A fear that is bigger than the danger
Most people dislike something: spiders in the basement, turbulence, the moment before a flu shot. A phobia is different in size and staying power. MedlinePlus describes a specific phobia as an ongoing, intense fear or anxiety about a certain object, animal, activity or setting that poses little to no actual danger. The American Psychiatric Association adds an important detail: the person usually knows the fear is excessive, but the feeling is overwhelming anyway.
Specific phobias are among the most common anxiety conditions. NIMH estimates that 9.1% of U.S. adults had a specific phobia in the past year and 12.5% will have one at some point. Many cases are mild: NIMH reports that nearly half of adults with a past-year specific phobia had mild impairment. A phobia matters clinically when it starts to cost you something.
Common phobias
MedlinePlus and the NHS list many of the most familiar ones:
- Animals and insects, such as dogs, snakes or spiders
- Heights, bridges, or enclosed spaces like elevators and MRI machines
- Flying
- Blood, injections and other medical procedures
- Storms and lightning, or water
- Tunnels and highway driving
- Vomit or other bodily fluids
Some of these collide with ordinary Michigan life: crossing the Mackinac Bridge on a family trip north, merging onto a busy freeway at rush hour, sitting through a summer thunderstorm, or flying out of DTW for a work conference. When the trigger is something you can easily avoid, a phobia may barely register. When it sits in the path of your job, your health care or your family, it can quietly run the calendar.
What a phobic reaction feels like
MedlinePlus notes that being exposed to the feared thing, or even thinking about it, can set off anxiety. For some people the reaction reaches a full panic attack. The NHS lists symptoms such as:
- Severe anxiety and dread
- Dizziness or lightheadedness
- A pounding or unusual heartbeat
- Tightness in the chest
- Nausea, vomiting or diarrhea
- Trembling or shaking
- Intense fear of fainting, losing control or dying
If panic attacks come only with a particular trigger, Panic Attack or Anxiety Attack? explains how clinicians think about those episodes.
When a fear starts running your life
Avoidance is the hallmark. MedlinePlus gives a simple example: someone afraid of tunnels may avoid driving through them, and that kind of avoidance can interfere with work and social life. Signs that a phobia has grown past an annoyance include:
- Turning down a job, promotion or trip because it involves flying
- Taking much longer routes to avoid highways or bridges
- Putting off blood work, dental care or vaccines because of needles
- Skipping a niece's graduation party because there will be a dog
- Spending days dreading an upcoming exposure, such as a scheduled scan
- Planning your week around the weather forecast
The medical phobias deserve special mention because the stakes are high. Delaying screenings, blood tests or procedures out of fear can affect your physical health. Telling your doctor about the fear before an appointment gives them a chance to help, and many offices are used to it.
What to tell a doctor or therapist
Be specific. Describe exactly what you fear, what happens in your body when you get close to it, what you now avoid, and when it started. Mention any upcoming situation you are dreading, such as surgery, a flight or a new commute, so the conversation can focus on what matters most right now.
Where phobias come from
MedlinePlus notes that phobias usually start in childhood or the teen years and continue into adulthood, and that their causes are not known, although they sometimes run in families. The NHS points out that many phobias can be traced to a frightening event, such as being chased by a dog, or can be learned by watching a family member's fear. Being embarrassed by others' reactions to your fear can make the anxiety stronger. Some people remember exactly when their phobia began; others have always had it.
What helps
The encouraging news is that phobias tend to persist but can respond to treatment. MedlinePlus says talk therapy is often tried first. Exposure-based treatment is the most widely described approach: gradually facing the feared thing, starting with the least frightening step and working up, first in imagination and then in real life. MedlinePlus also mentions group programs for common fears like flying. The NHS notes that some zoos and airlines run sessions for people with phobias.
Medication is sometimes used, particularly for a specific upcoming situation, and that is a conversation for your physician or psychiatrist. MedlinePlus notes that some anti-anxiety medicines can cause physical dependence. If you take something already, talk with your prescriber before changing anything.
A few things you can start on your own, drawn from NHS guidance:
- Practice slow breathing so you have something to do with your body when fear spikes
- Tell someone you trust about the phobia instead of hiding it
- Be careful looking things up online, where frightening images can set you back
- Cut caffeine and energy drinks after mid-afternoon, since they can disrupt sleep and raise anxiety
Because avoidance is what keeps a phobia strong, Why Avoidance Makes Anxiety Grow is worth reading alongside this guide.
Exposure-based work is a specialized skill, so ask any therapist whether they use it and how much experience they have with phobias. In anxiety therapy, Dr. Lehmann works with adults on the broader anxiety picture, including the history behind a fear and the ways it has shaped their choices, and can talk with you about whether a referral for focused exposure work would make sense.