Introduction

A phobia is an overwhelming and debilitating fear of an object, place, situation, feeling or animal.

Phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger about a situation or object.

If a phobia becomes very severe, a person may organise their life around avoiding the thing that's causing them anxiety. As well as restricting their day-to-day life, it can also cause a lot of distress.

Anxiety disorder

A phobia is a type of anxiety disorder. You may not experience any symptoms until you come into contact with the source of your phobia.

However, in some cases, even thinking about the source of a phobia can make a person feel anxious or panicky. This is known as anticipatory anxiety.

Symptoms may include:

  • unsteadiness, dizziness and lightheadedness
  • nausea
  • sweating
  • increased heart rate or palpitations
  • shortness of breath
  • trembling or shaking
  • an upset stomach

If you don't come into contact with the source of your phobia very often, it may not affect your everyday life. However, if you have a complex phobia such as agoraphobia (see below), leading a normal life may be very difficult.

Read more about the symptoms of phobias.

Types of phobia

There are a wide variety of objects or situations that someone could develop a phobia about. However, phobias can be divided into two main categories:

  • specific or simple phobias
  • complex phobias

The two categories are discussed below.

Specific or simple phobias

Specific or simple phobias centre around a particular object, animal, situation or activity. They often develop during childhood or adolescence and may become less severe as you get older.

Common examples of simple phobias include:

  • animal phobias – such as dogs, spiders, snakes or rodents
  • environmental phobias – such as heights, deep water and germs
  • situational phobias – such as visiting the dentist or flying
  • bodily phobias – such as blood, vomit or having injections
  • sexual phobias – such as performance anxiety or the fear of getting a sexually transmitted infection

Complex phobias

Complex phobias tend to be more disabling than simple phobias. They tend to develop during adulthood and are often associated with a deep-rooted fear or anxiety about a particular situation or circumstance.

The two most common complex phobias are:

Agoraphobia is often thought of as a fear of open spaces, but it's much more complex than this. Someone with agoraphobia will feel anxious about being in a place or situation where escaping may be difficult if they have a panic attack.

The anxiety usually results in the person avoiding situations such as:

  • being alone
  • being in crowded places, such as busy restaurants or supermarkets
  • travelling on public transport

Social phobia, also known as social anxiety disorder, centres around feeling anxious in social situations.

If you have a social phobia, you might be afraid of speaking in front of people for fear of embarrassing yourself and being humiliated in public.

In severe cases, this can become debilitating and may prevent you from carrying out everyday activities, such as eating out or meeting friends.

What causes phobias?

Phobias don't have a single cause, but there are a number of associated factors. For example:

  • a phobia may be associated with a particular incident or trauma
  • a phobia may be a learned response that a person develops early in life from a parent or sibling (brother or sister)
  • genetics may play a role – there's evidence to suggest that some people are born with a tendency to be more anxious than others

Read more about the causes of phobias.

Diagnosing phobias

Phobias aren't usually formally diagnosed. Most people with a phobia are fully aware of the problem.

A person will sometimes choose to live with a phobia, taking great care to avoid the object or situation they're afraid of. However, if you have a phobia, continually trying to avoid what you're afraid of will make the situation worse.

If you have a phobia, you should seek help from your GP. They may refer you to a specialist with expertise in behavioural therapy, such as a psychologist.

Treating phobias

Almost all phobias can be successfully treated and cured.

Simple phobias can be treated through gradual exposure to the object, animal, place or situation that causes fear and anxiety. This is known as desensitisation or self-exposure therapy.

You could try these methods with the help of a professional or as part of a self-help programme.

Treating complex phobias often takes longer and involves talking therapies, such as:

Medication isn't usually used to treat phobias. However, it's sometimes prescribed to help people cope with the effects of anxiety. Medications that may be used include:

Read more about how phobias are treated.

How common are phobias?

Phobias are the most common type of anxiety disorder. It's estimated that around 10 million people in the UK have a phobia.

They can affect anyone, regardless of age, sex and social background. Some of the most common phobias include:

  • arachnophobia – fear of spiders
  • claustrophobia – fear of confined spaces
  • agoraphobia – fear of open spaces and public places
  • social phobia – fear of social situations
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Symptoms

All phobias can limit your daily activities and may cause severe anxiety and depression. Complex phobias, such as agoraphobia and social phobia, are more likely to cause these symptoms.

People with phobias often purposely avoid coming into contact with the thing that causes them fear and anxiety. For example, someone with a fear of spiders (arachnophobia) may not want to touch a spider or even look at a picture of one.

In some cases, a person can develop a phobia where they become fearful of experiencing anxiety itself because it feels so uncomfortable.

You don't have to be in the situation you're fearful of to experience the symptoms of panic. The brain is able to create a reaction to fearsome situations even when you aren't actually in the situation.

Physical symptoms

People with phobias often have panic attacks. Panic attacks can be very frightening and distressing. The symptoms often occur suddenly and without warning.

As well as overwhelming feelings of anxiety, a panic attack can cause physical symptoms, such as:

  • sweating
  • trembling
  • hot flushes or chills
  • shortness of breath or difficulty breathing
  • a choking sensation
  • rapid heartbeat (tachycardia)
  • pain or tightness in the chest
  • a sensation of butterflies in the stomach
  • nausea
  • headaches and dizziness
  • feeling faint
  • numbness or pins and needles
  • dry mouth
  • a need to go to the toilet
  • ringing in your ears
  • confusion or disorientation

Psychological symptoms

In severe cases, you may also experience psychological symptoms, such as:

  • fear of losing control
  • fear of fainting
  • feelings of dread
  • fear of dying

Complex phobias

Complex phobias such as agoraphobia and social phobia can often have a detrimental effect on a person's everyday life and mental wellbeing.

Agoraphobia often involves a combination of several interlinked phobias. For example, someone with a fear of going outside or leaving their home may also have a fear of being left alone (monophobia) or of places where they feel trapped (claustrophobia).

The symptoms experienced by people with agoraphobia can vary in severity. For example, some people can feel very apprehensive and anxious if they have to leave their home to go the shops. Others may feel relatively comfortable travelling short distances from their home.

If you have a social phobia, the thought of being seen in public or at social events can make you feel frightened, anxious and vulnerable.

Intentionally avoiding meeting people in social situations is a sign of social phobia. In extreme cases of social phobia, as with agoraphobia, some people are too afraid to leave their home.

Several treatment options for phobias are available, including talking therapies and self-help techniques. However, it can often take some time to overcome a complex phobia.

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Causes

A phobia can develop during childhood, adolescence or early adulthood.

They're often linked to a frightening event or stressful situation. However, it's not always clear why some phobias occur.

Specific or simple phobias

Specific or simple phobias, such as a fear of heights (acrophobia), usually develop during childhood.

Simple phobias can often be linked to an early negative childhood experience. For example, if you're trapped in a confined space when you're young, you may develop a fear of enclosed spaces (claustrophobia) when you're older.

It's also thought that phobias can sometimes be "learnt" from an early age. For example, if someone in your family has a fear of spiders (arachnophobia), you may also develop the same fear yourself.

Other factors in the family environment, such as having parents who are particularly anxious, may also affect the way you deal with anxiety later in life.

Complex phobias

It's not known what causes complex phobias, such as agoraphobia and social phobia. However, it's thought that genetics, brain chemistry and life experiences may all play a part in these types of phobias.

The physical reactions (symptoms) a person experiences when faced with the object of their fear are real and aren't simply "in their head".

The body reacts to the threat by releasing the hormone adrenalin, which causes symptoms such as:

  • sweating
  • trembling
  • shortness of breath
  • a rapid heartbeat (tachycardia)
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Treatment

Many people with a phobia don't need treatment, and avoiding the object of their fear is enough to control the problem.

However, it may not always be possible to avoid certain phobias, such as a fear of flying. In this instance, you may decide to get professional help and advice to find out about treatment options.

Most phobias are curable, but no single treatment is guaranteed to work for all phobias. In some cases, a combination of different treatments may be recommended. The main treatment types are:

  • self-help techniques (see section below)
  • talking treatments
  • medication

Talking treatments

Talking treatments, such as counselling and psychotherapy, are often very effective methods for treating phobias. In particular, cognitive behavioural therapy (CBT) and mindfulness have been found to be very effective methods of treating phobias.

Cognitive behavioural therapy (CBT)

CBT is a type of counselling that can help you manage your problems by changing the way you think and behave. It can be used to develop practical ways of dealing with your phobia.

One part of the CBT treatment process that's often used to treat simple phobias involves gradual exposure to your fear, so you feel less anxious about it. This is known as desensitisation or exposure therapy.

For example, if you have a fear of snakes (ophidiophobia), your therapist may start by asking you to read about snakes. They may later show you a picture of a snake. They may then arrange for you to visit the reptile house of your local zoo to look at some real snakes. The final step would be for you to hold a snake.

Exposure therapy works by gradually increasing the level of exposure to your fear, which allows you to gain control over your phobia. As the treatment progresses, you should begin to feel less anxious about your phobia.

The National Institute for Health and Care Excellence (NICE) doesn't recommend the use of computerised CBT to treat specific phobias in adults.

Medication

Medication isn't usually recommended for treating phobias, because talking therapies are usually effective and don't have any side effects. However, medication is sometimes prescribed on a short-term basis to treat the effects of phobias such as anxiety.

Three types of medication are recommended for treating anxiety. These are:

  • antidepressants
  • tranquillisers
  • beta-blockers

Antidepressants

Antidepressants are often prescribed to help reduce anxiety. Selective serotonin reuptake inhibitors (SSRIs) are most often prescribed to treat anxiety, social phobia or panic disorder. These can include:

  • escitalopram (Cipralex)
  • sertraline (Lustral)
  • paroxetine (Seroxat)

Venlafaxine (Efexor), a serotonin and noradrenaline reuptake inhibitor (SNRI) may also be prescribed for anxiety.

Common side effects of these treatments include:

  • nausea
  • headaches
  • sleep problems
  • upset stomach

They may also, initially, make your anxiety worse and can cause sexual problems.

Clomipramine (Anafranil) is a type of tricyclic antidepressant (TCA) that's licensed to treat phobias. Side effects include:

  • dry mouth
  • drowsiness
  • blurred vision
  • tremors (shaking)
  • palpitations (irregular heartbeat)
  • constipation
  • difficulty urinating

Moclobemide (Manerix) is a type of antidepressant from the monoamine oxidase inhibitor (MAOI) group of antidepressants. It's sometimes prescribed to treat social phobia.

Moclobemide interacts with certain types of food, so if you're prescribed this medication, read the information leaflet that comes with it to find out which foods to avoid.

Other possible side effects of moclobemide include:

  • sleep problems
  • dizziness
  • stomach problems
  • headaches
  • restlessness
  • agitation

If you're prescribed antidepressants, it's very important that you don't suddenly stop taking them. Suddenly stopping can cause withdrawal symptoms. See your GP, who can gradually lower your dose.

Tranquillisers 

Benzodiazepines are a group of medicines that are categorised as minor tranquillisers. They include medicines such as diazepam (Valium) and are sometimes used on a short-term basis at the lowest possible dose to treat severe anxiety.

Like antidepressants, benzodiazepines should be stopped gradually to avoid withdrawal symptoms.

Beta-blockers

Beta-blockers are often used to treat cardiovascular conditions, such as heart problems and high blood pressure (hypertension). They are also sometimes prescribed to help reduce the symptoms of anxiety, such as palpitations (irregular heartbeat).

Beta-blockers slow down your heart rate and decrease your blood pressure. Propranolol (Inderal) is a beta-blocker that's commonly used to treat anxiety. Possible side effects include:

  • stomach problems
  • cold fingers
  • tiredness
  • sleep problems
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Self-help

Each phobia is different and no single self-help programme will work for everyone. You may decide to use your own self-help strategy, or get help from a mental healthcare specialist, such as a psychologist.

A self-help programme could include:

  • lifestyle changes
  • having a course of cognitive behavioural therapy (CBT)
  • attending a self-help group
  • using self-exposure therapy (see below) to try to overcome your fear
  • a combination of these

Lifestyle changes

Changing your lifestyle can help reduce the symptoms of a phobia, such as panic attacks. This could include:

  • regular exercise
  • regular meals on a schedule
  • getting enough sleep
  • reducing or avoiding caffeine and other stimulants

Self-exposure therapy

Self-exposure therapy (de-sensitisation) involves gradually increasing the length of time that you are exposed to the object of your phobia.

If you have agoraphobia (a fear of open spaces and public places), you might begin by going outside your house for a very short time, then gradually increasing the length of time you spend outside and the distance you travel from your house. This technique is often effective in allowing someone with a phobia to cope with their anxiety.

Other self-help techniques

Other self-help techniques include:

  • Relaxation techniques: a series of physical exercises that may help you relax and control your breathing.
  • Visualisation: combines relaxation and breathing techniques with mentally visualising how you will successfully deal with a situation that could cause anxiety.
  • Self-help groups: a useful way of meeting others with similar experiences and sharing ways of coping.

Computerised CBT

FearFighter is a computer software programme that you can access online. It's recommended by the National Institute for Health and Care Excellence (NICE) and has been shown to be an effective self-help method for treating panic disorder and phobia.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 10/02/2016 11:40:05