Mental Health

Author: Anxiety Canada

Are you afraid to fly? Do needles make you nervous? Do you avoid dental appointments, elevators, or contact with spiders because you are scared? If so, you may have a phobia. Phobias are intense fears about specific places, situations or things. Phobias can make it hard for you to go to places that you would like to go, make it hard to be effective at work, and put a strain on relationships. This is because people will do whatever they can to avoid the uncomfortable and often terrifying feelings associated with their phobia. If you have a phobia, you are not alone.

Be sure to watch our video for more information!

Recognizing specific phobias: Do I have a phobia?

Eric's Story:

Eric describes himself as "scared to death of flying," a fear that has gotten worse over the last few years. When he is on a plane, he feels trapped, and panicky. His heart races and his throat feels tight. He also sweats excessively. The worst part for Eric is when the plane starts to take off; the shaking of the plane makes him convinced that it is going to crash. He is especially afraid of smaller planes, and when the weather is bad during a flight. He used to start dreading a plane trip a few months before he was due to take one. Now, he won't fly at all. He thinks that his anxiety has become overwhelming and that he will freak out and have a panic attack on the plane.

When Eric considers employment opportunities, one of the first things he thinks about is whether the job would involve flying. He won't even apply for the job if he thinks there is a chance that he will have to travel anywhere by plane. He has also missed several important events, such as his sister's wedding in France. Eric knows his fear of flying is an irrational fear, but he can't seem to overcome it.

Karen's Story:

Karen has a dog phobia that dates back to when she was bitten as a child by a neighbour's dog. Since that time, she has avoided anything to do with dogs, including looking at pictures of dogs, and being around real dogs or places where dogs might be (e.g., local parks). She believes that dogs are very dangerous, and is afraid that if she gets near one it will bite her and that she will be seriously injured. She insisted that her husband give away his own dog before they were married, which created a great deal of tension in their relationship. She is often afraid to walk around her neighbourhood and is unable to walk her children to school, even though it is only a few blocks away. If there is a dog tied up by a store she will not be able to enter the store, which often interferes with her ability to shop and run errands. She often has nightmares about dogs, causing sleep problems. In the past, she has been unable to get out of her car while a dog and owner walked by, and at least three times this situation has triggered a full panic attack.

Karen is aware that her fear of dogs is excessive compared to other people. However, she cannot manage her extreme fear or her urges to avoid or escape anything related to dogs. Her fear of dogs has become a big problem for her and her family, and it prevents her from moving freely and comfortably outside of her home.

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What is a phobia?

There are five different categories of phobias:

• Animal: fears related to animals or insects (e.g. fear of spiders, snakes, dogs)

• Natural environment: fears related to nature, weather, and environmental events (e.g. fear of heights, fear of water/ocean, fear of lightning and thunderstorms)

• Blood-injection injury: fear of blood, injections, medical procedures and injuries involving blood often resulting in a fainting episode (e.g. getting bloodwork done, getting a vaccination, visiting the dentist)

• Situational: fears triggered by specific situations (e.g. fear of confined spaces, fear of the dark)

• Other: fears that don’t fit into the other categories (e.g. fear of vomiting, choking, sensations)

Simple vs complex phobias

Phobias can be further categorized under two classifications: simple or complex.

Simple phobias (also known as specific phobias listed in the 5 categories above) relate to one specific trigger with an average onset around the age of 8. Individuals with a simple phobia that are diagnosed earlier in their life have an increased likelihood of the symptoms diminishing over time. Simple phobias can be easier to manage because the trigger can typically be avoided more easily.

Complex phobias (most commonly associated with social phobia or agoraphobia) relate to a specific situation that involves numerous triggers. These are typically diagnosed later in life after adolescence/during adulthood, and are often more debilitating and disruptive to an individuals quality of life and functioning because the triggers are more challenging to avoid.

Adults with phobias realize their fears are irrational, but often facing, or even thinking about facing, the feared object or situation brings on severe anxiety. This intense fear reaction leads people to dread confronting common, everyday situations, or avoid them altogether.

For a comprehensive list of specific phobias, click here.

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How do people with a phobia typically react?

If you have a phobia, you may feel a wide range of intense emotions, from mild anxiety to very severe panic and terror. In more severe cases, you may even feel that you are going mad, losing control, or are about to die when facing the feared object or situation. The fear is usually expressed physically by an increased heart rate, sweating, trembling, feeling faint, nausea, feeling of choking, and/or increased blood pressure. Some people will even have a full-blown panic attack (click here to read more about panic attacks). Most of all, you will feel an overpowering urge to 'escape' from the very thing you fear.

Avoidance is the most common reaction because it helps you to feel better and less afraid. This is because avoidance works.in the short-term. But, avoidance tends to make your fear stronger in the long run, because it prevents you from learning new information (e.g., not all dogs are dangerous). Also, if you avoid something once, you are probably going to keep avoiding it every time you see it. The fear can worsen very rapidly as a result. This is why phobias can be such a big problem. To overcome your phobia, you need to face your fears rather than avoid them!

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How can I tell if I have a phobia or a different anxiety disorder?

Many people with an anxiety disorder are afraid of specific places, situations, or things, and often avoid them. However, this does not necessarily mean that they have a specific phobia. The following are some suggestions on how to tell the difference between a specific phobia and other anxiety disorders.

• A person with panic disorder may fear and avoid several types of situations, such as elevators, driving, or flying. However, the person's main fear is about having a panic attack in the situation and being trapped. Adults with Panic Disorder report that if they do not have panic attacks, they would not be afraid of being in these situations. On the other hand, a person with a specific phobia is afraid of the situation itself, for example, being in a plane crash, or getting in an accident, not the panic attack.

• A person with post-traumatic stress disorder (PTSD) may avoid certain situations, but the situations are related to a trauma that they have experienced. For example, a person with PTSD resulting from a serious car accident may avoid driving, because it reminds them of the crash, not because they have suddenly developed a phobia of cars or driving. Also, people with PTSD have symptoms of reliving the trauma, which don't occur in specific phobia.

• People with social anxiety disorder can fear several situations, such as parties, going to the mall, or talking to strangers. However, people with social anxiety disorder are afraid of being embarrassed or saying something "stupid" in social situations; they are not afraid of the situation itself, but rather the social interaction with others when they are in that situation. For example, a person with social anxiety may fear doctor appointments, but it is because of the social interaction involved rather than the medical procedures or injections.

TIP: Remember, a person may have more than one of these disorders at the same time. For example, you may have a specific phobia of choking and also experience a lot of social anxiety when eating in public.

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How does a phobia develop? Where do phobias come from?

There are many theories about the cause of specific phobias.

• Research suggests that phobias can run in families, and that both genetic and environmental factors (nature and nurture) can contribute to developing a phobia.

• Some people develop a phobia after being exposed to a traumatic or frightening event. For example, you can develop a fear of water after nearly drowning.

• People can develop a phobia after receiving frightening information about something, or being instructed to stay away from an object or situation (especially when young). This is often done inadvertently, but not always. For example, some children may develop a phobia of an animal after a trusted adult repeatedly warns them the animal is dangerous and might bite them.

• Finally, a person may develop a phobia by observing the anxious response of others to objects or situations. For example, a child may develop a spider phobia after watching an older sibling scream and run after being in contact with a spider. These 'childhood' phobias sometimes continue into adulthood.

Generally speaking, most people find that their phobia develops gradually over time, or comes and goes over a long period. Many people find that no particular cause or trigger is involved in the development of their phobia. Regardless, it is less helpful to spend a lot of time and energy 'rooting out the cause'. The point is to learn how to manage the phobia.

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Specific phobias: The facts

• Between 5.5% and 7.4% of individuals will develop a specific phobia in their lifetime, and about 60% of those individuals will develop an additional anxiety disorder on top of their phobia.

• About 5% more individuals who develop a phobia are women.

• Phobias are significantly more likely to develop in high to higher-middle income countries than in low to lower-middle income countries.

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