Specific Phobia

Book
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
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Excerpt

Anxiety describes an uncomfortable emotional state characterized by inner turmoil and dread over anticipated future events. Anxiety is closely related to and overlaps with fear, which is a response to perceived and actual threats. Anxiety often results in nervousness, rumination, pacing, and somatization. Every human experiences anxiety because it is an evolved behavioral response to prepare an individual to detect and deal with threats. Anxiety becomes pathological when it is so overwhelming that there is persistent distress, a decrease in the quality of life, and impairment in regular major life activities.

Anxiety disorders are common psychiatric disorders and are often underrecognized. Untreated anxiety disorders can significantly impair the quality of life, lead to comorbid psychiatric conditions, and interfere with social functioning. Individuals with anxiety disorders may experience a poorer quality of life compared to those without anxiety disorders, and the severity of anxiety can impact daily functioning.

Specific phobia is an anxiety disorder characterized by excessive and irrational fear of a particular object, situation, or activity. The anxiety response goes beyond normal apprehension and leads to avoidance behavior. The intensity of the fear is often disproportionate to the actual danger posed by the phobic stimulus. Common examples of specific phobias include fear of heights (acrophobia), fear of spiders (arachnophobia), fear of flying (aviophobia), and fear of needles (trypanophobia). People with specific phobias may experience intense anxiety or panic attacks when exposed to the feared object or situation.

Historically, extreme fears of specific situations or objects have been documented as far back as the ancient Greeks and Romans. In the late 19th and early 20th centuries, Sigmund Freud proposed that phobias were a psychological defense mechanism arising from repressed psychological conflict. These ideas influenced early psychological thought on phobias but were later critiqued and expanded upon. In the early 20th century, behaviorism became a dominant force in psychology—researchers like John B. Watson and B.F. Skinner emphasized observable behaviors and learning through conditioning. Phobias were often seen as learned responses, with specific phobias thought to develop through classical conditioning (associating a neutral stimulus with a negative experience).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a key resource for classifying mental health disorders; in its various editions, specific phobias have been included and refined. The DSM-III (1980) marked a significant step in systematically classifying phobias. Advances in neuroscience and research have contributed to a better understanding of the neural mechanisms underlying specific phobias, including insights into the role of the amygdala, a brain region involved in processing fear.

Over time, therapeutic approaches for specific phobias have evolved. Behavior therapy, including systematic desensitization (a type of exposure therapy), has been a key component. Cognitive behavioral therapy has also become a prominent and effective approach, focusing on changing negative thought patterns and behaviors associated with phobias. Today, specific phobias are recognized as a common type of anxiety disorder, and treatment approaches continue to evolve based on ongoing research and a deeper understanding of the psychological and neurobiological factors involved.

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