A phobia is an intense fear of a particular object, situation or activity that is far greater than the danger it poses, and that leads a person to avoid it. The fear is persistent, usually lasting six months or more, and it causes distress or disrupts ordinary activities such as work, travel or medical care.
Key points
- A phobia is fear of an object or situation, out of proportion to the danger, that leads to avoidance.
- What marks it out is the level of avoidance and impairment, not the fear itself, and it lasts six months or more.
- Specific phobias fall into five categories: animal, natural environment, blood-injection-injury, situational and other.
- Blood-injection-injury phobia is the type that commonly causes fainting, and treatment is adapted for that.
- Exposure-based cognitive behavioural therapy is the main treatment, and NICE has no guideline devoted to specific phobia.
Symptoms
- Racing heart, palpitations, chest tightness, dizziness, trembling, sweating, breathlessness and nausea on contact with the trigger.
- Severe anxiety out of proportion to the risk; fear of fainting, losing control or dying.
- Avoiding the trigger and anywhere it might appear; needing someone else present to face it; using distraction, alcohol or reassurance.
Causes and risk factors
- Frightening direct experiences, learned behaviour within a family, a family history of anxiety.
- Phobias usually begin in childhood, the teenage years or early adulthood, and are more common in women.
Treatment
- Exposure-based CBT: a graded exposure hierarchy from least to most frightening, staying in the situation until anxiety drops.
- For blood-injection-injury phobia, exposure is combined with muscle tensing and staying seated to prevent fainting.
- Antidepressants, beta blockers and sedatives are listed as options; no medication is licensed specifically for it in the UK.
When to speak to a professional
- Avoiding or postponing medical care, vaccinations or blood tests.
- Turning down work, study or travel because of the trigger.
- Drinking alcohol or using medication to get through encounters.
- Having panic attacks, or noticing the fear spread further.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.