an anxiety and fear disorder. The object of the fear is a specific place or situation, such as a square, a dark closed room, a crowded place, and transportation. 


Even though there is no danger at the time, the patient is still overly concerned that there is no immediately available escape exit, difficulty escaping, or that help will not be available.


The DSM-5 includes agoraphobia as a separate disorder from anxiety disorders, making it a separate subtype of the latter.


Social phobia

Social phobia, also known as social anxiety disorder, is a type of anxiety and fear disorder. There is an intense fear or anxiety about social or public situations and avoidance of social behavior. Patients are often accompanied by low self-esteem and fear of criticism.


Specific phobia

Specific phobia is also known as specific phobia, simple phobia. It refers to an unreasonable fear of a specific object, scene, or activity. The object of fear is usually not the thing itself but the possible dire consequences. For example, patients are afraid to touch sharp objects and fear traffic accidents.


Epidemiology

Epidemiological data vary for different types of phobias.


Agoraphobia

The incidence varies little across cultures and ethnicities. It can start in childhood, mainly in the 20s and 30s, and peak in late adolescence and early adulthood. The prevalence of the disease is higher in women than in men.


Social phobia

The lifetime prevalence of social phobia in the United States is 13.3%, more common in women than men, with an average age of onset of about 15 years.


Specific phobia

The lifetime prevalence of this type of phobia is 11.3%. The average age of onset is 15 years. The prevalence is more than twice as high in women as in men.


Causes of phobias

The etiology of phobias is still unclear and may be related to genetic, biological, qualitative, and psychosocial factors.


Underlying causes

Genetic factors

Research shows that phobia is related to inheritance. The heritability of agoraphobia has been reported to be even as high as 61%.


Neurobiology

The neurobiological etiology of social phobia is not clear. Studies suggest that it may be related to the adrenergic system, 5-hydroxytryptamine system.


Psychosocial factors

Adverse experiences during adolescence may lead to the development of a social phobia. And the persistence and generalization of symptoms lead to anxiety and fear in patients in an increasing number of situations.


Personality factors

People with personality traits such as timidity, shyness, dependence, high introversion, and compulsiveness are prone to phobias.


Symptoms of phobias

The primary manifestation of phobia is an unusual, excessive, and irrational fear of an external object or situation. It is often difficult to control, and the symptoms are recurrent.


Typical symptoms

Agoraphobia

  • Anxiety: When patients are exposed to public places or places where people gather, they are emotionally irritable, fear fainting, have difficulty controlling themselves, and have more frequent panic attacks.
  • Avoidance: Patients will reduce their anxiety by avoiding people and avoiding crowded places.
  • Anticipatory anxiety: Patients are anxious and nervous even before they arrive at a crowded gathering place. In severe cases, they cannot even leave the house.
  • Other symptoms: depressive symptoms, depersonalization, and obsessive-compulsive thinking may also occur.

Social phobia

Patients are shy in the social process. The patient is unusually nervous and embarrassed, fearing that they will make a fool of themself in public, that others will laugh at them, and that others will give them a wrong opinion.


The object of the patient's fear can be a stranger, an acquaintance, or even their relatives or spouse. The more common objects are the opposite sex, supervisors.


Specific phobia

It is an unreasonable fear of a specific object or animal, such as animals, natural environment, receiving injections, seeing blood, scenes, and other stimuli.


Usually, the patient has a fear of only one specific object. However, there is a fear of multiple objects simultaneously in rare cases, causing a strong emotional and physical reaction relieved by avoidance.


Seeking medical treatment

Diagnostic criteria for agoraphobia (DSM-5):

  1. Significant fear or anxiety about 2 or more of the following 5 conditions.
  • Travel by public transportation such as cars, buses, trains, boats, planes, etc
  • In open spaces such as parking lots, bazaars, bridges, etc
  • In enclosed spaces such as stores, theaters, cinemas, etc
  • Standing inline or in the middle of a crowd
  • Leaving home alone

  1. Individuals fear or avoid these situations because of the thought of panic-like symptoms or other symptoms of loss of function or distress, such as fear of falling, fear of incontinence, fear of difficulty escaping, or lack of help in the elderly.
  2. Square fear situations almost always promote fear or anxiety.

  1. The individual always actively avoids the square fear situation that needs company or endures with intense fear or anxiety.

  1. This fear or anxiety is not commensurate with the danger posed by the square’s fearful situation and socio-cultural environment.

  1. This fear, anxiety, or avoidance usually lasts for at least 6 months.

  1. This fear, anxiety, or avoidance causes clinically significant distress or leads to impairment in social, occupational, or other vital functions.

  1. This fear, anxiety, or avoidance is excessive even in the presence of other somatic diseases such as inflammatory bowel disease, Parkinson's disease, etc.

  1. Symptoms of other mental disorders cannot better explain this fear, anxiety, or avoidance. For example, it cannot be limited to specific phobias, situational symptoms: it cannot only involve social situations in social anxiety disorder; 

Similarly, it cannot be associated with obsessive thinking in obsessive-compulsive disorder, problems perceived in physical appearance in somatoform disorder, memories of traumatic events in posttraumatic stress disorder, or anxiety about separation in separation anxiety disorder.


Note: A diagnosis of agoraphobia can be made regardless of the presence or absence of panic attacks. Doctors may give both diagnoses if an individual's presentation meets the diagnostic criteria for panic disorder and agoraphobia.


Diagnostic criteria for social phobia:

  1. Individuals experience significant fear or anxiety when faced with one or more social situations in which others may scrutinize them. 

For example, social interactions, meeting and conversing with strangers, eating and drinking while being watched by others, and performing or speaking in front of others.


Note: This anxiety in children must occur when interacting with peers, not just when interacting with adults.


  1. Individuals fear that their words, actions, or presentation of anxiety symptoms will lead to negative evaluations, i.e., being humiliated or embarrassed, leading to rejection or offending others.

  1. Social situations can almost always promote fear or anxiety, such as fear or anxiety in children, manifest as crying, gasping, stunned, clinging to others, cowering, or being afraid to speak in social situations.

  1. People with social phobia avoid social situations or endure them with intense fear or anxiety.

  1. The fear or anxiety is not commensurate with the actual threat posed by the social situation and sociocultural environment.

  1. This fear, anxiety, or avoidance usually lasts for at least 6 months.

  1. This fear, anxiety, or avoidance causes clinically significant distress or leads to impairment in social, occupational, or other essential functions.

  1. This fear, anxiety, or avoidance cannot be attributed to a substance, such as drugs of abuse, medications, physiological effects, or other physical illnesses.

  1. This fear, anxiety, or avoidance cannot be better explained by symptoms of other psychiatric disorders, such as panic disorder, somatoform disorder, or autism spectrum disorder.
  2. If other physical illnesses are present, such as Parkinson's disease, obesity, burns, or trauma-induced deformities, the fear, anxiety, or avoidance is unrelated or excessive.

Diagnostic criteria for specific phobias:

  1. Significant fear or anxiety about specific things or situations, such as flying, heights, animals, receiving injections, seeing blood.

Note: Children's fear or anxiety may manifest as crying, tantrums, being stunned, or clinging to others.


  1. Fearful things or situations can almost always trigger immediate fear or anxiety.

  1. People with specific phobia actively avoid the fearful thing or situation or endure it with intense fear or anxiety.

  1. The fear or anxiety is not commensurate with the actual danger posed by the particular thing or situation and the socio-cultural environment in which it occurs.

  1. This fear, anxiety, or avoidance usually lasts for at least 6 months.

  1. This fear, anxiety, or avoidance causes clinically significant distress or leads to impairment in social, occupational, or other essential functions.

  1. The disorder cannot be better explained by symptoms of other mental disorders, including panic-like or other loss-of-function symptoms, things or situations associated with obsessive-compulsive thinking, cues associated with traumatic events, fear, anxiety, and avoidance due to leaving home or leaving an attachment figure, or social situations.

Medical Departments

People can visit a mental health center (psychiatric hospital), a psychiatric department, or a psychiatry department of a general hospital.


Related checks

There are no special tests related to the disease, mainly some routine tests to exclude organic diseases. Some specialized scale tests may be helpful for diagnosis.


Differential diagnosis

Agoraphobia should be differentiated from the following normal or pathological states:

  • Fear: Normal people also fear certain things or occasions, such as poisonous snakes, fierce animals, dark and silent environments, etc.

The point of differentiation is the reasonableness of the occurrence of this fear, the frequency, and degree of occurrence, whether it is accompanied by autonomic symptoms, whether it affects social interaction, and whether there is avoidance behavior. 


Generally speaking, the absence of avoidance is not pathological.

  • Generalized anxiety disorder: The core symptom is anxiety, but a specific object causes anxiety in phobias. In contrast, anxiety disorders often do not have a transparent object and often persist.
  • Obsessive-Compulsive Disorder: The fear in OCD does not originate from external things but one's own internal thoughts or ideas. Also, people with OCD engage in counter-compulsive behaviors.

We should differentiate social phobia from the following normal or pathological states:

  • Shyness: Some people can also show shyness and uneasiness when there are many people. At the same time, the diagnosis of social phobia requires a certain severity, and daily life is affected.
  • Somatic deformity disorder: Patients are reluctant to go out and interact with people because they believe their physical appearance is deformed.
  • Schizophrenia: Patients are reluctant to socialize because they are afraid of being talked about and persecuted and do not have any motivation to socialize, whereas patients with social phobia are anxious because of their fear of socializing.

Specific phobias should be differentiated from the following pathological states:

  • Obsessive-compulsive disorder: see the previous section for details.
  • Schizophrenia: Patients with phobias have a deep awareness of the irrationality of fear and do not have the typical symptoms of schizophrenia.
  • Others: such as hallucinogen abuse, tumors of the central nervous system, and cerebrovascular diseases, are accompanied mainly by somatic, sensory, and psychiatric abnormalities.

Treatments of phobia

Both psychotherapy and medication effectively treat phobias, and the combination of the two is most effective.


Medication

Due to significant individual differences, there is no absolute best, fastest, or most effective medication. 


In addition to commonly used over-the-counter medications, patients should select the most appropriate medication under the guidance of a physician with full consideration of individual circumstances.


Patients can be treated with the following medications under the guidance of a physician:

  • Anti-anxiety drugs: alprazolam and lorazepam are commonly used drugs for patients. The effect is rapid for patients with agoraphobia. These drugs are very effective for intense panic or anxiety in emergencies. Although patients with social phobia can also use these drugs, patients should not use them for a long time.
  • Antidepressants: It can be used to treat place fear disorder without depression but frequent panic attacks, and It’s the first-line medication for social phobia.
  • Other: beta-blockers are effective for tremors caused by psychological factors.

Psychotherapy

  • Behavioral therapy: the preferred method of treating square phobia. The doctor should first figure out how the patient's fear is formed. Then, in response to the patient's personality characteristics and mental stimuli, the doctor should use appropriate behavioral therapies, such as systematic desensitization therapy and exposure therapy.
  • Cognitive-behavioral therapy: Some relevant clinical studies suggest that the short-term efficacy of cognitive-behavioral therapy is similar to that of drugs. In contrast, the long-term efficacy may be better. Changing the patient's misconceptions about fear can reduce the fear response and decrease the occurrence of symptoms.
  • Supportive psychotherapy: This approach can facilitate adaptive coping with fear.
  • Relaxation therapy and mindfulness therapy are also helpful for phobias.

Prognosis

Agoraphobia: Although there are usually some cases of shorter duration, surveys have shown that agoraphobia with a duration of 1 year has little change over 5 years. 

Chronic agoraphobia can often present with short episodes of depressive symptoms, and patients are likely to seek help during this time.


Social phobia: The disorder usually lasts for many years. A community survey showed that the average duration of symptoms in patients diagnosed with social phobia is close to 20 years. 


Patients with this disorder are at an increased risk of developing depressive disorders. If patients are not treated promptly and effectively, their lives will be significantly affected.


Specific phobias: There are no systematic studies on the prognosis of specific phobias in adults. Clinical experience suggests that specific phobias originating in early childhood can persist for many years. In contrast, specific phobias that appear in adulthood have a better prognosis.


Daily Life

The daily management of the disease focuses on taking medication on time as prescribed by the doctor and moderate physical activity.


Home Care

Social phobia can take a long time to recover because of the long duration of the disease. Patients need not only regular treatment but also help from family and society. 


Family members and friends should be more supportive and accommodating. Regular encouragement will help the patient to recover.


The same is true for agoraphobia and specific phobias.


Daily life management

Patients should usually follow medical advice, take medication on time and follow up regularly; simultaneously, patients should also do moderate physical exercise to minimize the psychological stimulation of adverse factors.


Prevention

Fear is a painful experience, but it is not entirely negative fear, but instead has a self-defense role. Mental fear and tension is natural compensatory reaction, many of which are related to the psychological development of children. 


Therefore, early personal psychological development may be necessary for the prevention of the disease.

  • Agoraphobia: Patients should exercise their abilities and physical and mental health qualities, and family and friends should support them more.
  • Social phobia: Schools should provide pre-adolescent psychoeducation to adolescents, which allows early identification of sensitive populations. Also, schools should practice social skills with children in moderation.
  • Specific phobias: Schools can target the prevention of adverse factors that may trigger fear and reduce psychological stimulation.

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