Specific phobias
Specific phobia is a marked, persistent fear or anxiety about a circumscribed object or situation, lasting 6 months or more, that is out of proportion to the actual danger, provokes immediate fear on exposure, and is actively avoided or endured with distress; the diagnosis is clinical. First-line treatment is graded exposure therapy (a form of cognitive behavioral therapy), with a short-acting benzodiazepine reserved for a single known, planned exposure.
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What this article covers
- Overview
A circumscribed, disproportionate fear of one object or situation: specific phobia is an extreme, persistent fear and anxiety about a specific stimulus that is out of proportion to the actual danger…
- Epidemiology
More common in women, with onset typically in childhood: specific phobia is described as more common in women than men, and the fear usually begins early in life.
- Risk factors
Female sex and childhood onset: specific phobia is more common in women, and most cases begin in childhood; an early-onset fear that persists is a risk factor for a lasting phobia into adulthood.
- Pathophysiology
A learned, conditioned fear response that responds to habituation: gradual, repeated exposure to the stimulus produces habituation, with extinction of the fear response, a process known as systematic…
- Clinical features
Marked, persistent fear or anxiety about a specific object or situation, lasting 6 months or more: this duration threshold, not just the presence of fear, separates a phobia from an ordinary, transient scare.
- Differential diagnosis
Agoraphobia: fear, anxiety, or avoidance while facing or anticipating 2 or more specific situations (public transportation, open or closed spaces, crowds, being outside the home alone), driven by…
- Diagnosis
The diagnosis is clinical: marked and persistent (6 months or more) fear or anxiety about a specific object or situation, immediate fear on exposure, avoidance or endurance with distress, and a fear…
- Management
First-line management is graded exposure therapy, a form of cognitive behavioral therapy (CBT): expose the patient gradually to the feared stimulus in graded amounts rather than avoiding it.
- Complications
Avoidance of necessary medical care: a needle or blood phobia can lead patients to avoid vaccinations, venipuncture, or other required procedures, as in a young adult who has missed every recommended…
- Prognosis
Favorable with exposure-based treatment: graded exposure therapy produces habituation and extinction of the fear response in most patients.
- Prevention
Treat avoidance before it entrenches impairment: because the phobia is defined by fear and avoidance lasting 6 months or more, begin exposure-based therapy once avoidance has persisted at or beyond…
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Related articles
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Agoraphobia is marked fear, anxiety, or avoidance of two or more situations, such as public transportation, open or closed spaces, lines or crowds, or being outside the home alone, driven by the concern that escape or help may be unavailable, present for 6 months or more and now diagnosed independently of panic disorder even though the two frequently coexist. First-line treatment is exposure-based cognitive behavioral therapy, with an SSRI as the pharmacologic adjunct.
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