Overview

A phobia is an overwhelming and debilitating fear of an object, place, situation, feeling or animal.

Phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger about a situation or object.

If a phobia becomes very severe, a person may organise their life around avoiding the thing that's causing them anxiety. As well as restricting their day-to-day life, it can also cause a lot of distress.

Phobia symptoms

A phobia is a type of anxiety disorder. You may not experience any symptoms until you come into contact with the source of your phobia.

But in some cases, even thinking about the source of a phobia can make a person feel anxious or panicky. This is known as anticipatory anxiety.

Symptoms may include:

• unsteadiness, dizziness and lightheadedness
• nausea
• sweating
• increased heart rate or palpitations
• shortness of breath
• trembling or shaking
• an upset stomach

If you do not come into contact with the source of your phobia very often, it may not affect your everyday life.

But if you have a complex phobia, such as agoraphobia, leading a normal life may be very difficult.

Symptoms

Phobias can limit your daily activities and may cause severe anxiety and depression. Complex phobias, such as agoraphobia and social phobia, are more likely to cause these symptoms.

People with phobias often purposely avoid coming into contact with the thing that causes them fear and anxiety. For example, someone with a fear of spiders (arachnophobia) may not want to touch a spider or even look at a picture of one.

In some cases, a person can develop a phobia where they become fearful of experiencing anxiety itself because it feels so uncomfortable.

You don't have to be in the situation you're fearful of to experience the symptoms of panic. The brain is able to create a reaction to fearsome situations even when you aren't actually in the situation.

Physical symptoms

People with phobias can have panic attacks. These 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, such as:

• sweating
• trembling
• hot flushes or chills
• shortness of breath or difficulty breathing
• a choking sensation
• rapid heartbeat (tachycardia)
• pain or 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
• confusion or disorientation

Psychological symptoms

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

Complex phobias such as agoraphobia and social phobia can often have a detrimental effect on a person's everyday life and mental 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 people with agoraphobia can vary in severity. For example, some people can feel very apprehensive and anxious if they have to leave their home to go the shops. Others may feel relatively comfortable travelling short distances from their home.

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

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

Several treatments for phobias are available, including talking therapies and self-help techniques. However, it can often take some time to overcome a complex phobia.

Who can get it

A phobia can develop during childhood, adolescence or early adulthood.

They're often linked to a frightening event or stressful situation. However, it's not always clear why some phobias occur.

Specific or simple phobias

Specific or simple phobias, such as a fear of heights (acrophobia), usually develop during childhood.

Simple phobias can often be linked to an early negative childhood experience. For example, if you're trapped in a confined space when you're young, you may develop a fear of enclosed spaces (claustrophobia) when you're older.

It's also thought that phobias can sometimes be "learnt" from an early age. For example, if someone in your family has a fear of spiders (arachnophobia), you may also develop the same fear yourself.

Other factors in the family environment, such as having parents who are particularly anxious, may also affect the way you deal with anxiety later in life.

Complex phobias

It's not known what causes complex phobias, such as agoraphobia and social phobia. However, it's thought that genetics, brain chemistry and life experiences may all play a part in these types of phobias.

The physical reactions (symptoms) a person experiences when faced with the object of their fear are real and aren't simply "in their head".

The body reacts to the threat by releasing the hormone adrenalin, which causes symptoms such as:

• sweating
• trembling
• shortness of breath
• a rapid heartbeat (tachycardia)

Treatment

Many people with a phobia don't need treatment, and 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. In this instance, you may decide to get professional help and advice to find out about treatment options.

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 treatment types are:

• self-help techniques
• talking treatments
• medication

Talking treatments

Talking treatments, such as counselling, are often very effective at treating phobias. In particular, cognitive behavioural therapy (CBT) has been found to be very effective for treating phobias.

Cognitive behavioural therapy (CBT)

CBT is a type of counselling that can help you manage your problems by changing the way you think and behave. It can be used to develop practical ways of dealing with your phobia.

One part of the CBT treatment process that's often used to treat simple phobias involves gradual exposure to your fear, so you feel less anxious about it. This is known as desensitisation or exposure therapy.

For example, if you have a fear of snakes (ophidiophobia), your therapist may start by asking you to read about snakes. They may later show you a picture of a snake. They may then arrange for you to visit the reptile house of your local zoo to look at some real snakes. The final step would be for you to hold a snake.

Exposure therapy works by gradually increasing the level of exposure to your fear, which allows you to gain control over your phobia. As the treatment progresses, you should begin to feel less anxious about your phobia.

The National Institute for Health and Care Excellence (NICE) doesn't recommend the use of computerised CBT to treat specific phobias in adults.

Medication

Medication isn't usually recommended for treating phobias, because talking therapies are usually effective and don't have any side effects. However, medication is sometimes prescribed on a short-term basis to treat the effects of phobias such as anxiety.

There are different types of medication that may be prescribed.

Antidepressants

Antidepressants are often prescribed to help reduce anxiety. Selective serotonin reuptake inhibitors (SSRIs) are most often prescribed to treat anxiety, social phobia or panic disorder. These can include:

• escitalopram (Cipralex)
• sertraline (Lustral)
• paroxetine (Seroxat)

Venlafaxine (Efexor), a serotonin and noradrenaline reuptake inhibitor (SNRI) may also be prescribed for anxiety.

Common side effects of these treatments include:

• nausea
• headaches
• sleep problems (insomnia)
• upset stomach

They may also, initially, make your anxiety worse and can cause sexual problems.

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

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

Moclobemide (Manerix) is a type of antidepressant from the monoamine oxidase inhibitor (MAOI) group of antidepressants. It's sometimes prescribed to treat social phobia.

Moclobemide interacts with certain types of food, so if you're prescribed this medication, read the information leaflet that comes with it to find out which foods to avoid.

Other possible side effects of moclobemide include:

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

If you're prescribed antidepressants, it's very important that you don't suddenly stop taking them. Suddenly stopping can cause withdrawal symptoms. See your GP, who can gradually lower your dose.

Tranquillisers 

Benzodiazepines are a group of medicines that are categorised as minor tranquillisers. They include medicines such as diazepam (Valium) and are sometimes used on a short-term basis at the lowest possible dose to treat severe anxiety.

Like antidepressants, benzodiazepines should be stopped gradually to avoid withdrawal symptoms.

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 heart palpitations.

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

• stomach problems
• cold fingers
• tiredness
• sleep problems

Self-help

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.

A self-help programme could include:

• lifestyle changes
• 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

Making some simple changes to your lifestyle can help reduce the symptoms of a phobia, such as panic attacks.

This could include:

• regular exercise
• eating regular, healthy meals
• getting enough sleep
• reducing or avoiding caffeine and other stimulants

Exposure therapy (desensitisation)

Exposure therapy involves gradually increasing the length of time you're exposed to your phobia.

For example, if you have agoraphobia, a fear of open spaces and public places, you might start by going outside your house for a very short period of time, before gradually increasing the length of time you spend outside and the distance you travel from your house.

Exposure therapy can be a very effective way of enabling you to cope with your 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.