Phobias
On this page
Direct answer
A specific phobia is marked fear of a circumscribed object or situation that provokes immediate anxiety, is out of proportion to actual danger, is actively avoided or endured with distress, and persists at least six months with intact insight. Treatment of choice is graded in-vivo exposure, classically as systematic desensitisation. Social anxiety disorder — fear of scrutiny and negative evaluation — is treated with cognitive behavioural therapy and SSRIs, with propranolol reserved for performance-only anxiety.
What you must remember
- Specific phobia criteria: marked and disproportionate fear, immediate cue-provoked anxiety, avoidance or distress, six months' duration, intact insight and clinically significant impairment.
- Subtypes: animal, natural environment (heights, storms), blood-injection-injury, situational (flying, lifts, driving) and other (choking, loud sounds).
- Blood-injection-injury phobia is unique: it causes a vasovagal response with fainting, unlike the usual sympathetic surge of other phobias; relatives may share it, and applied tension — tensing muscles repeatedly — counteracts the faint.
- Treatment of choice: graded in-vivo exposure, or systematic desensitisation pairing relaxation with a feared-stimulus hierarchy; highly effective, sometimes even in single prolonged sessions.
- Social anxiety disorder: fear of judgement in social or performance situations, avoided or endured with distress; generalised cases need CBT and an SSRI or SNRI (sertraline, paroxetine, venlafaxine have evidence).
- Performance-only social anxiety: propranolol about an hour before the event blunts the physical surge of catecholamines; it does not treat generalised social anxiety.
- Agoraphobia is a separate DSM-5 diagnosis — fear of at least two of five situations such as public transport, crowds, queues, open or enclosed spaces, and being outside alone.
Common confusion
Panic disorder versus phobias turns on cueing: phobic anxiety is predictably provoked by a specific object or situation, whereas panic disorder attacks are unexpected and the fear is of the attacks themselves. Social anxiety disorder overlaps with avoidant personality disorder — fear of rejection versus a broader entrenched pattern of social inhibition — and both differ from agoraphobia, where fear attaches to situations from which escape might be difficult rather than to social judgement. Blood-injection-injury fainting distinguishes that phobia from all others and points to applied tension rather than standard relaxation.
Exam-focused takeaway
NEET-PG tests phobias through subtype vignettes, the six-month duration rule, and treatment-matching — systematic desensitisation or graded exposure for specific phobias, SSRIs plus CBT for generalised social anxiety, and propranolol for the violinist with performance tremor. The blood-injection-injury subtype appears in two disguises: the fainting patient needing applied tension, and the family-cluster question. Agoraphobia's two-of-five situation rule and its separation from panic disorder are favourite one-liners. Remember that insight is preserved in phobias, which separates them from delusional fear.
Frequently asked questions
What defines a specific phobia?
Marked, disproportionate, cue-triggered fear with avoidance, lasting at least six months, in a person with intact insight.
Which phobia causes fainting?
Blood-injection-injury phobia, through a vasovagal response; applied tension is the specific countermeasure.
What is the treatment of choice for specific phobia?
Graded in-vivo exposure, or systematic desensitisation combining relaxation with a hierarchy of feared stimuli.
How is performance-only social anxiety treated?
With propranolol taken about an hour before the performance to blunt the physical adrenergic surge.
What separates phobias from panic disorder?
Phobic anxiety is predictably cue-bound to a specific stimulus; panic attacks are unexpected, with fear centred on the attacks themselves.
What is agoraphobia?
Fear and avoidance of at least two of five situation types — transport, open or enclosed spaces, crowds or queues, and being outside alone — now diagnosed separately from panic disorder.