Phobia

A phobia is an intense, lasting fear of a specific object, situation or activity, out of proportion to the real danger, that you avoid or endure with great distress. Phobias are a type of anxiety condition. They are common, usually start in childhood or the teens, and respond well to treatment that faces the fear in planned steps.

Also called: specific phobia, for fear of one thing; the word comes from the Greek phobos, fear. The same ending is used for prejudice, as in xenophobia, which is not an anxiety condition (see below).

Types

WHO’s ICD-11 describes three groups:

Specific phobias: fear of one object or situation. Common ones are animals (dogs, insects, snakes, spiders), heights, flying, enclosed spaces, blood, injections and injury, and vomiting. Fears with their own names, such as zoophobia (animals) or xanthophobia (the colour yellow), all fall here.
Social anxiety disorder, once called social phobia: fear of being judged or embarrassed in social or performance situations.
Agoraphobia: fear of places where escape would be hard or help unavailable, such as crowds, buses or being out alone, often linked with panic attacks.

Across surveys in many countries, fear of animals was the most common specific phobia, then blood and injury, then heights.

Signs and symptoms

Near the feared thing, or even thinking about it, you may get a racing or pounding heart, sweating, trembling, a tight chest, feeling sick, dizziness, and a strong urge to get away. Some people fear they will faint, lose control or die. Between encounters, the fear shapes your life: you plan routes, turn down invitations or avoid the doctor. Children may cry, cling or freeze.

Causes

It’s not always clear why a phobia starts. Many follow a frightening event or a stressful period, for example being chased by a dog. Most begin in childhood, the teens or young adulthood, and in cross-national surveys the typical age of onset for a specific phobia was about eight. Phobias can be learned from a parent or friend who has one, and a family history of anxiety raises the risk.

Treatment

The treatment with the best evidence is exposure-based CBT: with a therapist, you build a ladder from the least to the most frightening version of the thing, climb it one step at a time, and stay at each step until the fear falls. Across 33 trials, exposure treatment produced large effects compared with no treatment and beat other therapies; facing the real thing worked better than imagining it, and more sessions did better than fewer. The approach is explained under exposure therapy.

Other talking therapies are sometimes offered. A doctor may prescribe an antidepressant or a beta blocker for the physical symptoms, but medicine doesn’t remove a phobia on its own. Day to day, it helps to tell someone you trust, to be careful about looking up images online before you are ready, and to avoid caffeine late in the day.

In Nigeria

In Nigeria’s national mental health survey of 6,752 adults, about 6 in 100 had had a specific phobia at some point, close to the global average and higher than any other anxiety disorder recorded. Animal phobias were the most common here too, then fear of still water or storms, blood and injury, enclosed spaces, heights and flying. Few people get treatment: across the countries surveyed, only about one in nine Nigerians with an anxiety disorder had any. Keep the line between fear and phobia honest. Being wary of snakes or stray dogs is sensible, since snakebite and rabies are real risks here; a phobia is when the fear is far beyond the risk and runs your choices.

Phobia vs fear vs anxiety

Fear is the normal response to a real threat, and it passes when the threat does. A phobia is fear out of proportion, lasting months, with avoidance. Anxiety that floats from one worry to the next, with no single trigger, points more to generalised anxiety. A panic attack can happen inside a phobia, but panic disorder is fear of the attacks themselves.

When to get help

Get help if the fear is stopping you doing things that matter, such as travelling, seeing a doctor or taking a job, or if you are organising your life around avoiding it. You can book a licensed therapist on Mytherapist.ng for anxiety and phobias; ask whether they use exposure-based CBT. Our full guide, Anxiety in Nigeria, covers the wider picture.