When fears become phobias

Most of us fear an object of a situation. For example, I fear tools such as drills and blenders because the noise they make reminds me of an accident I had a few years back with a food processor. It also scares me when large crowds gather for events such as concerts and demonstrations. But are these fears phobias? Actually not, because my fear doesn’t prevent me from using household electric appliances nor from going to the concerts of my favourite bands, although I might feel somewhat uncomfortable. A phobia is an intense and often irrational fear of an object or situation which results in aversion and which can also cause some unpleasant physical symptoms such as fast breathing, palpitations, sweating and shaking just to mention a few. An important component of every phobia is the anxiety associated with the feared object or situation. But what are the exact diagnostic criteria for being diagnosed with a phobia?

The diagnostic criteria for Specific Phobia

According to the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM – V), for an individual to be diagnosed with a specific phobia, he must experience the symptoms listed below persistently for 6 months or longer:

  1. An intense fear or anxiety about a specific object (e.g. an animal or a syringe) or situation (e.g. flying). Children might express fear or anxiety with crying, clinging, tantrums and freezing.
  2. Exposure to the phobic object or situation almost invariably results in immediate fear or anxiety.
  3. The individual actively avoids or endures with marked fear or anxiety the phobic object or situation.
  4. The fear or anxiety experienced is disproportionate to the threat that the object or situation poses and to the sociocultural context.
  5. The fear or anxiety impacts the social, occupational and other areas of functioning in the affected individual.
  6. the symptoms experienced cannot be better explained by another mental disorder such as panic, obsessive-compulsive disorder and others.

Why do people develop a phobia?

It is largely unclear why people develop phobias. However, different explanations have been put forward and these are considered below.

The biological explanation holds that phobias, like all other behaviours, is inherited. Research has shown that genetics account between 25 and 65% of the variance in the development of phobias. This means that genes play an important role in the development of phobias. Given this inescapable genetic predisposition, it is somewhat reassuring to know that the development of some common phobias such as the fear of spiders (arachnophobia) and the fear of snakes (ophidiophobia) has been explained in terms of an inbuilt and instinctive mechanism meant to increase one’s chances of survival. This is the evolutionary explanation to the development of phobias, which posits that any behaviour that is adaptive is therefore passed onto the next generation. According to this line of thought, humans are more likely to fear spiders and snakes because these are poisonous and difficult to spot. So fear would make us more careful and more alerted towards them than we would normally be. However, this explanation does not apply to all feared objects or situations. For example, the fear of hypodermic needles cannot be traces back to our ancestors and their increased chances of survival. Therefore, the biological explanations are somewhat limited.

Behavioural explanations propose a different account of why people develop phobias. According to behavioural explanations, all behaviour is learnt but the underlying mechanisms are different.

At a very basic level, it has been shown that fears and phobia can be learnt via association, what is known as Classical or Pavlovian Conditioning. The very famous and controversial experiment that Watson & Rayner (1920) carried out with little Albert, a boy about 11 months old, showed that the presentation of a white rabbit – a neutral stimulus, which as a definition elicited no response – when associated with a loud noise – the unconditioned stimulus – led little Albert to develop a fear of all white fluffy objects, e.g. rats and Santa Claus’ beard. This case study was used to support the theory that fears and phobias can be learnt. Indeed, many phobias develop following a stressful encounter with the feared object or situation, e.g. dog phobia might develop after having been attacked by a dog. However, not everyone who has a phobia has had a stressful encounter with the feared object or situation. Equally, many people who have had a frightening encounter have not developed a phobia. Therefore, there are some limitations to this explanation.

At a slightly deeper level, Operant Conditioning claims that fears and phobias can be learnt via mechanisms of reward and punishment, with rewards increasing the likelihood of a behaviour to occur again and the future and punishments decreasing the likelihood. For example, the first time a person displays a phobia she gets a lot of attention from family members who worry about her and the attention acts as a reward strengthening the phobic behaviour and increasing the likelihood that the person will behave similarly in the future.

At the highest level, Social Learning Theory explains the development of phobias in terms of observational learning supported by cases of offspring developing the same phobia as one of their parents for example. However fitting behavioural explanation might be for some cases of phobia development, neither of them can account for all cases. Therefore, behavioural explanations alone are insufficient to account for reasons why people develop phobias. The contribution of the cognitive processes underlying the development of a phobia should also be taken into consideration.

The cognitive explanation posits that people develop phobias due to cognitive biases and irrational thinking whereby the perceived threat of an object or situation is much greater than the actual threat. This overestimation causes the person to experience a great deal of anxiety with all the related physical symptoms and eventually leads to the development of a phobia. Research has shown that when asked to imagine that there was a spider in the room, people with arachnophobia had a greater number of interpretative biases compared to non-phobic, thus showing that cognitive processes are indeed involved in the development of phobias.

However, in most cases the development of a specific phobia depends on the interplay between one’s genetic predisposition and the environment.

What treatment is available for specific phobias?

One of the most effective treatment available for specific phobias is Exposure Therapy which is a type of cognitive behavioural therapy.In Exposure Therapy, the patient is repeatedly exposed to his phobia or fear in a safe context in order to decrease and eventually eliminate the anxiety that accompanies the feared object of situation. Exposure can be real, imaginal or interoceptive, which targets the feared bodily symptoms. For example, if the patient has arachnophobia, he might be exposed to real spiders in a natural history museum, he might be asked to imagine what it would feel like to come into contact with a spider, or might be asked how he would feel in the presence of a spider.

With most patients, 10 treatment sessions are sufficient to significantly reduce the fear or phobia and help him cope better with it. However, research has shown that 4 years after a single session of Exposure Therapy in which the patient had to imagine being exposed to the feared object or situation for a 1 to 3 hour long therapy session, 65% of patients no longer reported the symptoms of a specific phobia. This indicates that much shorter treatment sessions can be just as effective.

Do you have a phobia? If you have found this article interesting, please write and share your fears.