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Specific Phobic Disorders

By John H. Greist, MD

Specific phobic disorders consist of persistent, unreasonable, intense fears (phobias) of specific situations, circumstances, or objects. The fears provoke anxiety and avoidance. The causes of phobias are unknown. Phobic disorders are diagnosed based on history. Treatment is mainly with exposure therapy.

A specific phobia is fear of and anxiety about a particular situation or object (see Table: Some Common Phobias*). The situation or object is usually avoided when possible, but if exposure occurs, anxiety quickly develops. The anxiety may intensify to the level of a panic attack (see Panic Attacks and Panic Disorder). People with specific phobias typically recognize that their fear is unreasonable and excessive.

Specific phobias are the most common anxiety disorders. Some of the most are fear of animals (zoophobia), heights (acrophobia), and thunderstorms (astraphobia or brontophobia). Specific phobias affect about 13% of women and 4% of men during any 12-mo period. Some cause little inconvenience—as when city dwellers fear snakes (ophidiophobia), unless they are asked to hike in an area where snakes are found. However, other phobias interfere severely with functioning—as when people who must work on an upper floor of a skyscraper fear closed, confined places (claustrophobia), such as elevators. Fear of blood (hemophobia), injections (trypanophobia), needles or other sharp objects (belonephobia), or injury (traumatophobia) occurs to some degree in at least 5% of the population. People with a phobia of blood, needles, or injury, unlike those with other phobias or anxiety disorders, can actually faint because an excessive vasovagal reflex causes bradycardia and orthostatic hypotension.

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