Specific Phobias: Not Your Average Fear!

Imagine a fifteen years old girl hating to visit her best friend’s house just because of her small little kitten. Well that’s weird, isn’t it? To some people, it might be yes, but all I can say is welcome to my world.

Welcome to my world! A world where cats are considered a threat to my life

Even though they are very cute, small, and I surely won’t fit in their tiny stomachs, but believe me I say they are terrifying to me.

 Let me illustrate why I stopped visiting my best friend’s house

One day, she invited me to her birthday and I was super excited to be beside her on her special day. What I didn’t know was that this day will turn out to be one of my worst. She had received a small kitten as one of her gifts. At the sight of the cat, fear was flowing through all my body and I started shaking.

From this day on, I haven’t even come closer to her door.

Have you ever seen a pink banana? Me neither, but I bet you imagined it. What our brains love to do is fall into imagination. Foe example, you may imagine yourself walking on the beach, or flying over a pair of trees. For me, I can imagine myself being eaten by a cat, oh and not an ordinary cat, a small white kitten that my brain perceives as a lion, and that is the story behind my phobia.

 In the following lines, we will be discussing the background of this disorder, its causes, symptoms, diagnostic criteria, and treatment.

What is a phobia?

Phobia is defined by the American Psychiatric Association as an exaggerated and irrational fear.

Phobic disorders are part of the class of anxiety disorders

The DSM-V criteria classify phobias into two general groups:

• The simple phobia or a phobia that can be linked to an object or a situation, under this category falls in the specific phobias of our topic of discussion
• The complex phobia where the trigger is less easily recognized. Agoraphobia and social anxiety fall under this category

Specific phobias

 Five main categories are present under the umbrella of specific phobias:

• Fear of animals (e.g. fear of spiders: arachnophobia)
• Fear of natural environment (e.g. fear of darkness: nyctophobia)
• Fear of blood and needles are also known as hemophobia
• Situational fears (e.g. fear of flying: aviophobia)

Fear vs Phobia

Everyone, whether they admit it or not, has fears. It could be the fear of failing a test, losing someone close or speaking in front of a crowd. Yet, they work it out and it does not affect their everyday life. On the other hand, a phobia is an exaggerated fear that affects a person’s everyday life.

For example:

Let us suppose you dislike spiders and don’t like to be near them. If you only have a fear of spiders, it would not stop you from camping despite knowing that the woods can have spiders.

If someone is phobic – irrationally afraid from spiders – even if that person adores camping, they would avoid this activity to never be in contact with any spider.

When a person has a phobia, they will often shape their lives to avoid what they consider to be dangerous

Causes behind phobias

To this day, there is no specific course of disease describing the development of a phobia. Some recent reviews address the biopsychosocial model in explaining the rise of specific irrational fear.

Genetics might play a role meaning that if you have a phobic relative you are at greater risk of developing a phobia

Other factors might be traumatic experiences such as being attacked by a dog. In addition to that, the cultural aspect might be involved; for example, raising a child to fear snakes can turn into Ophidiophobia (snake phobia).

Symptoms

Symptoms may arise when the person is confronted by this object/situation of fear or sometimes when they’re just thinking about it. The dominant pattern of symptoms is caused by increased activity of the sympathetic autonomous nervous system such as increased heart rate, increased blood pressure, tachypnea, diaphoresis, trembling, and chest pain; chills can also be experienced.

Diagnostic criteria

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines 7 diagnostic criteria for specific phobias: 

• Marked fear or anxiety about a specific object or situation (in children fear or anxiety may be expressed by crying, tantrums, freezing, or clinging)
• The phobic object or situation almost always provokes immediate fear or anxiety
• The phobic object or situation is avoided or endured with intense fear or anxiety
• The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more
• The fear, anxiety, or avoidance is out of proportion to the actual danger posed by the specific object or situation and to the socio-cultural context
• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
• The disturbance is not better explained by symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms; objects or situations related to obsessions; reminders of traumatic events; separation from home or attachment figures; or social situations.

Treatment options

People living with phobias are generally aware of their condition. This is usually very helpful for the diagnosis and treatment journey

The first-line treatment is cognitive-behavioral therapy (CBT). The latter aims to teach people how to alter their response to their source of fear by being mindful of their irrational behavior. It also helps them understand that the worst-case scenario is less likely to happen.

Other approaches are desensitization or exposure therapy. Here, the patients are exposed systematically and gradually to their source of fear. They are also equipped with coping mechanisms and techniques that will help them overcome the situation.

Sometimes these therapies fail or do not give a significant effect

The psychiatrist might choose to add medications to the treatment course or to use them solely as a treatment option. Multiple classes of medication might be utilized for this matter: SSRIs for example are often prescribed. If they fail, they might be replaced with MAOI. Tranquillizers – such as benzodiazepines – on the other hand, are less likely to be used due to their risk of physical dependence. FDA warns against their use in this situation especially if the patient has a history of alcohol dependence. Other non-neurological drugs such as beta-blockers are sometimes prescribed to reduce physical signs of anxiety.