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Specific Phobias


John W. Barnhill

, MD, New York-Presbyterian Hospital

Reviewed/Revised Aug 2023
Topic Resources

Specific phobias involve persistent, unrealistic, intense anxiety about and fear of specific situations, circumstances, or objects.

Specific phobias are common anxiety disorders that affect about 8% of women and 3% of men yearly. The most common specific phobias include fear of animals (zoophobia), fear of heights (acrophobia), and fear of thunderstorms (astraphobia or brontophobia). At least 5% of people are to some degree afraid of blood, injections, or injury, which can lead to avoidance of blood tests and/or vaccinations. People who have a specific phobia often have 2 or more phobias.

People who have a specific phobia avoid specific situations or objects that trigger their anxiety and fear, or they endure them with great distress, sometimes resulting in a panic attack Panic Attacks and Panic Disorder A panic attack is a brief period of extreme distress, anxiety, or fear that begins suddenly and is accompanied by physical and/or emotional symptoms. Panic disorder involves recurrent panic... read more . However, they recognize that their anxiety is excessive and therefore are aware that they have a problem.

Some specific phobias cause little inconvenience. For example, a city dweller who is afraid of snakes may have no trouble avoiding them. Other specific phobias greatly interfere with functioning. For example, a city dweller who fears elevators may encounter them frequently and thus be routinely faced with a difficult choice: avoid an important work situation, climb many stairs, or endure the elevator ride with great discomfort.

Overview of Phobias

Symptoms of Specific Phobias

People with a specific phobia develop marked fear or anxiety in response to a specific object or situation. They may try to manage their fears and anxieties through avoidance.

Diagnosis of Specific Phobias

  • A doctor's evaluation, based on standard psychiatric diagnostic criteria

Doctors diagnose a specific phobia when people have fear or anxiety that involves all of the following:

  • Is intense and has been present 6 months or longer

  • Concerns a specific situation or object

  • Occurs immediately when the situation or object is encountered

  • Leads to avoidance of the situation or object

  • Is out of proportion to the actual danger

  • Causes significant distress or significantly impairs functioning

Also, doctors rule out other mental health disorders that can cause similar symptoms, such as agoraphobia Agoraphobia Agoraphobia is fear or anxiety about being in situations or places (for example, in crowds and shopping malls or while driving) with no way to escape easily or in which help might not be available... read more , social anxiety Social Anxiety Disorder Social anxiety disorder is characterized by fear or anxiety about certain social or performance situations. These situations are often avoided or endured with much distress. Humans are social... read more , or a stress disorder Specific Phobias Specific phobias involve persistent, unrealistic, intense anxiety about and fear of specific situations, circumstances, or objects. The anxiety caused by a phobic disorder can interfere with... read more . It is also possible for a person to have a specific phobia along with another mental health condition, such as the anxiety disorders already mentioned, depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more , bipolar disorder Bipolar Disorder In bipolar disorder (formerly called manic-depressive illness), episodes of depression alternate with episodes of mania or a less severe form of mania called hypomania. Mania is characterized... read more , substance-related disorders Overview of Substance-Related Disorders Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people ... read more , somatic symptom and related disorders Overview of Somatic Symptom and Related Disorders Somatic symptom and related disorders are mental health disorders characterized by an intense focus on physical (somatic) symptoms that causes significant distress and/or interferes with daily... read more , and personality disorders Overview of Personality Disorders Personality disorders are mental health conditions that involve long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or... read more —particularly dependent personality disorder Dependent Personality Disorder Dependent personality disorder is characterized by a pervasive, excessive need to be taken care of, leading to submissiveness and clinging behaviors. People with dependent personality disorder... read more .

Treatment of Specific Phobias

  • Exposure therapy

  • Relaxation and/or breathing techniques (for example, hypnosis)

  • Sometimes limited use of medications (for example, a benzodiazepine or beta-blocker)

Some people do well without treatment because the situation or object they fear is easy to avoid. Bats and caves are examples. If situations or objects (such as thunderstorms) are commonly encountered, treatment is often needed.

Exposure therapy, a type of psychotherapy, is the treatment of choice. Exposure therapy involves exposing people gradually and repeatedly—in their imagination or sometimes in reality—to whatever triggers their fear. People are also taught relaxation and/or breathing techniques to use before and during exposure. Exposure therapy is repeated until people become very comfortable with the anxiety-provoking situation. A therapist can help ensure that the therapy is carried out correctly, although people can do it on their own.

Exposure therapy helps more than 90% of people who do it faithfully. It is almost always the only treatment needed for specific phobias. Even people with a phobia of blood or needles respond well to exposure therapy. For example, such people might begin the exposure by just visiting a doctor's office (or perhaps just walking by the office). The next day (or week), they might sit in an exam room with no intention of getting any blood drawn. The next step might be allowing a needle to be brought close to their skin. Exposure may increase quickly or slowly, but eventually people should allow blood to be drawn.

Medications are not very useful in helping people overcome specific phobias. An exception is the use of benzodiazepines (antianxiety medications) for some specific phobias. For example, people with flying phobias may use a benzodiazepine prior to boarding the plane. The benzodiazepine alone does not generally eliminate the phobia, but it does allow the person to fly. A beta-blocker such as propranolol may be used just prior to an anxiety-producing event such as public speaking.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

Generic Name Select Brand Names
HEMANGEOL, Inderal, Inderal LA, Inderal XL, InnoPran XL
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