What is a Specific Phobia?
Fears are common and expected in childhood; however, for some children and teens, their fears can become very severe over time, and even develop into a phobia. A phobia is an intense and unreasonable fear of a specific object or situation. This means having an extreme anxiety response towards something that is not causing immediate danger. Someone may have a phobia of dogs, spiders, or elevators, for example. Research suggests that phobias can run in families, and that both genetic and environmental factors (nature and nurture) can contribute to developing a phobia. Some children and teens develop a phobia after being exposed to a traumatic or frightening event such as a fear of water after a near drowning or fear of dogs are being bitten. However, other children may develop a phobia by observing others' anxious response to objects or situations. It is not uncommon for a child to develop a spider phobia after watching an older sibling scream and run when in contact with a spider. Although a combination of nature and nurture likely play a role in the emergence of a phobia, many youth cannot explain how or why their phobia begun.
- On average, specific phobias begin in childhood, between seven to eleven years with most cases starting before age ten
- Approximately 5% of children and 16% of adolescents will have a specific phobia in their lifetime
- Girls are more likely to experience a phobia than boys at a rate of 2:1
- Phobias are different than common childhood fears. While young children generally become less afraid of things such as strangers, the bath, or the boogie monster, as they mature, children with phobias typically become more afraid as they mature. Furthermore, phobias rarely go away on their own
- Phobias do not decrease with appropriate reassurance and provision of information. For example, a dog phobia persists despite telling your child that grandmas dog is kind, has no teeth to bite because it is old, and will not scratch
Signs & Symptoms
- It’s going to bite/sting me
- I can’t handle it
- It’ll be awful
- What if I vomit
- Increased heart rate
- Trembling or shaking
- Shortness of breath
- Feeling of choking
- Chest pain or discomfort
- Upset stomach
- Chills or hot flashes
- Looking flushed
- Avoiding the feared stimuli or locations where the stimuli might exist
- Making parents check things first (e.g. make sure a room is free of bugs before bedtime)
- Asking a parent to be present or available
- Running away
Common Situations or Affected Areas
- School refusal if known feared stimuli might exist
- Avoiding parks, recreational areas, and outdoor space
- Refusal to attend appointments at doctors, dentists, hospitals, etc.
- Avoiding playing in gardens, beaches, and other locations where insects might exist
- Missing field trips if known feared stimuli will be present (e.g. trip to the park because of fear of dogs)
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How a specific phobia impacts the child at different ages:
Young children often rely on adults to protect them from immediate threat or danger more so than older children and teens. As a result, when young children are faced with a specific phobia they may cry, tantrum, cling, freeze, or want to be picked up. Young children are more likely to be afraid of concrete and immediate situations such as storms, insects, animals, and clowns among others. In contrast, when faced with a feared item or situation, older youth are more likely to express feared thoughts or predictions such as “It will bite me,” or “I’m going to die.” In addition, unlike young children who have less control over their daily lives, older teens can choose to avoid certain situations or escape when confronted with their fear. For example, a teen that is afraid of enclosed spaces can avoid taking an elevator whereas a young child may have to go on an elevator if the whole family wants to travel that way. Finally, teens are more likely than younger children realize that their fear is unreasonable or excessive.
Is there such a thing as a School Phobia?
School phobia is not a diagnosis, although over the lifespan as many as a third of youth will exhibit fears of attending school that present in a similar way to a phobia. For example, school fears can be expressed as minor complaints about having to attend, to full blown tantrums and refusal to attend in younger children, and skipping or cutting school in adolescents. Youth can be afraid of school for many reasons such as being apart from parents as seen in separation anxiety disorder, being in contact with germs as in OCD, and having to interact with peers and teachers like with social anxiety. In all of these cases, your child or teen is not actually afraid of the school itself, but of what could happen while at school. Because of this, the term school phobia is not accurate. Here you can find additional information on managing school refusal (link) when it exists as part of an anxiety disorder.
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