14th February 2025

Phobias

Overview of phobias

Phobias are recurrent, excessive (disproportionate) and irrational fears with anxiety symptoms regarding specific objects or situations. They often lead to avoidance behaviours.

For a phobia diagnosis, symptoms must last for at least several months and be severe enough to cause significant distress and impairment in interpersonal, social and/or occupational functioning.

In general, first-line treatment is with CBT and may include exposure therapy (graded desensitisation) and relaxation training. Pharmacological measures may also be needed, including SSRIs or SNRIs. Beta blockers can be used as required for somatic anxiety symptoms (particularly in social phobia). Benzodiazepines are used for short-term treatment only, such as to help engage with exposure therapy.

Specific phobias

In specific phobias, a simple object or situation, or anticipation of its exposure, is the subject of the phobia. This is in contrast to “complex” phobias such as agoraphobia or social phobia. 

The most common subjects are spiders (arachnophobia), snakes (ophidiophobia) and heights (acrophobia).

Agoraphobia

Agoraphobia is an anxiety disorder characterised by anxiety symptoms in places which are difficult to leave, such as crowded or public spaces, with active avoidance of these situations. There are fears regarding specific negative outcomes such as incapacitation, panic attacks, or embarrassing events.

There is an overlap of aetiological factors, clinical features, and effective treatments with panic disorder.

Social phobia

Social phobia is also known as social anxiety disorder.

The patient has severe anxiety symptoms in specific social situations, such as meeting strangers, public speaking or eating in front of others. There are preoccupations that the individual will be negatively perceived by others due to how they come across. These social situations are either avoided or endured with intense anxiety symptoms.

There is a high rate of concomitant anxiety disorders, depressive disorders and substance misuse.