Running Head: PHOBIAS

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The Causes of Phobias and Why People Have Them

Andrea R. Bankovich

DuBois Area High School

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Abstract

This paper explores what a phobia is and how they are caused. A phobia is an excessive and

irrational fear reaction to people, places, or things. The questions that arise are why are some

people so afraid of one thing and others are not? When does a person begin to have a phobia and

how can this be avoided? Once you have a phobia can you get rid of it? These are all questions

that will be discussed in this research paper. This paper explains the differences between the

three types of phobias: specific phobia, social phobia, and agoraphobia. Christian Nordqvist

offers up explanations of how the brain works during a phobia. The biological, environmental,

and genetic explanations of phobias are discussed. The treatments and medications that are

available, and the therapy used to overcome phobias will be discussed. Overall this paper will

focus on what a phobia is, the causes of them, and the ways to overcome them.
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The Causes of Phobias and Why People Have Them

“A phobia is a type of anxiety disorder that causes an individual to experience extreme,

irrational fear about a situation, living creature, place, or object” (​Nordqvist, 2017​). When a

person has a phobia, they will often shape their lives to avoid their imagined threat. The

difference between a “normal” fear and a phobia is the degree of anxiety involved, and the length

of time that a high level of anxiety persists. A person with a phobia has a high level of anxiety

and terror when they come into contact with the object of their phobia. A person experiences this

level of fear for a period of six months or more (​Boston Children's Hospital, 2019​). Even if a

person is aware of their extreme reactions, they cannot control their fear. Phobias are a

diagnosable mental disorder. A phobia becomes diagnosable when a person begins organizing

their lives around avoiding the cause of their fear (​Nordqvist 2017​). According to the Boston

Children’s Hospital (2019), in the United States, approximately 19 million people have phobias

and ​up to 9.2 percent of children and adolescents are believed to experience some type of phobia.

There are three types of phobia recognized by the American Psychiatric Association

(APA) and they are specific phobia, social phobia, and agoraphobia. (​Nordqvist, 2017​). Specific

phobia usually develops between the ages of four and eight years old. Symptoms of specific

phobia can include avoiding the object of the phobia, fearfully anticipating an encounter with the

phobic object, and enduring an encounter or experience with the phobic object while feeling such

a high level of anxiety that the child’s normal routines and activities are significantly disrupted

(​Boston Children's Hospital, 2019​). One cause of specific phobia is a traumatic early experience.

Medical News Today explains that if a young child has an unpleasant experience in a confined

space, then claustrophobia could develop for that individual over time. Another cause of specific
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phobia is inheritance. ​Just as a child can inherit a parent’s brown hair, green eyes and

nearsightedness, a child can also inherit that parent’s tendency toward excessive anxiety. In

addition, anxiety may be learned from family members and others who are noticeably stressed or

anxious around a child. For example, a child whose parent shows immense fear of spiders may

learn to fear spiders, too (Boston Children's Hospital, 2019).

A social phobia as a profound fear of public humiliation and being singled out or judged

by others in a social situation (​Nordqvist, 2017​). For someone with a social phobia, the idea of a

large social gathering is terrifying. ​Children with social phobia experience intense fear of one or

more social or performance situations. Exposure to these situations provokes anxiety responses

like panic, freezing, blushing, tantrums, crying and clinging. People with social anxiety disorder

tend to avoid these situations for obvious reasons. Over time, this gets in the way of social

development and can become a real cost to them in terms of education, family functioning,

employment and overall happiness. Social phobia is rare and is estimated to occur in only 1.4

percent of children and adolescents. Symptoms typically emerge during early adolescence, but

can develop in younger children, as well (Boston Children's Hospital, 2019).

Agoraphobia is a more complex type of phobia. Panic attacks are more common for

people with agoraphobia (​Nordqvist, 2017​). ​Agoraphobia is an intense fear of the outside world.

In these cases, people are so terrified of encountering or experiencing the object of their fear that

they feel unsafe anywhere but at home, and will resist venturing out for any reason. ​Agoraphobia

can also apply to being confined in a small space, such as an elevator.

Researchers currently believe that phobias are caused by a combination of life

experiences, brain chemistry, and genetics (​Nordqvist, 2017​). Some areas of the brain store and
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recall dangerous events. If a person experiences a similar event later in life, areas of the brain

retrieve the stressful memory and this causes the body to experience the same reaction.

Sometimes the brain retrieves these memories more than once causing you to be afraid of the

same experience over and over. In a phobia, the areas of the brain that deal with fear and stress

keep retrieving the frightening event inappropriately (​Nordqvist, 2017)​. ​The brain has special

chemicals, called neurotransmitters, that send messages back and forth to control the way a

person feels. Serotonin and dopamine are two important neurotransmitters that, when “out of

whack,” can cause feelings of anxiety (Boston Children's Hospital, 2019).

Researchers have been able to identify certain parts of the brain and specific neural

pathways that are associated with phobias by using neuroimaging. One part of the brain being

studied is the amygdala, an almond-shaped body of nerve cells involved in normal fear

conditioning (Metcalf, T., & Metcalf, G., 2009). The amygdala, which lies behind the pituitary

gland in the brain, can trigger the release of “fight-or-flight” hormones. These put the body and

mind in a highly alert and stressed state (​Nordqvist, 2017​). As measurement and experimental

techniques have developed over the past decade, the findings have developed as well. Lea

Winerman writes about a 2003 study from ​Neuroscience Letters ​(Vol. 348, No. 1, pages 29-32).

Psychologist Wolfgang Miltner, PhD, and his colleagues at Friedrich Schiller University in

Germany used fMRI to examine spider phobics as they viewed pictures of spiders, snakes and

mushrooms. The researchers found that the amygdala was more active in the spider phobics than

in control participants (​Winerman, 2005​). Similarly, researchers have found that some

hypersensitive people have unique chemical reactions in the brain that cause them to respond

much more strongly to stress. These people may also be especially sensitive to caffeine, which
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triggers certain brain chemical responses. Chemical responses have been studied on selective

serotonin reuptake inhibitors (SSRI), a class of drugs that enhance 5-HT. These drugs have

shown how the chemicals in the brain react during a phobia. These drugs have been found to be

effective for phobias. The studies indicated the improvement of specific phobias with SSRI is

accompanied by decreased regional cerebral blood flow in the amygdala (Garcia, 2017). The

studies revealed the low levels of 5-HT in the amygdala may be involved in the pathophysiology

of phobias (Garcia, 2017).

Now researchers are taking the next step, says psychologist and phobia researcher Arne

Öhman, PhD, of the clinical neuroscience department at the Karolinska Institute in Sweden.

They are using neuroimaging techniques like positron-emission tomography (PET) and

functional magnetic resonance imaging (fMRI) to understand the brain circuitry that underlies

phobia and what happens in the brain during treatment (Winerman, 2005). The first studies, from

the early and mid 1990s, were symptom-provocation studies: Researchers would show, say, a

snake-phobic person a snake or a picture of a snake, and then use PET scans to examine the

brain's reaction (Winerman, 2005).

At birth, there are observable temperamental differences that appear to be a function of

genetics (​Jacofsky, M., Santos, M., Khemlani-Patel, S., & Neziroglu, F., 2015​). Some babies are

much more sensitive to stimulation and stress than other babies (​Jacofsky et al, 2015​). These

differences remain as the child grows. People born with these ultra sensitive temperaments are

thought to be at a greater risk for developing anxiety disorders later in life because their nervous

system is more easily aroused. People with these extra-sensitive temperaments are prone to

experience greater intensity, frequency, and duration of symptoms (​Jacofsky et al, 2015​). These
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symptoms include sweating, abnormal breathing, accelerated heartbeat, trembling, hot flashes or

chills, a choking sensation, chest pains or tightness, butterflies in the stomach, pins and needles,

dry mouth, confusion and disorientation, nausea, dizziness, and headaches. Nordqvist (2017)

explains that a feeling of anxiety can be produced simply by thinking about the object of the

phobia. In younger children, parents my notice that their children cry, become very clingy, hide

behind the legs of a parent, or throw tantrums to show their distress (​Nordqvist, 2017​).

Conclusions and Future Study

Although phobias are a diagnosable disorder, there are ways to treat phobias. ​The good

news is that over the past several decades, psychologists and other researchers have developed

some effective behavioral and pharmacological treatments for phobia, as well as technological

interventions (Winerman, 2005). some researchers have begun to look particularly at what

happens in the brain during and after phobia treatment. Psychologists Tomas Furmark, PhD,

Mats Fredrikson, PhD, and their colleagues at Uppsala University in Sweden used PET scans to

examine the brain activity of 18 people with social phobia as the people spoke in front of a

group. Then, one-third of the participants received nine weeks of cognitive-behavioral therapy,

one-third received the selective serotonin reuptake inhibitor Citalopram and one-third received

no treatment. The researchers tested the patients again, using the same public speaking task, at

nine weeks and again after one year. They found that the activation in the amygdala and related

cortical areas at nine weeks could predict which people's symptoms would improve after one

year. Though all of these findings are shaping researchers' understanding of the parts of the brain

that give rise to phobia, the picture is far from complete. "This is a critical area of research for

the future," says Rauch (Winerman, 2005).

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References

Fritscher, L. (2018, May 10). How Does Clinical Hypnotherapy Work? Retrieved from

https://www.verywellmind.com/hypnotherapy-2671993

Garcia, R. (2017, June 2). “Neurobiology of Fear and Specific Phobias.” Cold Spring Laboratory

Press. Retrieved from http://learnmem.cshlp.org/content/24/9/462.full

Jacofsky, M., Santos, M., Khemlani-Patel, S., & Neziroglu, F. (2015, January 1). Biological

Explanations Of Anxiety Disorders. Centersite, LLC. Retrieved from

https://www.mentalhelp.net/articles/biological-explanations-of-anxiety-disorders/

Metcalf, T., & Metcalf, G. (2009). ​Phobias​ (1st ed.). Farmington Hills, MI: Greenhaven

Press/Gale Cengage Learning.

Nordqvist, C. (2017, December 20). “Everything you need to know about phobias.” ​Medical

News Today.​ Retrieved from https://www.medicalnewstoday.com/articals/249347.php

Phobias Symptoms & Causes | Boston Children's Hospital. (2019). Retrieved from

http://www.childrenshospital.org/conditions-and-treatments/conditions/p/phobias/sympto

ms-and-causes

Winerman, L. (2005, July/August). Figuring Out Phobia. Retrieved from

https://www.apa.org/monitor/julaug05/figuring
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Appendix