Phobias are characterized by an intense fear reaction in relation to an object that is generated by the same mechanism that underlies anxiety. Phobia is an exaggerated reaction of the brain’s alarm system to a specific threat. If anxiety is the generic alarm reaction, an apprehensive waiting in the absence of a specific object, fear is a specific reaction. Anxiety is relative to the future, fear to the present.
Phobias are characterized by a specific object such as, for example, dogs, spiders, heights, travels, etc., associated with an intense physiological activation reaction that people manage by avoiding the situation or enduring it with great discomfort.
The genesis of phobias can be traced back to interactions between genetics and the environment. From an evolutionary point of view we are more inclined to develop fears for some objects than for others; for example, animals considered repellent generally populate unhealthy areas, therefore, feeling disgusted has led us to stay away from these environments, allowing us to avoid possible infections and diseases. The other perspective is that of learning or experience. Experiencing unpleasant experiences, or witnessing negative experiences of others, can lead us to develop a phobia. For example, people who are attacked by a dog or witness third party assaults can develop a dog phobia.
The two perspectives are not mutually exclusive but, on the contrary, they integrate with elegance. In fact, research has shown that it is very easy to develop a phobia towards some animals, while it is difficult to condition a phobia towards something that, evolutionarily, it was not useful to fear – such as tools or weapons of recent invention of man. It is in fact much more likely to find phobias of harmless animals than of dangerous weapons.
Anxiety vs fear: 6 similarities …
Anxiety and fear are considered to be two similar emotions; fear is the characteristic emotion of phobias. Let’s try to understand how anxiety and fear are similar and how they differ.
Similarities
- Waiting for danger or discomfort
- Apprehension and tension
- Physiological activation
- Negative emotional state
- Discomfort
- Presence of bodily sensations
… And 10 differences
| Fear | Anxiety |
| The object of the threat is specific | The source of the threat is elusive |
| The connection between threat and fear is understandable | The link between anxiety and threat is uncertain |
| Usually episodic | Prolonged |
| Circumscribed tension | Pervasive discomfort |
| Identifiable term | Uncertain term |
| The threat area is limited | There are no clear limits |
| The threat is imminent | The threat is rarely imminent |
| Emergency font | Increased alertness |
| Body sensations typical of an emergency situation | Body sensations typical of a condition of alertness |
| Rational | Disconcerting |
taken from Rachman 2004
Normal fears vs phobias
Fear is an emotion that has allowed us to survive for millennia and helps us stay away from dangerous situations. The price to pay for this ‘alert system’ is that, at times, we feel fear in situations that recall dangerous situations but are not; it would be reckless not to be afraid of a pack of growling Dobermans but it is an overreaction to change the sidewalk to avoid crossing a poodle on a leash. Care must be taken to discriminate between normal fears and phobias.
| Normal fear | Phobias |
| Feeling anxious during a turbulent flight or taking off during a storm | Don’t go to a dear friend’s wedding because you would have to take a plane |
| Feeling butterflies in your stomach when looking down from the top of a skyscraper or a mountain ledge | Refuse a job because it would be on the 10th floor of a building |
| Feeling nervous when seeing a pit bull or rottweiler | Avoid the parks because you might encounter a dog |
| Feeling a little nauseous after a vaccine or blood sample | Avoid undergoing medical tests or treatments for fear of needles |
Normal fears in children
Many fears are typical of childhood and disappear over time, as such they should not be considered phobias. If your children’s fears do not interfere with their daily routine and cause them no significant discomfort, there is no reason to worry.
Which of my children’s fears are normal?
According to the Child Anxiety Network the following fears are very common and are considered normal:
- 0-2 years old – loud noises, separation from parents and large objects.
- 3-6 years old – imaginary things like ghosts, monsters, darkness, sleeping alone and weird noises.
- 7-16 years – more concrete things like injuries, illnesses, school performance, death and natural disasters.
Symptoms of phobias
Symptoms of specific phobias can range from medium-sized feelings of apprehension to full-blown panic attacks. Generally, the closer a phobic person gets to what they fear, the stronger the fear becomes. Another factor that increases fear is the lack of control of the situation as in the inability to be able to move away from the object of the phobia.
Central to this is excessive fear (or disgust) of the feared object or situation.
The object is avoided or endured with great discomfort. For example, take a longer route to avoid passing through a park where dogs often meet.
Presence of anticipatory anxiety which involves becoming nervous or anxious at the idea of being in certain situations or coming into contact with the object of the phobia. For example, starting to be anxious in the morning about having to take the car in the evening.
Physical symptoms:
- difficulty in breathing
- tachycardia (except blood and injury phobias)
- chest pain
- tremors or jolts
- dizziness or light-headedness
- stomach in turmoil
- tingling in the limbs
- cold chills or hot flashes
- sweating
Associated sensations:
- overwhelming feeling of anxiety and panic
- feeling of a strong need to escape
- feeling of unreality
- feeling of losing control
- feeling of being about to pass out or die
- awareness of reacting disproportionately associated with the inability to do otherwise
The symptoms of blood phobias, injections and wounds are slightly different. After an initial physiological activation, an opposite reaction of decreasing this activation is observed which can also lead the person to faint.
Common phobias
Phobias can be grouped into five large groups:
- Animal phobias: generally of dangerous animals associated with a fear response and repellent animals associated with a response of disgust. Phobias generalize to objects with characteristics similar to that from which the phobia arose, so a person for fear of a dangerous dog may have developed a phobia to all dogs and have a fear response even to harmless-looking dogs and funny. These are the most common phobias.
- Phobias of natural environments: for example of heights, thunderstorms, the sea and the dark. They are very common in animals.
- Situational phobias: for example of closed spaces, of flying, of driving, of bridges or tunnels. In this case it is a situation rather than an object that triggers the phobia and the reason is not so much the situation itself but what could happen in this situation. Agoraphobia and social phobia are complex situational phobias.
- Blood-Injection-Injury Phobias: Fear of blood, injections, invasive medical procedures and even the sight of human body impairments. It is a peculiar category because the physiological reactions underlying these phobias are opposite to the others.
- Other phobias: for example the fear of falling, noisy sounds and the fear of masked characters such as clowns. It is a ‘wildcard category’ for all those phobias that do not fit into the four categories above.
Treatment
The treatment of specific phobias is one of the simplest treatments with the highest success rates.
The evidence-based treatments ( evidence based therapies ) supported by the international scientific research for phobias are cognitive behavioral therapy and drug therapy.
Behavioral treatment involves learning relaxation techniques that lead to eliminating anxiety and replacing the relaxation response to the fear response in front of the object of the phobia.
Cognitive treatments have proved useful when used in conjunction with the behavioral approach; it is taught to identify and modify some dysfunctional thinking styles that automatically lead to the phobic reaction.
Drug therapy has been shown to be effective for symptoms but is useless for the purpose of curing the phobia. They are a valuable short-term help when used to overcome a specific feared situation, it’s like taking a painkiller: you don’t feel the fear but you don’t cure the phobia. Benzodiazepines are useful to keep the anticipatory anxiety of a feared situation at bay (for example, for those who have the phobia of taking the plane to be able to sleep the night before), the beta blockers by inhibiting the physiological reactions of fear are able to reduce or eliminate the discomfort associated with dealing with a feared situation (eg, if I am afraid to speak in public and have to speak at a conference).
Frequent questions
How common are specific phobias?
The most likely estimates are around 6-9% of the adult population, 5% in children and 16% in adolescents aged 13 to 17. In women it is much more common than in men, a ratio of about 2: 1 is observed.
At what age do they start?
They usually develop in early childhood, usually before age 10. The average age of onset is 7-11 years.
What are the effective treatments available for specific phobias?
Scientific research supports cognitive and behavioral therapy as the treatment of choice.
How effective is the treatment of specific phobias?
Research shows that on average 90% of patients improve thanks to a cognitive-behavioral intervention based on in vivo exposures.
How long does the psychotherapeutic treatment last for specific phobias?
However, phobias are the disorders that can be cured in the shortest time and with the highest success rate ever. In most cases, results can be seen in a very small number of sessions (1-4).
Much of the success of therapy treatment depends on the collaboration between patient and therapist and the patient’s commitment to work at home as well.
I think I have a specific phobia, should I contact a psychotherapist?
No. Ask yourself how uncomfortable this is and how much it affects your life and then consider whether it is worth talking to a specialist. If you live in a city and have a bear phobia you can easily live with it for the rest of your life.
