Specific Phobia in Adults

ICD-10 code: F40.298

Specific phobia is part of a cluster of diagnoses called the anxiety disorders. Anxiety disorders are a group of psychiatric conditions that include:

  • Generalized anxiety disorder
  • Social anxiety disorder
  • Panic disorder
  • Agoraphobia
  • Specific phobia
  • Separation anxiety disorder
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These disorders are characterized primarily by the experience of excessive fear and anxiety. People with generalized anxiety disorder spend a lot of time worrying about a lot of different things. People with social anxiety disorder feel very anxious around other people because they are afraid of embarrassing themselves or being disliked. People with panic disorder have sudden rushes of intense fear or discomfort called panic attacks. They often worry about having another panic attack and might avoid certain situations that might trigger a panic attack. People with agoraphobia are afraid of going into certain situations because they are afraid it might be difficult to escape or because they might experience panic-like or other embarrassing symptoms. Commonly avoided situations are using public transportation, being in open spaces like parking lots, being in enclosed places like movie theaters, or being in a crowd. People with a specific phobia are afraid of a certain object or situation, such as flying, heights, animals, or seeing blood. People with separation anxiety disorder are afraid of being away from a certain person, usually because they are afraid that something bad might happen to them or the other person if they are separated.

The anxiety disorders are characterized by excessive fear and anxiety, along with behavioral disturbances, like avoiding certain places, people, or situations. The anxiety disorders differ from each other in the target or focus of the fear. In some anxiety disorders, like specific phobia, the person is only excessively fearful of a very specific object or situation. In other anxiety disorders, like GAD, the person may feel anxious a great deal of the time or about a lot of different things.

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What is specific phobia?

Specific phobia is a relatively common psychiatric disorder that affects approximately 7-9% of adults. Specific phobia is characterized by fear or anxiety about a specific object or situation. Most people with specific phobia fear more than one object or situation.

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Some common specific phobias include:

  • Flying
  • Heights
  • Certain animals (such as dogs, bees, or spiders)
  • Receiving an injection or seeing blood (called blood/injection/injury phobia)
  • Claustrophobia (fear of confined spaces)
  • Emetophobia (fear of vomiting)

For specific phobia to be diagnosed, the feared object or situation must almost always provoke immediate fear or anxiety. The person actively avoids the object or situation or endures it with intense anxiety. To be diagnosed with specific phobia, the fear or avoidance also needs to be distressing (upsetting) or impairing (getting in the way of the person's life).

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Understanding Specific Phobia

Specific phobia severity can range from mild to very impairing. In severe cases, specific phobia can lead to serious problems at work, school, or leisure activities. For example, some individuals with flying phobia have significant difficulty traveling for business or family vacations.

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Some individuals with medical-related phobias (for example dental phobia) will not pursue medical treatment even when necessary. Most people with specific phobia have multiple feared objects or situations.

Specific phobia seems to be characterized by abnormalities in certain brain regions, particularly those related to emotion generation (e.g., the amygdala and insula), which are thought to contribute to symptoms. In addition, avoiding the feared object or situation is thought to contribute to the maintenance of the phobia. Blood-injection-injury phobia is often characterized by an exaggerated vasovagal response to the feared stimulus, which can result in lightheadedness, nausea, hot or cold flashes, visual disturbance, and/or loss of consciousness (vasovagal syncope). Specific phobia, especially blood-injection-injury phobias, may have a genetic component, although having a genetic predisposition does not necessarily mean that someone will develop specific phobia.

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How is specific phobia treated?

Specific phobia is treatable. Published treatment guidelines for specific phobia are provided by the Society of Clinical Psychology.

First Line Treatment

Exposure therapy is the first line treatment for specific phobia. Exposure therapy consists of gradually exposing the person to the feared object(s) or situation(s).

Other Treatments to Consider

The following treatments have been shown to be effective in the treatment of specific phobia:

  • Alternative cognitive-behavioral strategies such as flooding (exposure therapy administered in a single session), systematic desensitization (exposure therapy administered with guided relaxation exercises), cognitive therapy (learning to think about the situation differently; particularly efficacious for claustrophobia), self-guided or computer-guided exposure therapy, and virtual reality exposure therapy
  • Applied muscle tension (repeatedly contracting large muscle groups) in the case of blood-injection-injury phobia

Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might also be considered:

  • Hypnotherapy
  • Cognitive-behavioral therapy augmented with d-cycloserine
  • Note: benzodiazepines show short-term efficacy in reducing anxiety symptoms, but are associated with poorer long-term outcomes. The benefits should be weighed carefully against the potential complications of physiological and/or psychological dependence. Benzodiazepine treatment may reduce the efficacy of cognitive-behavioral therapy for specific phobia.