Phobias are set apart from other types of anxiety because they result from exposure to: a) specific feared objects or, b) public performance and/or social situations. Exposure to the phobic object or situation will usually precipitate situationally-bound (cued) panic attacks, and subsequently lead to avoidance. Phobias are the avoidance of specific objects or social situations, due to fear when no real danger is present. Adolescents and adults recognize their fear is excessive or unreasonable, but this criterion is not required for children. In the event an adult does not recognize their fear is unreasonable, other rather severe psychiatric disorders should be considered instead (such as Delusional Disorder). Phobias are subdivided into Specific Phobias and Social Phobias.
Specific Phobias involve an excessive fear that is triggered when anticipating, or faced with, exposure to a particular object or situation. There is a quick response to the stimulus; usually situationally-bound (cued) panic attacks. Specific Phobias are further divided into five types, which are listed here in order of frequency in adults, beginning with the most common: 1) Situational Type (bridges, boats, airplanes, etc.), 2) Natural Environment Type (thunderstorms, heights, etc.), 3) Blood-Injury-Injection Type (seeing blood, getting a injection, etc.), 4) Animal Type (dogs, snakes, rats, etc.), and 5) Other Type (clowns, fear of vomiting, etc.). It is not unusual to have more than one phobia, and it is believed that having one phobia increases the chances of having another.
Fear of certain objects such as snakes, or certain situations such as the fear of the dark, are quite common, particularly among children. It is important to keep in mind that a diagnosis is not warranted if there is no marked impairment in functioning or significant distress. For example, having an irrational fear of kangaroos would not be diagnosed as a phobia if someone does not live in the Australian Outback since it is unlikely to cause impairment in functioning. While adults must exhibit the persistent fear for one year, children need only six months to meet the criteria for phobias. Treatment for Specific Phobia is found in the treatment section.
Social Phobia (previously called social anxiety disorder) is an excessive fear of public performance, or social situations, where a person fears public embarrassment, or is fearful of appearing foolish, weak, or otherwise inadequate. Like Specific Phobias, situationally-bound (cued) panic attacks are a common symptom, and phobic situations are avoided. Blushing, trembling, or difficulty speaking are frequently evident during situationally-bound panic attacks. Social Phobia typically includes fear of: 1) public performance, and/or 2) social gatherings. Examples of public performance anxiety include situations involving public speaking such as being called upon by a teacher in class, or making a sales presentation at work. People with public performance anxiety are typically worried that others will notice their shaking hands and trembling voice, and that they will be embarrassed and negatively judged by others. Examples of social gathering anxiety include social events such as a birthday parties, office parties, wedding receptions, or any gathering of people such as a night club. People with this type of anxiety have excessive concerns about being negatively judged, ridiculed, or embarrassed. They may be afraid to eat or drink in front of others because they fear others will notice their shaking hands, or that they will do something embarrassing (such as spill their drink).
In children, typical symptoms include being very shy in unfamiliar places; staying close to familiar individuals (like their parents); and turning down play groups, or being the outsider of the group. Unlike adults, children usually cannot avoid these situations and can have a hard time understanding why they are anxious. Signs may include refusing to go to school, or avoiding participation in activities appropriate for their age. In older children and teens, some temporary social avoidance or anxiety can be normal; however, this diminishes after a short period of time. For instance, a preteen boy goes through a phase where he avoids speaking with girls his own age. In order to meet the diagnostic criteria, children and teens must demonstrate diminished functioning (when compared to their prior level of functioning), or fail to meet generally accepted standards of functioning for their age group. Treatment for Social Phobia is found in the treatment section.