Phobias

A phobia is more than a simple fear. It develops when a person begins to organise their life around avoiding the thing they are afraid of, whether it’s an animal, object, place or situation.

A phobia is a type of anxiety disorder. If you have a phobia, you will have an overwhelming need to avoid all contact with the source of your anxiety. Coming into contact with the cause of your phobia or even the thought of this can make you anxious and may cause you to panic.

If the cause of your phobia is an object or animal that you do not come into contact with regularly, such as a snake, it is unlikely to affect your day-to-day life. However, if you have a more complex phobia, such as agoraphobia (see below), you may find it very difficult to lead a normal life.

Read more about the symptoms of phobias

Types of phobia

There are many different phobias, which can be divided into two main categories:

• simple phobias
• complex phobias

Although most people are aware of a phobia, it may help to identify some complex phobias by speaking to a GP and answering questions about your anxiety.

Read more about how phobias are diagnosed

Simple phobias

Simple phobias are fears about specific objects, animals, situations or activities. Some common examples include:

• dogs
• spiders
• snakes
• enclosed spaces
• dentists
• flying

Phobias affect different people in different ways. Some people only react with mild anxiety when confronted with the object of their fear, while others experience severe anxiety or have a severe panic attack.

Complex phobias

Complex phobias tend to be more disabling than simple phobias because they are often associated with a deep-rooted fear or anxiety about a particular circumstance or situation. Two common examples of complex phobias are agoraphobia and social phobia.

Agoraphobia is a fear of being in situations where escape might be difficult, or help wouldn't be available if things go wrong.

A person with agoraphobia may be scared of:

• travelling on public transport
• visiting a shopping centre
• and in the most severe cases – leaving home

Social phobia is a fear of social situations, such as weddings, or performing in social situations, such as public speaking. People with a social phobia have a fear of embarrassing themselves or of being humiliated in public.

How common are phobias?

Phobias are the most common type of anxiety disorder. In the UK, an estimated 10 million people have phobias. Phobias can affect anyone, regardless of age, sex and social background.

Simple phobias, such as a fear of going to the dentist, usually start during early childhood, often between the ages of four and eight. Simple phobias often disappear on their own as the child gets older and usually do not cause problems in adulthood.

Complex phobias usually start later in life. Social phobias often begin during puberty and agoraphobia in the late teens to early twenties. Sometimes, complex phobias continue for many years.

Read more about the causes of phobias

How are phobias treated?

Almost all phobias can be successfully treated and cured. Treating simple phobias involves gradually becoming exposed to the animal, object, place or situation that causes fear. This is known as desensitisation or self-exposure therapy. You could try these methods with the help of a professional or by using self-help techniques.

Treating complex phobias often takes longer and involves talking therapies, such as counselling, psychotherapy and cognitive behavioural therapy (CBT).

Read more about how phobias are treated

Medication is not usually used to treat phobias. However, it is sometimes prescribed to help people cope with the effects of anxiety. The medication used may include:

• antidepressants
• tranquilisers
• beta-blockers

All phobias, particularly complex phobias such as agoraphobia (a fear of open spaces and public places), can limit your daily activities and may cause severe anxiety and depression.

People with phobias usually need to avoid contact with the thing that causes fear and anxiety. How far someone with a phobia will go to avoid contact varies considerably.

For example, someone with a fear of spiders (arachnophobia) may not want to touch a spider, whereas someone else with the same fear may not even want to look at a picture of one.

Physical symptoms

Panic attacks are common among people with phobias. They can be very frightening and distressing. The symptoms often occur suddenly and without warning.

As well as overwhelming feelings of anxiety, a panic attack can cause physical symptoms including:

• sweating
• trembling
• hot flushes or chills
• shortness of breath or difficulty breathing
• a choking sensation
• rapid heartbeat (tachycardia)
• chest pain or a feeling of tightness in the chest
• a sensation of butterflies in the stomach
• nausea
• headaches and dizziness
• feeling faint
• numbness or pins and needles
• dry mouth
• a need to go to the toilet
• ringing in your ears
• feeling confused or disorientated

In severe cases, you may also experience psychological symptoms such as:

• fear of losing control
• fear of fainting
• feelings of dread
• fear of dying

Complex phobias

Like simple phobias, complex phobias, such as agoraphobia and social phobia, can affect your wellbeing.

Agoraphobia often involves a combination of several interlinked phobias. For example, someone with a fear of going outside or leaving their home may also have a fear of being left alone (monophobia) or of places where they feel trapped (claustrophobia).

The symptoms experienced by agoraphobics vary in severity. Some people feel very apprehensive and anxious if they have to leave their home to visit the shops, whereas others may feel relatively comfortable travelling a short distance from their home.

If you have a social phobia, the thought of being seen in public or appearing at social events can make you feel very anxious and frightened. These situations can make you feel vulnerable.

Intentionally avoiding meeting people in social situations, such as at a dinner party, is a sign of social phobia. As with agoraphobia, in extreme cases of social phobia, some people are too afraid to leave their home.

It may take some time to overcome a complex phobia but there are several treatment options for phobias available, including talking therapies and self-help techniques.

Phobias usually develop during childhood, adolescence or early adulthood following a frightening event or a stressful situation. However, it is not always clear why some phobias occur.

Simple phobias

Simple phobias usually develop in early childhood, often between the ages of four and eight. A simple phobia can sometimes be traced to an early childhood experience. For example, if a young child is trapped in a confined space, they may develop a fear of enclosed spaces (claustrophobia) when they are older.

If someone shares the same phobia with another family member, such as a fear of spiders (arachnophobia), this may be because they learned to fear spiders as a child, rather than the phobia being passed on genetically (running in families).

Complex phobias

The exact causes of complex phobias, such as agoraphobia and social phobia, are unknown. However, it is thought that genetics, brain chemistry and life experiences may all play a part in the development of these phobias.

Social phobias may be caused by a previous intense or anxious experience in a social situation. Alternatively, a person’s social confidence may not have had the chance to fully develop past the normal stage of shyness experienced as a young child.

Most people with a phobia are usually fully aware that they have one. Many people live with a phobia without having it formally diagnosed and take great care to avoid the thing they are afraid of.

However, if you have a phobia, getting help from your GP and a specialist with expertise in behavioural therapy, such as a psychologist, can often be beneficial. You may also choose to book an appointment privately.

Complex phobias

If you have a complex phobia, such as agoraphobia (a fear of open spaces and public places) or social phobia, see your GP. They may refer you to a mental healthcare specialist, such as a psychologist or psychiatrist, who can help.

Agoraphobia

The anxiety disorder charity Anxiety UK has produced a list of questions to help people identify whether they have agoraphobia. If you answer yes to most of the questions below, it is likely that you have agoraphobia.

During the past six months:

• Do you regularly avoid situations because you are frightened of having a panic attack?

Do any of the following situations make you feel anxious:

• going outside, away from your home
• standing in long lines
• being in a confined space, such as in a tunnel or the underground
• being at home alone
• being in wide open spaces, such as in a field or park
• being in crowded places

Do you avoid being in any of the above situations?

If you answer yes to most of these questions, see your GP who will be able to make a formal diagnosis of agoraphobia and provide you with further information and advice.

Social phobia

Anxiety UK has produced a list of questions to help people identify whether they have social phobia. If you answer yes to most of the questions listed below, it is likely that you have social phobia.

During the past six months:

• Do you worry a lot about embarrassing yourself in front of others?
• Do you worry about what people might think of you?
• Do you feel anxious in social situations?

Do you worry about behaving anxiously in any of the following situations:

• public speaking
• eating and drinking in front of other people
• writing in front of other people
• going to parties and other social gatherings

Do you avoid any of the above situations because they make you feel anxious?

If you answer yes to most of these questions, see your GP, who can make a formal diagnosis of social phobia and provide you with further information and advice.

To diagnose you with social phobia, your GP will need to use the following criteria:

• your symptoms must be caused by anxiety and not be secondary to other symptoms, such as delusions or obsessions
• the anxiety must be the direct result of being in social situations
• avoiding social situations must be a prominent feature of your condition

Many people with a phobia do not need treatment and find that avoiding the object of their fear is enough to control the problem.

However, it may not always be possible to avoid certain phobias, such as a fear of flying. You may want to get professional help and advice to find out about treatment options or you may wish to try self-help techniques.

Most phobias are curable, but no single treatment is guaranteed to work for all phobias. In some cases, a combination of different treatments may be recommended. The main types of treatment are outlined below.

Talking treatments

Talking treatments are often very effective for people with phobias. There are several different types of talking therapy:

Counselling: a trained counsellor listens to your problems, such as feeling anxious in certain situations, and helps you to overcome them.

Psychotherapy: a psychotherapist uses an in-depth approach to find the cause of your problem and suggests ways to deal with it.

Cognitive behavioural therapy (CBT): a type of counselling that explores your thoughts, feelings and behaviour to develop practical ways of effectively dealing with the phobia.

Speak to your GP to find out if talking treatments would be suitable for you and whether they are available on the NHS in your area.

Desensitisation

Many simple phobias can be treated using a form of behaviour therapy known as desensitisation or self-exposure therapy. It involves being gradually exposed over a period of time to the object or situation of your fear so that you start to feel less anxious about it.

Sometimes, a combination of behaviour therapy and medication may be recommended.

Medication

Medication is not usually recommended for treating phobias because talking therapies are normally successful. However, medication is sometimes prescribed for treating the effects of phobias, such as anxiety.

Three types of medication are recommended for treating anxiety. The medication used may include:

• antidepressants
• tranquillisers
• beta-blockers

Antidepressants

Antidepressants are often prescribed to help reduce anxiety. Paroxetine (Seroxat), a selective serotonin reuptake inhibitor (SSRI), is licensed to treat social phobia. Citalopram (Cipramil) and escitalopram (Cipralex) are licensed for the treatment of panic disorder. Venlafaxine (Efexor) is licensed for generalised anxiety disorder (GAD).

Common side effects of these treatments include:

• nausea
• headaches
• sleep problems

Initially, they may make your anxiety worse.

Clomipramine (Anafranil) is a type of tricyclic antidepressant (TCA) that is licensed to treat phobias. Side effects include:

• dry mouth
• drowsiness
• blurred vision
• tremors (shaking)
• palpitations (irregular heartbeat)
• constipation
• difficulty urinating

Moclobemide (Manerix) is a type of antidepressant from the monoamine oxidase inhibitor (MAOI) group of antidepressants. It is sometimes prescribed to treat social phobia. Moclobemide interacts with certain types of food, so if you are prescribed this medication, read the information leaflet that comes with it to find out which foods you should not eat.

Other possible side effects include:

• sleep problems
• dizziness
• stomach problems
• headaches
• restlessness
• agitation

Antidepressants can cause withdrawal symptoms. If you are prescribed antidepressants, it is important that you don't stop taking them suddenly. See your GP, who will lower your dose gradually over time.

Tranquillisers

Benzodiazepines are a group of medicines that are also known as minor tranquillisers. They are sometimes used to treat severe anxiety, but are usually only prescribed in the lowest possible dose for the shortest possible time. This is because they are associated with withdrawal and dependence problems.

Benzodiazepines are usually only prescribed for a maximum of four weeks at a time. Like antidepressants, their use should be stopped gradually. Benzodiazepines that are often used include:

• diazepam (Valium)
• alprazolam (Xanax)
• chlordiazepoxide
• lorazepam (Ativan)
• oxazepam

Side effects of these medications include:

• drowsiness
• tiredness
• confusion

Two other types of tranquillisers that are licensed to treat severe anxiety are buspirone and meprobamate. Like benzodiazepines, these drugs are only prescribed on a short-term basis.

The side effects of meprobamate are similar to those of benzodiazepines. The side effects of buspirone include:

• nausea
• dizziness
• headaches
• nervousness
• light-headedness

Beta-blockers

Beta-blockers are often used to treat cardiovascular conditions, such as heart problems and high blood pressure (hypertension). They are also sometimes prescribed to help reduce the symptoms of anxiety, such as palpitations (irregular heartbeat).

Beta-blockers slow down your heart rate and decrease your blood pressure. Propranolol (Inderal) is a beta-blocker that is commonly used to treat anxiety. Side effects include:

• stomach problems
• cold fingers
• tiredness
• sleep problems

Each phobia is different and no single self-help programme will work for everyone. You may decide to use your own self-help strategy, or get help from a mental healthcare specialist, such as a psychologist.

Phobias self-help guide

Our mental health self-help guides are based on Cognitive Behavioural Therapy (CBT) and have proven highly successful in helping people with anxiety and other mental health issues.

Other types of self-help

A self-help programme could include:

• lifestyle changes
• having a course of cognitive behavioural therapy (CBT)
• attending a self-help group
• using self-exposure therapy (see below) to try to overcome your fear
• a combination of these

Lifestyle changes

Changing your lifestyle can help reduce the symptoms of a phobia, such as panic attacks. This could include:

• regular exercise
• regular meals on a schedule
• getting enough sleep
• reducing or avoiding caffeine and other stimulants

Self-exposure therapy

Self-exposure therapy (de-sensitisation) involves gradually increasing the length of time that you are exposed to the object of your phobia.

If you have agoraphobia (a fear of open spaces and public places), you might begin by going outside your house for a very short time, then gradually increasing the length of time you spend outside and the distance you travel from your house. This technique is often effective in allowing someone with a phobia to cope with their anxiety.

Other self-help techniques

Other self-help techniques include:

• relaxation techniques: a series of physical exercises that may help you relax and control your breathing.
• visualisation: combines relaxation and breathing techniques with mentally visualising how you will successfully deal with a situation that could cause anxiety.
• self-help groups: a useful way of meeting others with similar experiences and sharing ways of coping.  
• FearFighter is a software programme you can access on the internet which is recommended by the Department of Health and may be useful if you are considering self-help for panic disorder and phobia.