Specific Phobia

Fear is a normal human feeling when we face threat or danger. Specific Phobia is an extreme, irrational, lasting, and uncontrollable fear when faced with something (e.g., object, situation, animal, thought) not considered dangerous. Children and teens with Specific Phobia are not usually anxious in general, only when they see the thing that scares them. Common specific phobias include dogs, clowns, bugs, storms, blood, injections, darkness, small spaces, and loud noises. Being around the thing they are afraid of or even thinking about it causes severe anxiety. Teens with Specific Phobia usually understand that their fears aren’t logical, but younger children often don’t. They will try very hard to avoid the thing they’re afraid of, which can disrupt their daily lives.

What are the symptoms of Specific Phobia?

Specific Phobias usually fit into one of five categories:

– Animal Type (dogs, bugs, snakes, etc.)

– Natural Environment Type (storms, earthquakes, floods, fires, etc.)

– Blood-Injection-Injury Type (getting shots, seeing blood or injuries)

– Situational Type (flying, driving, heights, small spaces)

– Other Type (anything else)

Core symptoms of Specific Phobia

– Noticeable anxiety or fear about something specific

– The situation or object almost always causes immediate anxiety or fear

– The situation or object is actively avoided or endured with obvious distress

– The fear, anxiety, or avoidance is greater than any actual danger

Associated symptoms of Specific Phobia

– Tantrums or mood swings

– Crying

– Freezing

– Clinging

– Trembling

– Dizziness

– Sweating

How is Specific Phobia diagnosed?

A child-adolescent psychiatrist may diagnose a child or teen with Specific Phobia if they show extreme fear of something not usually considered dangerous; the fear, anxiety, or avoidance they experience is much more than normal for their age and happens almost every time they encounter the feared object or situation; and their symptoms last for six months or more and cause significant problems in everyday life (e.g., social, family, school, etc.).

The child-adolescent psychiatrist may interview and/or assess both the child and a caregiver to figure out the specifics of the child’s fear(s). Many practitioners also use questionnaires or behavior/emotion rating forms to help with the diagnosis and measure the severity of the problem. The practitioner will also try to determine that the child’s or teen’s fear is not related to something unexpected.

Specific Phobia facts

Worldwide frequency of the condition:

Specific phobias are estimated to affect approximately 6% of the European population, although estimates vary between 6% and 9% depending on the phobia. Anxiety disorders, in general, affect 6.5% of the global population.

Impact of the condition in Brazil:

Despite limited data, the estimated prevalence of anxiety disorders in Brazil is 2.9% in children (5-9 years) and 8.6% in adolescents (10-19 years). Specific phobia is a type of anxiety disorder, and regarding it alone, there is no nationally representative data.

Gender ratio:

Specific Phobia is diagnosed more frequently in girls than in boys, with an estimated ratio of 2:1.

Peak age of onset:

The average age of onset of Specific Phobia is approximately 5.5 years — similar to the average age of onset of anxiety disorders in general.

Proportion of cases arising before age 18:

According to recent data, 75% of individuals with Specific Phobia will have received a diagnosis by the age of 18.

What are the associated factors for Specific Phobia?

Some common factors linked with Specific Phobia are:

– Genetic and familial factors: A tendency toward an anxiety disorder most likely comes from a combination of multiple genes interacting with environmental factors. Also, having a close relative with a Specific Phobia makes a child more likely to develop the same phobia.

– Environmental factors: These include bad experiences (e.g., trauma), parenting styles (e.g., overprotection, overcontrol, or encouraging avoidance behaviors), parental loss, and parental separation.

What other disorders co-occur with Specific Phobia?

Even though each child and teen is different, Specific Phobia is not usually seen alone, and those who have it are at higher risk for other anxiety disorders (e.g., Generalized Anxiety Disorder, Separation Anxiety Disorder, multiple specific phobias), as well as depression and bipolar disorders.

How is Specific Phobia treated?

Specific Phobia is treated with therapy. Caregivers and other family members are an important part of treatment, since they can help kids and teens practice the skills they learn in therapy.

Many therapies effectively treat Specific Phobia, but the one with the most evidence is cognitive-behavioral therapy (CBT). CBT uses many different cognitive and behavioral techniques. One CBT technique is called exposure and response prevention (ERP). This means the child is slowly and gradually exposed to the thing they are afraid of, again and again, until they learn the threat is not so bad and their fear lessens. This treatment works very well for most children with Specific Phobia.

For example, a child afraid of dogs might first look at a picture of a dog, then play with a stuffed dog. Slowly, they would get closer to real small dogs and spend a few minutes with them.

Medication is not usually used to treat Specific Phobia.

References

Clinical description, symptoms, and diagnostic information

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Child Mind Institute. (2021, September 7). Specific Phobia in children: A quick guide. _https://childmind.org/guide/quick-guide-to-specific-phobia/_

– World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6B03 Specific Phobia. _https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/239513569_

Facts

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from _http://vizhub.healthdata.org/gbd-compare_. (Accessed 11/15/2022)

– Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365. _https://doi.org/10.1111/jcpp.12381_

– Sacco, R., Camilleri, N., Eberhardt, J., Umla-Runge, K., & Newbury-Birch, D. (2022). A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. European Child & Adolescent Psychiatry. _https://doi.org/10.1007/s00787-022-02131-2_

– Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. _https://doi.org/10.1038/s41380-021-01161-7_

– Somers, J. M., Goldner, E. M., Waraich, P., & Hsu, L. (2006). Prevalence and Incidence Studies of Anxiety Disorders: A Systematic Review of the Literature. The Canadian Journal of Psychiatry, 51(2), 100–113. _https://doi.org/10.1177/070674370605100206_

Associated factors

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Capriola-Hall, N. N., Booker, J. A., & Ollendick, T. H. (2020). Parent- and Child-Factors in Specific Phobias: The Interplay of Overprotection and Negative Affectivity. Journal of Abnormal Child Psychology, 48(10), 1291–1302. _https://doi.org/10.1007/s10802-020-00662-3_

– Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. _https://doi.org/10.1038/mp.2013.50_

– Lawrence, P. J., Murayama, K., & Creswell, C. (2019). Systematic Review and Meta-Analysis: Anxiety and Depressive Disorders in Offspring of Parents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 58(1), 46–60. _https://doi.org/10.1016/j.jaac.2018.07.898_

– Ståhlberg, T., Khanal, P., Chudal, R., Luntamo, T., Kronström, K., & Sourander, A. (2020). Prenatal and perinatal risk factors for anxiety disorders among children and adolescents: A systematic review. Journal of Affective Disorders, 277, 85–93. _https://doi.org/10.1016/j.jad.2020.08.004_

Co-occurring disorders

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– de Vries, Y. A., Al-Hamzawi, A., Alonso, J., Borges, G., Bruffaerts, R., Bunting, B., Caldas-de-Almeida, J. M., Cia, A. H., De Girolamo, G., Dinolova, R. V., Esan, O., Florescu, S., Gureje, O., Haro, J. M., Hu, C., Karam, E. G., Karam, A., Kawakami, N., Kiejna, A., … de Jonge, P. (2019). Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: Results from the World Mental Health Surveys. BMC Medicine, 17(1), 101. _https://doi.org/10.1186/s12916-019-1328-3_

– Saha, S., Lim, C. C. W., Cannon, D. L., Burton, L., Bremner, M., Cosgrove, P., Huo, Y., & McGrath, J. (2021). Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depression and Anxiety, 38(3), 286–306. _https://doi.org/10.1002/da.23113_

Interventions

– Böhnlein, J., Altegoer, L., Muck, N. K., Roesmann, K., Redlich, R., Dannlowski, U., & Leehr, E. J. (2020). Factors influencing the success of exposure therapy for specific phobia: A systematic review. Neuroscience & Biobehavioral Reviews, 108, 796–820. _https://doi.org/10.1016/j.neubiorev.2019.12.009_

– Correll, C. U., Cortese, S., Croatto, G., Monaco, F., Krinitski, D., Arrondo, G., Ostinelli, E. G., Zangani, C., Fornaro, M., Estradé, A., Fusar‐Poli, P., Carvalho, A. F., & Solmi, M. (2021). Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: An umbrella review. World Psychiatry, 20(2), 244–275. _https://doi.org/10.1002/wps.20881_

– Schopf, K., Mohr, C., Lippert, M. W., Sommer, K., Meyer, A. H., & Schneider, S. (2020). The role of exposure in the treatment of anxiety in children and adolescents: Protocol of a systematic review and meta-analysis. Systematic Reviews, 9(1), 96. _https://doi.org/10.1186/s13643-020-01337-2_

– Wang, Z., Whiteside, S. P. H., Sim, L., et al. (2017). Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: A systematic review and meta-analysis. JAMA Pediatrics, 171(11), 1049. _https://doi.org/10.1001/jamapediatrics.2017.3036_

– Zhou, X., Zhang, Y., Furukawa, T. A., Cuijpers, P., Pu, J., Weisz, J. R., Yang, L., Hetrick, S. E., Del Giovane, C., Cohen, D., James, A. C., Yuan, S., Whittington, C., Jiang, X., Teng, T., Cipriani, A., & Xie, P. (2019). Different types and acceptability of psychotherapies for acute anxiety disorders in children and adolescents: A network meta-analysis. JAMA Psychiatry, 76(1), 41. _https://doi.org/10.1001/jamapsychiatry.2018.3070_