Irrational fears can be the stuff of family legend—the uncle who never left his house; the sister who missed a family trip to Alaska because she wouldn’t get on an airplane, or the 10-year-old nephew so terrified of shots he refused to see a doctor.

While most of us wouldn’t be thrilled to find a snake in the toilet or a hairy spider under the covers when these fears trigger digestive distress or interfere with a good night’s sleep, it’s probably time to get help.

The Difference Between Fear and Phobia

The term “phobia” gets thrown around a lot these days, but having a fear and having a phobia aren’t exactly the same thing.

Essentially, fear is temporary; phobia isn’t.

Having a phobia creates a stumbling block in your life, and the fear it causes can be so strong that you’ll do anything to avoid the object of that phobia. Phobia that becomes debilitating is a type of anxiety disorder. Take, for example, a job offer. You made it through the hardest part—landing your dream position—only to find out that your office will be on the 20th floor of an office building…and you have a phobia of heights. In order to avoid being so high off the ground, you turn the position down and pass up a significant job opportunity because of your phobia.1

Phobias can be debilitating and crippling, and they can keep you from enjoying the things you love with the people you love. But it doesn’t have to be this way. There is hope and help for people with phobias.

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A phobia is an intense as well as irrational fear toward one or more things or situations for which the level or intensity of fear does not match the actual danger of what you fear.

A phobia can be specific, like a fear of dogs or being high off the ground. But it can also be overarching, like being in any social setting or public place.2

While fear is a natural and universal human emotion,  having a “phobia” is a medical diagnosis and not a word to be tossed around lightly. To understand phobias, it is helpful to have a deeper understanding of fear and why we experience it.

How Fear Works in the Brain

One of the ways the brain helps keep you alive is by warning you of dangers. When the brain senses danger, an internal alarm system is activated, sending out various signals that trigger feelings of fear or anxiety. These are physical and cognitive reactions triggered in response to whatever it is that your brain perceives as dangerous or scary.

Sometimes, we should be fearful—without fear, we would unknowingly put ourselves into life-threatening situations without taking proper precautions. But the difference between having healthy, occasional bouts of fear and having a phobia is that a phobia is by definition irrational: Despite the intense fear you feel, the circumstance or object of your fear poses little or no actual threat to you.3

Think of a phobia as the brain’s alarm system in overdrive—it overestimates the threat of a particular situation, triggering intense anxiety and leading you to avoid that situation in the future. That avoidance actually makes a phobia worse because it solidifies the brain’s overblown association between the situation and its threat level.

For example, someone who has a phobia of dogs will feel their brain’s alarm system go off every time they are near a dog, explains Steve Mazza, PhD, a senior clinical psychologist at the Columbia University Clinic for Anxiety and Related Disorders in New York. If this person continues to avoid dogs, the brain’s “miscalibration is reinforced, and the person never has the opportunity to recalibrate their alarm system to the actual threat of the environment,” Mazza says.

Knowing that phobias result from brain processes that are meant to protect us from danger can help people de-stigmatize phobias, according to Joe Bienvenu, MD, a professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine in Baltimore. Our brains are adapted to be afraid of things like snakes for safety reasons. But even social phobias, like a phobia of public speaking, can be adaptive because “we’re social animals, and how other people evaluate us often does have consequences,” says Dr. Bienvenu.

What Are the Three Types of Phobias?

There are three main types of phobias, and all of them fall under the category of anxiety disorders: specific phobias (the most common type of phobia), social anxiety disorder, and agoraphobia.6,9 What they have in common, according to Mazza, is an intense emotional reaction that is not commensurate with what is actually happening in the environment, and the avoidance of the stimuli is what maintains the intense, emotional reaction.

Here are the differences between the types of phobias:

Types of Specific Phobias

A specific phobia is defined as an extreme, irrational fear or aversion to a particular thing (an object like an insect or a clown) or situation such as a thunderstorm or being in small, tight places, etc. The fear is so intense it interferes with the way you live. What’s key here is that the object or situation usually does not pose significant (or any) danger, and yet the fear of it is intense and often interferes with your life.1

Within specific phobias, there are five different categories:1

  • Phobias of animals or insects like dogs, snakes, or spiders
  • Phobias of natural phenomena like heights, storms, or water
  • Phobias of blood or injury like getting a blood test or needles
  • Phobias of specific situations like flying in planes, driving cars, or being in confined places
  • Other phobias like choking, vomiting, or catching an illness

It’s estimated that 12.5% of US adults and 19.3% of teens will deal with a specific phobia at some time in their lives, making it the most common type of phobia and the most common type of anxiety disorder overall. Adult women tend to develop specific phobias at twice the rate as men, while the numbers among teens are closer. Anxiety disorders across the board are more prevalent among women than men. The reasons for this are still being explored, but it likely relates to hormonal differences.4,5

Social Anxiety Disorder (previously known as social phobia)

Most people have felt nervous or anxious in a social setting at some point in their lives—that’s a natural feeling. Some examples of particularly nerve-wracking social situations include first dates, job interviews, and giving a performance or speech.

But a social anxiety disorder is not just an occasional bout of nerves. It’s a disorder that leads you to avoid certain or all social circumstances due to intense anxiety, fear, and embarrassment of other people watching or judging you. The fear that comes with social anxiety disorder is debilitating. People with social anxiety disorder may experience these strong feelings of fear only in particular social settings, like meeting new people, in everyday occurrences like talking to colleagues at work or going to school, or when they must perform in front of an audience.7

It’s estimated that 12.1% of US adults and 9.1% of teens will experience a social anxiety disorder at some time in their lives, making it slightly less common overall than specific phobias. Social anxiety disorder also affects women more often than men.8

Agoraphobia

Agoraphobia is a phobia of any place or situation from which you fear you can’t escape or access help easily, leading you to avoid these places.9 Agoraphobia might manifest as avoiding travel on public transportation, being in a crowded area, or being alone in public.

It’s rooted in fear of experiencing anxiety (typically in the form of a panic attack) in certain places, rather than a fear of the place itself. It is highly related to panic disorder, which is characterized by frequent panic attacks. It’s estimated that one out of three people with panic disorder will develop agoraphobia and that 1.3% of U.S. adults and 2.4% of teens will experience agoraphobia at some point, making it the least common type of phobia. The prevalence of agoraphobia is slightly higher among women than men.10

Causes of Specific Phobia

The reasons why phobias develop are not fully understood. Specific phobias tend to begin in children, whose developing brains are still developing patterns about how to respond to the world around them. A common example of this is a child who develops a phobia of dogs after being bitten by one, but there are many more subtle ways that a child’s brain can take in information that teaches them to fear something. For example, they could learn to fear a dog by watching a movie that features a scary dog or watch a family member flinch in response to a dog’s bark.1

Still, experiences in childhood are only one of many potential reasons why one may go on to develop a specific phobia. Genetics may also play a role.1
Many specific phobias may be due to a complex interplay between genetics and life experiences. The same goes for social anxiety disorders and agoraphobia. Teens are more vulnerable to developing social anxiety disorders, likely because the teen years are marked by hormonal changes and new social pressures. Agoraphobia and panic disorders have a lot of overlap, and they both tend to start in young adulthood.6,11,12

Specific Phobia Risk Factors

Risk factors for developing a specific phobia are temperamental, environmental, and genetic. For instance, negative affectivity (a propensity to feel negative emotions such as disgust, anger, fear, or guilt) or behavioral inhibition are temperamental risk factors for a variety of anxiety disorders, including specific phobias.

Parental overprotectiveness, physical and sexual abuse and traumatic encounters are examples of environmental risk factors that increase the likelihood of an individual developing a specific phobia.

There may also be a genetic susceptibility to a certain category of a specific phobia; for example, if an individual has an immediate relative with a specific situational phobia of flying, the individual is more likely to have the same specific phobia than any other category of phobia.

Phobia Symptoms

Symptoms common to all types of phobias include feelings of panic and fear; racing heart; difficulty breathing; shaking or trembling; a strong urge to exit the situation.2 Each type of phobia can also have unique symptoms related to the type of fear it causes and its source.

Symptoms can also be broken down into physical and emotional symptoms.

Physical Symptoms

  • Racing heart
  • Difficulty breathing
  • Trembling or shaking
  • Sweating
  • Nausea
  • Dry mouth
  • Chest pain or tightness

Emotional Symptoms

  • Feeling overwhelming anxiety or fear
  • Knowing that your fear is irrational, but feeling powerless to overcome it
  • Fear of losing control
  • Feeling an intense need to escape

Social anxiety disorder symptoms often manifest as the avoidance of social situations or intense discomfort in social situations that are difficult to avoid. 14

Similarly, signs of agoraphobia include fear or avoidance of certain situations, like being outside your home alone and being in a crowded or enclosed space.12 However, avoiding these situations is usually rooted in fear of experiencing anxiety or a panic attack in these settings and being unable to escape or find help.

Specific Phobia Symptoms

If you have a specific phobia (a fear of clowns or dogs, for example) you may experience the following symptoms:

  • Sudden fear, anxiety, and panic in the presence of (or when thinking about) the source of the phobia
  • The inability to control or subdue the fear
  • Anxiety that intensifies as you get closer to the source of the fear
  • Avoiding the source of the fear at all costs
  • If avoidance is impossible or difficult, experiencing debilitating anxiety when facing the source
  • Difficulty functioning normally or to the best of your ability as a result of the phobia. 13

DSM-5 Specific Phobia

Like other mental health disorders, phobias are mainly diagnosed based on specific criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM).15 To be diagnosed with a phobia, a doctor will evaluate you to see if you meet certain characteristics defined in the DSM. Each type of phobia has its own list of diagnostic features.

If you think you may have a phobia, make an appointment with your doctor or a psychologist. At the appointment, your doctor will ask you about your symptoms and assess your history of medical, psychiatric, and social conditions or illnesses.

Seven Diagnostic Criteria for Specific Phobias

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines seven 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 or anxiety 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 is persistent, typically lasting for 6 months or more.
  • 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.

Specific Phobia Treatment

With the proper treatment, many phobias can be cured. While specific phobias may seem less complex than the other types, treatment for all phobias actually is quite similar.

“That’s one of the things that should be encouraging for people with anxiety,” says Lily Brown, PhD, an assistant professor and the director at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania in Philadelphia. “There’s actually a lot of data that the same principles that are efficacious for treating specific phobia are also really efficacious for treating social anxiety disorder and agoraphobia.”

Those principles are cognitive behavioral therapy (CBT) and exposure therapy, she says.

Cognitive Behavioral Therapy (CBT)

The clinical term for talk therapy is psychotherapy. CBT is one type of psychotherapy and involves working with a trained mental health professional in a group or in one-on-one sessions. “Homework” (or therapy exercises) is frequently assigned and expected to be completed outside of the sessions—think of them as mental health homework. CBT’s goal in treating phobias is to change thinking, behavior, and reactions surrounding your anxiety. Through sessions and outside exercises, you’ll be encouraged to identify negative or irrational thinking patterns and alter them.16

One facet of CBT that is particularly important in treating phobias is exposure therapy. Exposure therapy involves exposing you to the object or situation you fear. By facing it and not experiencing a scary outcome, the thinking is that you’ll get used to it and stop responding to it with anxiety.

“You’re exposing the person to the feared stimuli until their body naturally calibrates to the threat level. So, the alarm system becomes less sensitive and it becomes more based on reality,” says Mazza.17,18

Using exposure therapy to treat a dog phobia may work like this:15

  • In early sessions, you may be asked to think about dogs and explain what comes to mind.
  • Then you may be asked to look at pictures of dogs.
  • Then you may be asked to go near a dog.
  • Then you may be asked to pet a dog.

The same general approach can be used to treat social anxiety disorder or agoraphobia.

Research has shown that, in some cases, CBT can be equally or even more effective than medications and other forms of talk therapy in treating mental illnesses like phobias.19

Other Treatments for Phobias That Don’t Involve Medication

Alternatives to medication can be effective for treating phobias. Other treatments for phobias that don’t involve medication include:

Social Skills Training

For people with social anxiety disorder, social skills training may be a part of treatment alongside CBT. Social skills training may involve role-playing social interactions with a therapist, exposure to social situations, or general exercises to practice social skills.14

Mindfulness

Mindfulness is a type of meditation that may help with a phobia or other anxiety disorders. It’s somewhat similar to CBT in that it encourages awareness of feelings and sensations in the present moment.17

Support Groups

Joining an in-person or online support group for people who share the same or a similar type of phobia can help you learn more about your condition and about effective ways that other people cope with it.16

Treating Phobias with Medication

A few medications may be used to treat different kinds of phobias on their own or in conjunction with CBT. These medications aren’t considered cures, but they can help reduce or manage anxiety symptoms. Based on the type of phobia you have and the severity of your symptoms, your doctor will tell you if medication may be helpful for you and which type may be best. Be sure to ask your doctor questions about why they recommend a certain medication, the benefits of the medication, and what to expect while taking it.16

Medication options that may be used as a part of treating phobias include:

  • Anti-anxiety medications. They help lessen the frequency or severity of anxiety symptoms or panic attacks. The most commonly used anti-anxiety medications are benzodiazepines. They are quick-acting, meaning that they can lead to an immediate reduction in anxiety symptoms. However, they can also have a sedating effect, meaning they make you tired. Plus, they can be addictive. They’re typically only prescribed for a short time and are meant to be taken on an occasional basis for people with intense anxiety episodes in situations that are difficult to avoid, like flying on an airplane.16, 15
  • Antidepressants. Antidepressants balance the levels of certain neurotransmitters, brain chemicals involved in mood and emotion. Two types of antidepressants are most commonly prescribed for anxiety disorders and phobias, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). If you are prescribed an antidepressant, you will likely need to take the medication for a number of weeks or even months before you notice improvement.16
  • Beta-blockers. These are drugs designed to treat high blood pressure, but they can also help reduce the physical manifestations of anxiety, like a racing heartbeat and shaking or trembling. They’re best used on an as-needed basis to prevent anxiety in specific instances, like before giving a speech.16

    Phobia Resources

    If you are wondering if you have a phobia, have been diagnosed with a phobia, or have a loved one struggling with a phobia, check out these resources for more information and coping strategies:

    • National Institute of Mental Health. The National Institute of Mental Health, the top federal agency for mental disorders, has a wealth of information on its website about phobias and other anxiety disorders.
    • National Alliance on Mental Illness. This is the largest mental health organization in the United States. Check out their website to learn more about phobias and other anxiety disorders, participate in their online community, discover the latest research, and access their resources to find mental health providers.
    • Behavioral Health Treatment Program Locator. The Substance Abuse and Mental Health Services Administration (SAMHSA) can help you find treatment for phobias and other anxiety disorders using their mental health treatment program locator.

    Phobia FAQs

    What's the difference between fear and phobia?

    Fear is a natural emotion triggered by the brain in response to situations that it considers dangerous. Fear protects us from danger, or at least allows us to calculate the risks of a scary situation and take precautions. A phobia is an exaggerated and intense version of fear that leads us to feel extreme anxiety in certain settings (or avoid them altogether) even though the situation poses little or no danger. While occasional fear can protect us, phobias can greatly interfere with your quality of life.

    What is the most common phobia?

    Specific phobias are the most common type of phobia and the most common type of anxiety disorder overall. Phobias of heights and animals are thought to be some of the most common specific phobias.20

    How do you know if you have a specific phobia?

    Here are some of the signs that you may have a phobia and should seek treatment for it:16
    ● You feel intense anxiety or fear toward a specific thing, such as an object, location, or activity.
    ● You feel intense anxiety or fear toward broader circumstances, like social settings or being in public.
    ● Your fear is so intense that it leads you to avoid the source of your fear or endure it with great difficulty.
    ● Your fear is interfering with your ability to enjoy life or function normally.

    How do phobias develop?

    We don’t know exactly why phobias develop. Specific phobias tend to begin during childhood, likely because a child's brain is still learning how to react to certain stimuli. For example, a child who develops a fear of heights may have had a bad experience with heights, like falling off a jungle gym, or may have taken in information that encouraged a fear of heights, like seeing someone fall on TV or seeing a fear of heights in a family member. However, past experiences are not the only potential cause of specific phobias. Genetics may also play a role in the risk of developing a specific phobia.1

    The causes of other types of phobias, like social anxiety disorder and agoraphobia, are also thought to be a combination of genetics and life experiences. Social anxiety disorders typically start in the teen years, likely because of the hormonal changes and social pressures teenagers endure. Since agoraphobia is highly related to panic disorder, the average age of onset is similar to panic disorder. Panic disorder and agoraphobia most often begin in young adults.11, 6, 12

    How many phobias are there?

    There are three main categories of phobias: specific phobias, social anxiety disorder, and agoraphobia. The numerous types of specific phobias are broken down into the following groups: animals (such as spiders and dogs), natural environment (such as heights or thunderstorms), situations (confined spaces or being in the dark), blood and injuries (seeing blood or getting injections or shots), and “other” (such as choking or vomiting).

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Last Updated: Jul 7, 2021