Specific Phobia Disorder

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Most people have heard of things like arachnophobia, the fear of spiders, but did you know that having a fear of spiders can actually become a clinically significant diagnosis? Specific Phobia is a disorder that is triggered by specific events or objects in a way that is considered out of the normal range of response.

Specific Phobia Disorder

The Diagnostic and Statistics Manual of Mental Disorders first recognized Specific Phobia in the third version of the manual (DSM-3) back in 1980. Since then, Specific Phobia has evolved in its definition and treatment methods since then. Today, the requirements for a diagnosis of Specific Phobia disorder are as follows:

You must experience significant fear or anxiety about a specific object or situation
The phobia trigger nearly always provokes immediate fear or anxiety
The phobia trigger is actively avoided or endured with intense fear or anxiety
The phobia trigger does not present a reasonable amount of danger that matches what is perceived by the person experiencing the phobia
The person with the phobia experiences a clinical amount of distress or impairment in their social, work, or other areas of important functioning.
The phobias are not better explained by another mental disorder, past traumatic events, or social situations

Because there are so many opportunities for people to experience different types of phobias, it is often listed in a person’s diagnosis which type of phobia they have. There are five broader categories that make up the potential phobias:

Animal

Includes fear of spiders, insects, dogs
A person will actively avoid lawns and nature for a spider or insect specific phobia

Natural environment

Includes fear of heights, storms, water
A person will actively avoid flying or tall buildings with a fear of heights.

Blood-injection-injury

Includes fears of needles, blood, or invasive medical procedures
A person with a needle disorder may experience panic attacks or fainting when required to undergo a blood draw for medical reasons.

Situational

Includes fears or airplanes, elevators, or enclosed places
A person with a fear of elevators or enclosed spaces may take the stairs, even if they need to climb up to high numbered floor.

Other

Includes fears of choking, vomiting, loud sounds, costumed characters, etc.
A person with a fear of vomiting (emetophobia) may avoid performing the bodily process when ill, to the point of making themselves sicker, or will be unable to be around others who are ill and needing to vomit.

This list isn’t exhaustive, as there can be a phobia for any object or situation.

Specific Phobia Symptoms

The main symptom of specific phobia that is most easily recognized is a panic attack, however, it is not required for you to have a panic attack in order to still fit the clinical definition for Specific Phobia Disorder. As a refresher, here is a list of panic attack symptoms:

nausea or upset stomach
chest pain or tightness
feeling like you’re choking
dry mouth
profuse sweating
increased blood pressure
racing or pounding heart
shortness of breath
trembling or shaking
feeling like you’re choking
feeling dizzy or light-headed
feeling a sense of impending doom
being unable to speak or rapid (potentially incoherent) speech

Specific Phobia Causes

There are multiple potential contributing factors for Specific Phobia. Sometimes it can be a lone outlying factor or a combination of factors that lead to the presence of Specific Phobias.

Biological

The way our brains work and how overstimulated our brains become in the presence of a stressor, even a slight one, can predispose someone towards an Anxiety disorder. If you have a family member with Anxiety, it is possible that your genes, or the way in which they are methylated (turned off/silenced) could contribute to your developing Anxiety.

Genetic

Having a family member with an Anxiety disorder, or a Specific Phobia can dramatically increase your chances of developing the same condition as there are learned patterns in fear that children can experience and then emulate later on. Having overprotective parents can lead to misguided levels of fear, while parents who over criticize could lead to a neural environment with a higher chance of overstimulation in the presence of stress.

Whether you saw fears modeled to you, or were conditioned over time to exert more caution than necessary, the environment, and the way fears were handled in front of you can open the door to a Specific Phobia.

Psychological

Traumatic experiences, especially ones experienced as a child can lead to a diagnosis of a Specific Phobia. Repeated trauma heightens the chances. Brain injuries, ongoing medical conditions and substance abuse can also contribute to the development of a phobia.

Diagnosing Specific Phobia

Statistically speaking, women and children, or people from low socio-economic statuses are most at risk for developing a specific phobia. Men, on the other hand, are the most likely to develop a fear of dentists or visiting the doctor.

Different types of Anxiety can mimic each other, and narrowing down your specific type of anxiety may take time and further testing or evaluations. Here is a list of closely related forms of Anxiety that your symptoms may match with, at least partially.

With schizophrenia, hallucinations and other mental disturbances can cause a person to develop a phobia, however, unlike a person with Specific Phobia Disorder, a person with schizophrenia fails the reality test.

Most people who suffer from Specific Phobia Disorder are aware that their fears are irrational, and can then learn to cope with their fears.

Specific Phobia Treatment

The first suggested form of treatment for Specific Phobia is a form of Cognitive Behavioral Therapy (CBT). Exposure therapy, although mentally and emotionally taxing, can have the most practical results for you if you’re struggling with a specific phobia.

Not everyone is willing to put themselves through a full course of exposure therapy and may not receive the full treatment they need. With exposure therapy though, you can be coached through relaxation techniques and breathing exercises to lessen your reaction to your phobia, and still receive CBT for future interaction with your phobia that can lower your anticipatory anxiety and resulting symptoms.

Flooding is a more intense form of Exposure Therapy that requires a greater commitment from you as the intent is to make your phobia feel like a normal occurrence. Of course, with this form of therapy, there need to be carefully set guidelines and alternate methods in place to help you deal with the emotional toll this type of therapy can take on you. Beta-blockers and benzodiazepines (medications better suited to intense physical reactions and anxiety symptoms, i.e. panic attacks) may be prescribed in advance to help deal with this form of therapy.

Virtual therapy is something which anyone can engage in. While the benefits of this type of therapy aren’t yet fully researched or measured, it is possible that viewing or interacting with your phobia from the safety of your computer may be a potential way to start the process of exposure therapy, or continue your already instituted CBT program.

Other forms of therapy recommended for Specific Phobia is hypnosis, to help retrain your reactions, as well as supportive therapy and family therapy. Since anxiety disorders can cause significant distress on not just the person who deals with it, but also those closest to them, having an environment where your loved ones can discuss the toll your anxiety is taking on them as well as you can be helpful to your recovery process.

Pharmacotherapy is considered to be a better first step for severe forms of Specific Phobia as there is a biological component to anxiety and how our brains respond to different stimuli. Cognitive Behavioral Therapy may not even be used, or minimally used, until your severe Specific Phobia is under control with medication enough to allow you to benefit from your CBT. That being said, if you are using benzodiazepines to control your anxiety, the amount of remission achieved while taking these meds usually vanishes when you stop taking the medication.

Getting a proper diagnosis is tough. People with Specific Phobia are more likely to visit doctors with bodily complaints as they may experience panic attacks that leave them feeling the need for medical advice. Most doctors, however, are either untrained, or practically uncomfortable with addressing a patient’s anxiety and so there aren’t as many people seeking psychiatric help as what there should be after a traditional doctor’s visit. This is where finding a psychiatric professional, clinical pharmacist or a nurse to help recognize your struggles can be the most helpful first step to recovery.

Continuing treatment- even on a reduced maintenance schedule- can be the key to maintaining remission.

Conclusion

Specific Phobia is a type of Anxiety that arises from biological factors, childhood environment, and trauma based experiences. With proper diagnosis and ongoing, or routine, treatment, it is possible to achieve remission. If your symptoms are unmanageable and lead to any form of social, academic, work or any type of impairment, make certain to seek professional help, as Specific Phobias can be debilitating if left untreated. There are many forms of treatment available, don’t be afraid to look around and try different methods until you find something that works for you.

May God Bless and Keep You.