Psychopathology Sum-Up: Specific Phobias

It’s Friday, which means a mental health summary. This post is about so called ‘specific’ phobias, which excludes social phobia. Another Sum-Up will deal with that. 

The Overview:

Specific phobias are a category of anxiety disorders. (Anxiety disorders also include OCD, Post-Traumatic Stress Disorder, and Generalized Anxiety Disorder, among others.) Specific phobias are can be seen as the Mad Libs of anxiety: “fear of [insert a noun here]”. The fear is paralyzing, and often interferes with normal functioning, but most are easily cured. In fact, this makes them unusual–one of the only disorders where upon discovery, we know what to do, and we know you’ll most likely be cured.

Specific phobias are also fairly common, and occur most often in adolescence. When the phobia interferes with functioning, people are quite good about seeking treatment. Otherwise, most people avoid the trigger (sometimes going to great lengths), and live their lives. Common phobias include flying, enclosed places, heights, dogs, escalators, spiders, and snakes. (NIMH)

Phobia Treatment:

Blood/Injury/Injection Treatment: Fear of needles, blood, wounds, injuries, or some combination thereof is known as BII. In severe cases, just reading about injuries, even in fiction, can cause wooziness. Treatment is actually different from other phobias, because it’s hard to unlearn fainting. Clients are taught to tense all of their muscles at once when triggered, which raises blood pressure.

Exposure Therapy: Exposure therapy can work in a single day, which is kinda cool. Of course, it takes all day, but no other therapy is quite so simple. Client and therapist both decide on a series of experiences from mild to very scary, and work through each. For instance, looking at a picture of a snake, then talking about snakes, imagining a snake, being in the same room as a snake, being near a snake, and finally, holding a snake. Update: Cuttlefish expands on this very very well–there’s a few types of ET, and they’re very different from each other.

Cognitive therapy: Talking through excessively fearful thought processes and challenging them. This is often combined with exposure therapy.

Medication: Never been shown to be effective.

Important Note: Just because phobias are irrational fears and easily treated does not mean you should badger, mock, or otherwise force someone to face their phobia. It’s rude and callous. Don’t do it.

Things Specific Phobias are Not:

Disliking things: hating dogs is not the same as being scared of them.

Rational fear: I think we can all agree that it’s rational to fear the idea of a plane crash, or developing a terminal illness. However, it’s slightly less rational to refuse to look at planes because of a fear of plane crashes. Phobias are irrational fears.

If any information is incorrect, please note it in the comments! However, I am going to ask for citations. I have access to journals as a student, so no worries if it appears behind a paywall. Also, please chime in with your own experiences, misconceptions, myths you’ve heard, and any book suggestions!

Previous Psychopathology Sum-Ups:
Bipolar Disorder

Psychopathology Sum-Up: Specific Phobias

11 thoughts on “Psychopathology Sum-Up: Specific Phobias

  1. 1

    I’m pretty sure I got one of these phobias. There was one time when I encountered a very big spider chilling out in my kitchen. It was unlike anything I’ve ever felt in my life. I could feel the blood draining from my face, my body going numb, I couldn’t move. Very horrifiyng. Perhaps I should look into it eventually. /hmm

  2. 2

    Yep. I’ve got a very, very severe phobia of needles. It’s so specific and irrational that I’m unable to even look at a picture of a needle piercing skin without having a horrible panic attack and feeling sick. I WISH I felt faint, that’d solve a lot of problems!
    Heck, it’s so bad that if I’m even in a room with someone else having an injection, I’ll be in a corner, sobbing.
    Childbirth was a very, very trying experience!

    It’s so strange to be in total and utter terror mode, screaming and biting a pillow over what you know is something so trivial and helpful, and being totally fine two minutes later and thanking the doctor/anaesthetist whilst apologising. When you can speak again, heh. The midwife had apparently never seen such a severe case!

    I find it hilariously silly. I’ve sought treatment, but the nature of the trauma makes exposure therapy nigh impossible to cope with and CBT has been entirely useless. I generally just avoid exposure at any cost that doesn’t involve harm to anyone else, and try to mitigate the negative effects as much as possible, like the lovely midwives who gave me my vaccinations simultaneously and as quickly as possible whilst I screamed and tried my hardest not to simply bolt.

    A phobia is a huge inconvenience, and I especially feel for people who have phobias of things that they’re guaranteed to deal with almost daily such as agoraphobia. It’s hard enough for me to go to a doctor, I’m always terrified they’ll ask for a blood test, and the phobia is so powerful that not only do I slip into abject terror, my veins collapse so they can never get anything, making the whole thing that much more traumatic as they have to try again and again, failing each time. Seriously. It’s bonkers.

  3. 3

    There are types of exposure therapies; for instance, flooding, in which the individual is deliberately exposed to a high-anxiety level of the feared stimulus (e.g., a germ-phobic person handling dog feces without gloves, or a snake-phobic person handling a python) until, essentially, their anxiety burns itself out, and the association between the stimulus and fear is broken. It’s based on simple extinction, with the unconditioned stimulus (some sort of actual harm) *not* being associated with the conditioned stimulus (the feared object). The specifics of what stimulus is presented matter greatly and will vary from person to person even within the same phobia (for instance, a spider phobia for one person might have big hairy tarantulas as the ultimate fear, while another person’s ultimate might be a shiny, bald, spindly-legged spider). As you say, this can be successful in one session… but if it is not, escape from this session may lead to operant strengthening of the fear response (negative reinforcement, or reinforcement due to the removal of a stimulus).

    A more gradual, less stressful exposure therapy would be counterconditioning, in which (as you say) a hierarchy of feared stimuli, from weaker to stronger (again, individualized according to the specifics of a person’s phobia) are paired with (usually) some form of systematic relaxation (the thinking being that relaxation is incompatible with fear). If an object signals relaxation (either in the classical conditioning elicitation sense, or the operant discriminative stimulus sense), it will not signal fear. This was one of the first, if not *the* first, behavioral treatments, credited to Mary Cover Jones in 1924. Verbal therapies tried to imitate the gradual hierarchical approach, but often chose to have clients *imagine* the feared objects or situations instead of actually being exposed to them; this was less successful. Relaxing in the presence of a picture of a snake, a movie of a snake, a small snake, a larger snake… (assuming this is the client’s hierarchy–some will have fears beginning with actually touching a snake, while others are unreasonably nervous around the letter S; the hierarchy must be sensitive to the individual’s situation), the client is eventually able to handle a snake, hold a tarantula, speak in public, climb a ladder, or whatever is needed.

    Other sorts of exposure therapies more-or-less use a combination of bits and pieces of one or the other of these two; again, the important thing is to have treatment by a a knowledgeable therapist, custom-tailored to the needs of the individual. There are no one-size-fits-all therapies; this is not a simple recipe to be followed the same way for everyone.

    Exposure therapies like this are not limited to phobias, of course; the case of phobias is just one of several situations where the same theoretical foundation is useful–for instance, childbirth, and biathlon. The theory behind these treatments holds that phobias are learned in the same manner as pretty much anything else; it is not a weakness, not some sort of failure, but the specifics of one’s life history which lead to the phobia. Mocking or badgering is clearly not called for.

    1. 4.1

      Age ten is considered the start of average onset.
      Yours is both interesting because you have a memory of something that occurred before age three, (Almost everyone doesn’t, though they may have ‘learned memories’ they heard from others and adapted) and because it was a specific phobia.
      I agree: hunh.

  4. 5

    Closest thing I have to a phobia, I think, is fear of seeing someone else fall to their death.
    Heights don’t bother me at all, but if I see someone ELSE hanging off the edge of a cliff by a tree limb for a better view I start wanting to dive to the ground, and I tend to get very pissed off at them.

    I think I have figured out what in my childhood caused this. Maybe.
    Troubled kid in grade school several times threatened and tried to jump to his death in front of me.
    Odd thing is how I went for years, close to middle age. without thinking of Richard and his troubles and that there might be a connection.

    Of course, maybe I have TONS of phobias, seeing as I’m practically a shut-in. :shrug:
    The odd thing is that the really extreme stuff that later happened to me and which resulted in PTSD don’t seem to have caused any actual specific phobias.

  5. 6

    Thanks for writing this. People without accurate knowledge of psychology tend to dismiss phobias as ‘silly’. They need to know how serious an issue it really is for someone with one.

  6. 7

    Sophia, I’ve been using Xanax to get injections/blood drawn for years. I’ve slowly gone from 3mg (a ridiculously high dose!) down to half a mg, which is more typical for a panic disorder. I think that taking the panic away and letting me have a calm (albeit sedated) experience with a needle has been sort of a med-assisted exposure therapy. It’s worth a shot… please excuse the pun. =/

    It’s funny, though. I work in a lab and I use syringes all the time. I just can’t take having them pointed at me!

  7. 9

    I have a terrible phobia of needles. Just talking or thinking about them is triggering. I’ve been known to pass out, to have panic attacks from crying to full-fledged-needing-to-be-restrained-hitting-doctors-freakout and weirdest of all, I have strong physical reactions: My arms hurt just from thinking about it, and once I accompanied a friend who went for a vaccination, and although I stayed in the waiting room and never even saw the needle, when we left I noticed a huge lump in the shot place in my arm that hurt like hell and took hours to fade. In fact, my arms are hurting right now as I write this…

Leave a Reply

Your email address will not be published. Required fields are marked *