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Raphael D. Rose· Michelle A. Blackmore· Michelle G. Craske

WHAT IS SPECIFIC PHOBIA?

Specific phobias (also known as simple phobias) refer to excessive fears and avoidance of a wide range of circumscribed situations or objects (American Psychiatric Association, 1994). In contrast to more commonly occurring fears, phobias are severe enough to cause significant interference in life functioning and/or cause significant distress (Craske, 2003). Individuals who meet DSM-IV criteria for specific phobia rec-ognize that their fear is excessive or more than what would be expected. Unlike adults, children are not required to acknowledge that their fears are unreasonable or exces-sive, and in order to prevent the overdiagnosis of transitory developmental fears, per-sistence of symptoms is required for at least six months. Historically, the various specific phobias (e.g., animals, heights, blood, flying) were grouped together, but recent research suggests marked differences across the various phobias (Himle, McPhee, Cameron, & Curtis, 1989; Ost, 1987), including age of onset (Curtis, Hill, & Lewis, 1998; Ost, 1987), rates of cooccurring disorders (Himle et aI., 1989), response profiles (Craske, Zarate, Burton, & Barlow, 1993), familial aggregations data (Himle et al., 1989), and genetic variance data (Kendler, Neale, Kessler, Heath, & Eaves, 1993). Hence, while phobias vary greatly in terms of the particular feared stimulus and other factors mentioned above, typically individuals with specific phobias fall into the fol-lowing four subtypes: animal fears (e.g., snakes, insects), natural environment fears (e.g., storms, heights), blood injection-injury fears (e.g., receiving or observing nee-dle injections or blood injuries), and situational fears (e.g., flying or enclosed spaces).

When individuals with specific phobias are not exposed to their feared object or situation, they experience the least severe and impairing anxiety disorder (Barlow et al., 1985). However, when encountering feared objects or situations, individuals with phobias tend to experience severe discomfort and may attempt to escape the situa-tion or else endure it with great distress. This distress is often accompanied by physi-cal symptoms such as palpitations, sweating, blushing, and trembling, which may take the form of a situationally bound panic attack. Individuals may also experience simi-lar distress in advance or anticipation of exposure to a feared situation or object (e.g., before a scheduled flight, prior to a medical appointment). As a result, feared situa-tions are often avoided. Such fear and avoidance may significantly interfere with the individual’s functioning, often resulting in a change in normal routines, a decline in occupational opportunities, negative impact on social relationships, or changes in regular health

BASIC FACTS ABOUT SPECIFIC PHOBIAS

Mild fears of specific situations and objects are quite common in the general pop-ulation (King et al., 1989); however, specific phobias (that cause clinically signifi-cant interference and/or distress) are among the most common of the anxiety

disorders. The National Comorbidity Survey found lifetime prevalence rates for specific phobias, using DSM-IV criteria, to be 12.5% (Kessler, Berglund, Demler, Jin, & Walters, 2005). Fredrikson, Annas, Fischer, and Wik (1966) found slightly higher prevalence rates (16.3%) among their Swedish sample of 704 adults.
Women (15.7%) are more likely than men (6.7%) to receive a specific phobia diagnosis (Kessler et aI., 1994). Overall, 75-90% of individuals with animal, natural environment, or situational specific phobia are female, with slightly lower rates (55-70%) for individuals with phobias of heights or blood-injection (Himle et al., 1989).

Age of onset, course, and demographic characteristics

The majority of individuals with animal and blood-injection specific phobia report an onset of difficulties by childhood (ages 7-9), whereas situational and natural environment subtypes exhibit a bimodal distribution of onset, in early childhood and early adulthood (Himle et al., 1989), with situational subtypes more commonly developing in young adulthood (Ost & Treffers, 2001). Additionally, for those pho-bias occurring during childhood, elevations are often seen between 10 and 13 years of age (Strauss & Last, 1993).

Untreated specific phobias tend to be chronic or recurrent (Yonkers, Dyck, &, Keller, 2001), with a remission rate over a seven-year period as low as 16% (Wittchen, 1988). Interestingly, despite the relatively high prevalence and chronic-ity of specific phobias, individuals rarely seek treatment, perhaps because most peo-ple with specific phobias are able to function despite strong fears and phobias. Individuals with higher levels of functional impairment, multiple phobias, panic symptoms in the phobic situation, and surprisingly, absence of blood phobias, injury or medical procedures were all related to higher help-seeking (Chapman, Fyer, Mannuzza, & Klein, 1993). As a result of the generally circumscribed nature of spe-cific phobias, they are associated with less distress overall in comparison to other anxiety disorders (Craske, 2003).