Now, let’s talk about phobias,
starting with this
case example of Sam.
Sam is a 28-year-old sales representative
who’s been terrified of animals
since she was a child.
That didn’t cause many
problems before because
her family opted not to have pets,
and Sam preferred to play indoors.
But now that she’s an adult,
Sam is working in sales,
and her job requires
She was on a plane once which
needed to make an emergency landing
after going through
And now, she’s
terrified of flying
Not only that but she’s
struggling in her job
because she doesn’t like to
eat in front of other people.
This is a problem because many of her business
deals are done over lunches or dinners.
And although Sam is very
engaging on an individual basis,
she often finds ways to avoid giving any
speeches or presentations to large audiences
because she’s afraid of
Keeping that case example in mind,
let’s think about what is a phobia.
Sam has a lot going on, and
let’s start by defining phobia.
So it’s an irrational fear that leads to
an avoidance of the fear
to object or situation.
There are different types of phobias,
specific phobias and social phobias.
Here is an important point.
Specific phobias involve a
fear of objects or things,
while social phobias involve the fear
of embarrassing oneself in public.
So, how would you define
a specific phobia?
Well, it’s an anxiety disorder characterized
by clinically significant fear
of a particular object or situation
that leads to avoidant behavior.
Now, how would you
define social phobia?
It’s the feared situation as
related to social settings
in which the patient might be embarrassed
or humiliated in front of other people.
And again, some common examples of
social phobia include public speaking,
eating in public, and
using a public restroom.
Phobias are the most
common mental disorders.
At least 5% to 10% of the U.S.
population is affected.
And specific phobias occur far more
frequently than social phobias.
The age of onset -- the range
is huge, it’s 5 to 35,
but the average age of
onset is in the mid teens.
Females are affected
more often than males.
Now, an important note about
the epidemiology of phobias,
the age of onset depends
on the type of phobia.
For example, animal and blood
injection injury phobias
are much more likely
to occur in childhood,
whereas situational or natural
tend to occur in late
adolescents or even adulthood.
Phobias can also be induced by traumatic
that can occur
throughout one’s life.
The development of a specific phobia
is influenced by a complex interaction
of biological, psychological, and
social and environmental factors.
Let’s go through
them one by one.
When it comes to genetics, how do
specific phobias run in families?
Well, we tend to think that
they aggregate in families.
First-degree relatives of
individuals with specific phobias
have an increased risk all
the way up to close to 31%.
This may be associated with an inherited
exaggerated vasovagal response.
And first-degree relatives of
patients with social phobias
are also more likely to
develop that disorder.
So behaviorally, what
Well, often, traumatic events.
And neurobiologically speaking, what parts
of the brain are connected with phobias?
It’s specific neuroanatomical pathways,
things including the hyper activation
of the amygdala and insula,
structures involved in
negative emotional responses.
When it comes to personality, what are the
traits that affect development of phobias?
There’s something called
This is the tendency to experience
disgust in response to certain stimuli,
a developmental factor for certain animal
and blood injection injury phobias.
There’s also anxiety sensitivity
that some people experience.
This is a dispositional
variable reflecting beliefs
that the physical sensations of
anxiety are somehow harmful.
And it has also been found to
be elevated in specific phobia,
When it comes to cognition, how does
the cognitive factor affects phobias?
There’s an attentional bias to
and perceptual and cognitive distortions
are consistent within one’s phobia.
What social or environmental
factors affect phobias?
The answer is the context
of a traumatic event,
stress at the time of the event,
previous and subsequent
exposure to a phobic stimulus,
and one’s level of support.
And when it comes to the evolutionary
pathway, what types of fears are there?
Well, fears may be innate, such as a
fear of scorpions, snakes, or heights,
or they can be biologically
When it comes to the assessment,
you want to consider what are
some specifiers for phobias.
There are animal types:
spiders, insects, dogs.
There’s natural environmental:
things like heights, storms, water.
Blood-injection injury is another type,
such as needles or invasive
Situational subtypes, things like
being on an airplane or elevator
or being inside the enclosed space.
Other types are situations that
could lead to choking, vomiting,
loud noises, and even
seeing costumed characters.
So, going back to our
case study, consider Sam,
and she’s had a lot of issues and fears
going on since she was a young child,
all the way through her
adulthood into her career.
So, what types of phobias do you
think Sam has been exhibiting?
There are a few, right?
So Sam has both specific
and social phobias.
She’s afraid of animals and flying.
In addition, she has fears of public
speaking and also eating in front of others
for fear that she will
What co-morbidities is Sam
at risk for developing?
So, what other disorders could she
develop here along with her phobias?
Well, she’s at risk for a few
things; agoraphobia, OCD,
PTSD, and separation
You want to be sure to also
screen her for an eating disorder
as many people with fears of eating
in public will later go on to develop
some maladaptive eating behaviors
that can lead to its own disorder.
Let’s define these one by one now.
So agoraphobia, that’s anxiety
in situations where the person
perceives the environment to be unsafe,
where there’s no easy way to get out.
So this often comes up in open public
market spaces, public transportation,
during times when somebody is at shopping
malls, and it can be very debilitating.
How about OCD?
This is a psychiatric
disorder in which patients
have recurrent intrusive
thoughts or obsessions
that increase anxiety
and are relieved
by performing standardized
behaviors or compulsive acts.
Well, what’s separation
This is a condition in which an
individual becomes fearful and nervous
when away from home or
separated from a loved one.
And how about PTSD?
That’s an anxiety disorder that is the
response to a life-threatening event
in which an individual
re-experiences the trauma,
avoids places, and experiences
numbing or hyperarousal.
When it comes to diagnosing
and assessing phobia,
patient must meet all of
the following criteria.
So they have a marked fear of anxiety
about a specific object or situation.
The phobic object or
situation almost always
provokes an immediate
fear or anxiety.
And the phobic object or
situation is actively avoided
or endured but with
intense fear and anxiety.
The fear or anxiety is out of
proportion to the actual danger
posed by the specific
object or situation.
The fear, anxiety, or
avoidance is persistent
and it can last for typically,
six months or even longer.
The fear, anxiety,
or avoidance causes
clinical distress and impairment
in day to day functioning.
And other medical and
have been ruled out before
diagnosing a phobia.
It’s important to consider
the socio-cultural context
of an individual when assessing
for a phobic disorder.
Now, how would you
Let’s start with
The prognosis is actually excellent
with exposure-based treatment.
Medication is actually
not useful here.
Instead, systematic desensitization along
with supportive therapy is useful.
This gradually exposes the patient
to a fear to object or situation
while teaching them relaxation
and breathing techniques
so they can manage their
anxieties as they arise.
Social phobias, actually, are
treated with medication.
SSRIs, such as paroxetine
are FDA approved
for the treatment of
social anxiety disorder.
also be very helpful
in controlling symptoms
of performance anxiety.
And also, therapy is useful.
Cognitive and behavioral therapies are
very useful in addition to medication.
So, what would your treatment
approach for Sam be?
Well, probably multi-fold.
You might address her specific phobia
by targeting that specific phobia
with a non-pharmacological approach
offering her gradual exposure.
For example, showing her
pictures, of flying, of animals,
maybe going to the movies where
she’ll watch some of these things.
And then when it comes to her fear of
flying, maybe take her to an airport;
send her off on a short flight.
And when it comes to her fear of dogs,
you might actually introduce
her to a small puppy,
and then later, invite
her to go to a dog park.
When it comes to her social phobias, this
might require a more invasive approach
including treatment with
an SSRI or beta-blocker,
so you can reduce some of the somatic
symptoms such as heart racing and so forth,
and then in addition, offer
some therapy to her.
This concludes our overview of phobias
both specific and social phobia.
You now should have an
awareness of how to assess,
diagnose, and manage these
disorders as they arise.