Specific Phobia

Specific phobia is intense, disproportionate fear and avoidance of a defined object or situation (animals, heights, blood injection injury, flying, enclosed spaces), lasting 6 months or more.

• Lifetime prevalence 7 to 12%, onset in childhood, female predominance except blood injection injury.
• Blood injection injury phobia causes vasovagal fainting, unlike other phobias.
• Learned through conditioning, observation or information, with genetic contribution.
• Frequently untreated; impairment depends on avoidance (needle phobia may lead to avoided medical care).

• Immediate anxiety or panic on exposure, anticipatory dread, avoidance, recognition that fear is excessive (children may cry, freeze or cling).
• Autonomic arousal; syncope with blood injection injury.
• Occupational and travel restriction.

• Clinical: identify trigger, duration, avoidance and distress.
• Exclude panic disorder, agoraphobia, PTSD, OCD, social anxiety and medical contributors.
• Fear Survey Schedule or a behavioural avoidance test for severity.

• Exposure therapy (graded in vivo, virtual reality) is first line, with success in 80 to 90%; single session intensive exposure (about 3 hours) is effective.
• Applied tension technique (muscle tensing) for blood injection injury fainting.
• Medication has limited role: propranolol 20 to 40 mg or lorazepam 0.5 to 1 mg as single dose for unavoidable exposure (flight); D-cycloserine 50 to 100 mg before exposure sessions may enhance learning.
• Avoid regular benzodiazepines (impair extinction).
• Treat comorbid conditions; relapse prevention with periodic exposure.