Phobias: Much Ado About Nothing?

Specific Phobias are the experience of extreme fear resulting from encounters with specific things or situations that juuusssst don't get most people all that upset.

Yes, people with phobias know that perhaps their fears are not rational. Clearly, a person with a fear of spiders, for example, is aware that he or she is much larger than a spider, and that this fact alone suggests that he or she is also likely far more lethal than even the worst of our eight-legged friends (or foes, as the case might be). All of us have probably known someone who gets so upset during spider encounters that there is all kind of ruckus until the spider is removed, such as screaming, freezing, or running from the room. An individual with a phobic response to spiders, however, is likely to experience a full blown anxiety attack in their presence, or otherwise endure the situation with such intense anxiety that they will go to great lengths to avoid any situation in which a spider might be encountered, seen, or even thought about.

Now, as it turns out there are lots of spiders in the world. Avoiding them entirely requires effort, planning, and energy, but people with real phobic response have developed all kinds of strategies to do just that.

About 1 out of 10 people, and somewhat more women than men, have some sort of severe irrational fear

but most folks will never seek treatment for their irrational fears until avoiding the object or situation in question becomes, well, unavoidable. For example, a business person with a severe irrational fear of flying who receives a promotion that requires air travel may choose to get treatment to overcome his or her fear rather than pass up the prime position. Or a woman might meet someone she would really like to get to know better . . .  if it wasn't for that great big dog of his.

Like the other anxiety disorders, our irrational fears don't warrant a diagnosis of "Specific Phobia," unless they cause clinically significant impairment

in an individual's normal routine, occupational or school functioning, or social activities or relationships.

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5) the following criteria must be met to warrant a diagnosis:

  • Marked and persistent fear that is excessive and unreasonable, cued by the presence or anticipation of a specific object or situation, such as flying, heights, animals, injections, etc.
  • Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of situationally bound or situationally predisposed Panic Attack. In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging
  • The person recognizes that the fear is excessive or unreasonable, though this feature may not be present in children
  • The phobic situation(s) is avoided or else is endured with intense anxiety or distress
  • The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational or academic functioning, or social activities or relationships, or there is marked distress about having the phobia
  • In individuals under age 18 years, the duration is at least 6 months
  • The anxiety, panic attacks, or phobic avoidance are not better explained by another anxiety disorder or other mental disorder

Fortunately, phobias are surprisingly easy to treat, so no worries

Specific Phobias have specific treatments and they are generally behavioral. Systematic desensitization, or the very gradual exposure to the feared object or situation, first in thought and then for real, is still considered the "gold standard" of phobia treatment. Relaxation, mindfulness, and modeling techniques (in which the therapist models ways to handle anxiety-provoking situations) can all be practiced in the office with a trained therapist before there is any need to approach anything scary on your own.

By the way, the most common irrational fears

are of spiders, snakes, and heights but inidviduals can develop a phobic response to just about anything. If you are wondering about image at the top of the page, I didn't want to scare anyone off by including a picture of a commonly held fear. Hopefully, you are all ok enough with funky gradient green to have gotten this far--although I did know someone who was afraid of the color yellow.

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