Phobia: definition, symptoms and treatment

By Cristiano Antonino On Jan 15, 2023

A phobia is an extreme, irrational and disproportionate fear of something that poses no real threat and with which others are confronted without particular psychological torment

The sufferer is overcome with terror at the idea of perhaps coming into contact with a harmless animal such as a spider or a lizard, or at the prospect of performing an action that leaves most people indifferent (e.g. the claustrophobic cannot take the lift or the underground).

A phobia is a marked and persistent fear with peculiar characteristics:

it is out of proportion to the real danger of the object or situation;
cannot be controlled with rational explanations, demonstrations and reasoning;
exceeds the subject’s capacity for voluntary control;
produces systematic avoidance of the feared situation-stimulus;
persists for a prolonged period of time without resolving or abating;
involves a certain degree of maladjustment for the individual concerned;
the individual recognises that the fear is unreasonable and that it is not due to actual dangerousness of the feared object, activity or situation.

People suffering from phobias are fully aware of the irrationality of their fear, but cannot control it.

Phobic anxiety is expressed by physiological symptoms such as tachycardia, dizziness, extrasystole, gastric and urinary disturbances, nausea, diarrhoea, choking, redness, excessive sweating, trembling and exhaustion.

With fear, one feels sick and wants only one thing: to run away! Running away, on the other hand, is an emergency strategy.

The tendency to avoid all situations or conditions that may be associated with fear, although it reduces the effects of the phobia in the moment, in reality constitutes a deadly trap: each avoidance, in fact, confirms the dangerousness of the avoided situation and prepares for the next avoidance (in technical terms, it is said that each avoidance negatively reinforces the fear).

This spiral of progressive avoidance produces an increase, not only in distrust of one’s own resources, but also in the person’s phobic reaction, to the point of significantly interfering with the individual’s normal routine, work or school functioning, or social activities or relationships. The discomfort thus becomes increasingly limiting.

One who has a phobia of flying may, for example, have to forego many trips, and it becomes embarrassing if one has to travel for work.

Those who are afraid of needles and syringes may forego necessary medical check-ups or deprive themselves of the experience of pregnancy.

Someone who is afraid of pigeons does not walk through squares and cannot enjoy a coffee sitting at an outdoor café table, and so on.

Types of phobia

When we talk about phobias, we generally refer to: dog phobia, cat phobia, spider phobia, phobia of enclosed spaces, insect phobia, aeroplane phobia, blood phobia, injection phobia, etc.

More precisely, there are the generalised phobias (agoraphobia and social phobia), which are highly disabling, and the common specific phobias, which are generally well managed by the subjects by avoiding the feared stimuli, which are classified as follows

Animal type. Spider phobia (arachnophobia), bird phobia or pigeon phobia (ornithophobia), insect phobia, dog phobia (cynophobia), cat phobia (ailurophobia), mouse phobia, etc.
Natural environment type. Phobia of thunderstorms (brontophobia), phobia of heights (acrophobia), phobia of the dark (scotophobia), phobia of water (hydrophobia), etc..
Blood-injection-injury type. Blood phobia (haemophobia), needle phobia, syringe phobia, etc.. In general, if the fear is provoked by the sight of blood or a wound or by receiving an injection or other invasive medical procedures.
Situational type. In cases where the fear is provoked by a specific situation, such as public transport, tunnels, bridges, lifts, flying (aviophobia), driving, or enclosed places (claustrophobia or agoraphobia).
Other type. Where fear is triggered by other stimuli such as: fear or avoidance of situations that could lead to suffocation or contracting an illness (see also obsessive-compulsive disorder and hypochondria), etc. A particular form of phobia concerns one’s own body or a part of it, which the person sees as hideous, unsightly, repulsive (dysmorphia).

It is important to clarify that the type of phobia one suffers from does not have any unconscious symbolic meaning, as is suggested by some psychoanalysts, and the specific fear is only linked to involuntary mislearning experiences (not necessarily remembered by the subject), whereby the organism involuntarily associates danger with an object or situation that is objectively not dangerous.

It is, in essence, a process of so-called ‘classical conditioning’.

This conditioning is maintained unchanged over time due to the spontaneous systematic avoidance that phobic subjects put in place with regard to the feared situation.

Phobias cure

The treatment of phobias is relatively simple, if not complicated by other psychological disorders, and primarily involves short-term (often within 3-4 months) cognitive behavioural psychotherapy.

The treatment of phobias, after a period of case evaluation that usually ends within the first month, necessarily involves the use of graduated exposure techniques to feared stimuli.

The patient is brought very progressively closer to the stimuli that trigger fear, starting with those furthest from the central object or situation (e.g. the image of a new syringe for a needle phobic or a tin of food for a dog phobic).

Contact with such stimuli is maintained until inevitably the habit takes over and they no longer generate anxiety.

Only at that point is exposure to a slightly more anxiety-provoking stimulus, in a hierarchy carefully prepared in session beforehand. In this way, over the course of a few weeks, it is possible to move up the hierarchy to much stronger exposures, without ever arousing too much anxiety in the subject and repeating each exercise until it has become ‘neutral’.

This procedure can be very frightening for people suffering from a phobia, as it involves facing the feared object or situation face to face, but if done well, with the help of an experienced therapist, it is absolutely applicable and guarantees success in 90-95% of cases in curing the phobia.

In some cases, to make the method more effective, the patient is taught physiological relaxation strategies and asked to use them shortly before exposing himself to anxiety-provoking stimuli, so as to facilitate the creation of a new conditioning, in which the organism associates relaxation, rather than anxiety, with such stimuli.

In the case of disabling phobias, it is very common to use anxiolytic drugs ‘as needed’ to manage anxiety by necessarily having to face certain feared situations (e.g. before taking a plane).

This strategy makes it possible to survive the event, but achieves nothing more than the effect of reinforcing the phobia.

More useful, possibly, although not comparable and undoubtedly less effective than cognitive-behavioural techniques, may be appropriate and prolonged therapies based on SSRI antidepressants, under careful medical evaluation.

Amaxophobia, How To Overcome The Fear Of Driving?

Panic Attacks: Symptoms And Treatment Of The Most Common Anxiety Disorder

First Aid: How To Deal With Panic Attacks

Rorschach Test: The Meaning Of The Stains

Anxiety: A Feeling Of Nervousness, Worry Or Restlessness

War And Prisoner Psychopathologies: Stages Of Panic, Collective Violence, Medical Interventions

First Aid And Epilepsy: How To Recognise A Seizure And Help A Patient

Panic Attack Disorder: Feeling Of Imminent Death And Anguish

Firefighters / Pyromania And Obsession With Fire: Profile And Diagnosis Of Those With This Disorder

Rescuer Safety: Rates Of PTSD (Post-Traumatic Stress Disorder) In Firefighters

Anxiety, When Does A Normal Reaction To Stress Become Pathological?

Defusing Among First Responders: How To Manage The Sense Of Guilt?