Defined as a persistent and irrational fear of a specific object, activity, or situation, a phobia results in a compelling desire to avoid the perceived hazard. The patient recognizes that his fear is out of proportion to any actual danger, but he can’t control it or explain it away.

Three types of phobias exist: agoraphobia, the fear of being alone or of open space; social, the fear of embarrassing oneself in public; and specific,
the fear of a single, specific object or situation, such as animals or heights.

About 7% of all Americans suffer from a phobic disorder. In fact, phobias are the most common psychiatric disorders in women and the second most common in men. More men than women experience social phobias, whereas agoraphobia and specific phobias are more common in women.

A social phobia typically begins in late childhood or early adolescence; a specific phobia usually begins in childhood. Most phobic patients have no family history of psychiatric illness, including phobias.

Agoraphobia and social phobia tend to be chronic; however, new treatments are improving the prognosis. A specific phobia usually resolves spontaneously as the child matures.


A phobia develops when anxiety about an object or a situation compels the patient to avoid it. The precise cause of most phobias is unknown. Psychoanalytic theory holds that the phobia is actually repression and displacement of an internal conflict. Behavior theorists view phobia as a stimulus-response reflex, whereby the patient avoids a situation or object that causes anxiety.

Signs and symptoms

The phobic patient typically reports signs of severe anxiety when confronted with the feared object or situation. A patient with agoraphobia, for example, may complain of dizziness, a sensation of falling, a feeling of unreality (depersonalization), loss of bladder or bowel control, vomiting, or cardiac distress when he leaves home or crosses a bridge. Similarly, a patient who fears flying may report that he begins to sweat, his heart pounds, and he feels panicky and short of breath when he’s on an airplane.

A patient who routinely avoids the object of his phobia may report a loss of self-esteem and feelings of weakness, cowardice, or ineffectiveness. If he hasn’t mastered the phobia, he may also exhibit signs of mild depression, such as self-medicating with alcohol or drugs.


For characteristic findings in this condition, see Diagnosing phobias, page 636.

Jun 16, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Phobias

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