Phobias: Types, Symptoms and Treatment

A phobia is an intense fear of an object, animal, place or situation that is out of proportion to the real danger. It makes you avoid the thing, even when you know the risk is small. Phobias are very common and can be treated. Talking therapy (CBT) with step-by-step exposure works best. This guide is by Dr. Pedro Yelamo Vera, a GP licensed in Spain (Colegiado No. 484814280).

What is a phobia?

It is a type of anxiety disorder. You feel a very strong fear of something specific, or even just at the thought of it, and you do all you can to avoid it. Doctors call it a phobia when the fear lasts for months and gets in the way of daily life.

What are the symptoms of a phobia?

• A racing heart, sweating, shaking and feeling short of breath.
• Dizziness, feeling sick or a tight chest.
• A sense of losing control, or a strong urge to escape.
• Worry for days before you have to face the thing you fear.
• Avoiding it: changing routes, turning down plans or jobs.

Sometimes the fear builds into a panic attack, which peaks within a few minutes.

What types of phobia are there?

• Simple (specific) phobias: of animals (spiders, dogs, snakes), heights, blood or needles, flying, storms or being sick.
• Fears of sounds or sensations: such as globophobia, the fear of balloons and of them popping, or a fear of loud noises. Trypophobia, a dislike of clusters of small holes, is not an official diagnosis, but it can be very upsetting.
• Social anxiety (social phobia).
• Agoraphobia.

What is social anxiety?

It is a strong fear of social situations: speaking in public, eating in front of others, meeting people or making phone calls. You fear looking foolish or being judged. It goes beyond shyness and can affect your work and relationships. It responds well to therapy and, sometimes, medicine.

What is agoraphobia?

It is a fear of places or situations where it would be hard to get out or get help: public transport, shopping centres, queues, crowds, or leaving home alone. It often starts after panic attacks. In severe cases, people stop leaving the house.

What is claustrophobia?

It is a fear of small or closed spaces: lifts, tunnels, planes or MRI scanners. If you have claustrophobia and need an MRI scan, say so beforehand. There are ways to make the scan easier.

What about a fear of driving?

A strong fear of driving is common, above all after a crash, or on motorways, bridges or in tunnels. It can mix features of a simple phobia and agoraphobia. It responds well to gradual exposure, sometimes with driving schools that offer this. If the fear started after a crash and you have flashbacks or nightmares, see a doctor. It may be post-traumatic stress.

Why do phobias start?

They often begin in childhood or the teens. A bad experience, seeing a parent's fear, genes and an anxious nature all play a part. Many fears in young children, such as of the dark or of people in costumes, are normal and pass with time.

How are phobias treated?

• CBT with exposure: you face what you fear bit by bit, in a planned way and with support, until the anxiety fades. This has the best evidence, above all for simple phobias.
• Self-help: slow breathing, relaxation, and not running away as soon as the anxiety rises.
• Medicines: for social anxiety and agoraphobia, a doctor may suggest an antidepressant such as sertraline. Beta blockers are sometimes used for a one-off event, such as a speech. This practice does not prescribe benzodiazepines by video.
• Habits: exercise, good sleep, and less caffeine and alcohol.

What do I ask for in Spain?

In Spanish, a phobia is a fobia, social anxiety is fobia social or ansiedad social, and CBT is terapia cognitivo-conductual (TCC). Therapy is given by a psychologist (psicólogo); in the public system you are referred by your GP.

When to see a doctor

• Fear makes you avoid places, trips, jobs or important plans.
• You have panic attacks.
• You find it hard to leave home.
• You use alcohol or drugs to cope.
• You feel low or hopeless.

When to call 112

• Chest pain, shortness of breath or fainting, above all if it is the first time or you are not sure it is anxiety.
• Thoughts of harming yourself with immediate danger.

If you have thoughts of suicide, call 024, Spain's free suicide prevention line.

Frequently asked questions about phobias

Getting a medical assessment

If a fear is holding you back, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read about anxiety treatment and anxiety and depression follow-up. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.