Anxiety Disorders 291
rate and blood pressure, which often causes fainting. Among people with this type of
phobia, over half report having fainted in response to a feared stimulus (Öst, 1992).
Situational Type
Asituational type of specifi c phobia involves a fear of a particular situation, such as be-
ing in an airplane, elevator, or enclosed space, or of driving a car. Some people develop
this type of phobia in childhood, but in general it has a later onset, often in the mid-20s.
People with this type tend to experience more panic attacks than do people with other
types of specifi c phobia (Lipsitz et al., 2002). Situational phobia has a gender ratio, age
of onset, and family history similar to those of panic disorder with agoraphobia.
Some researchers have argued that situational and natural environment fearsoverlap; for instance, fear of the dark is both a situational and a natural environ-
ment phobia. These researchers propose that these two types should be combined
or that there should be no types, and mental health professionals should simply
name the feared stimuli specifi cally (Antony & Swinson, 2000b).
Other Type
This category includes any other type of specifi c phobia that does not fall into the
four categories already discussed. Examples of specifi c phobias that would be clas-
sifi ed as “other” are a fear of falling down when not near a wall or some other type
of support, a fear of costumed characters (such as clowns at a circus), and a pho-
bic avoidance of situations that may lead to choking, vomiting, or contracting an
illness—the last of which Hughes may have had.
Specifi c Phobias
As noted in Table 7.11, the majority of people who have one sort of specifi c phobia are
likely to have at least one more (Stinson et al., 2007). This high comorbidity among
specifi c phobias has led some researchers to suggest that, like social phobia, specifi c
phobia may take two forms: a focused type that is limited to a specifi c stimulus, and a
more generalized type that involves fear of various stimuli (Stinson et al., 2007).
The unrealistic fears and extreme anxiety of a specifi c phobia occur in the pres-ence of the feared stimulus but may even occur when simply thinking about it. Often,
people with a specifi c phobia fear that something bad will happen as a result of contact
with the stimulus: “What if I get stuck in the tunnel and it cracks open and fl oods?”
“What if the spider bites me and I get a deadly disease?” People may also be afraid
of the consequences of their reaction to the phobic stimulus, such as losing control of
themselves or not being able to get help: “What if I mess my pants after the spider bites
me?” or “What if I faint or have a heart attack while I’m in the tunnel?” In this sense,
the fear of somehow losing control is similar to that in panic disorder (Horwath et al.,
1993). The situation or object that causes fear and anxiety is related to the content of
the worry about losing control: Someone who is afraid of heights may worry about
getting dizzy when high up (and, as a result, plummeting to the ground).
There is a very long list of stimuli to which people have developed phobias (seehttp://www.phobialist.com),,) but people do not seem to develop specifi c phobias toward
all kinds of stimuli. Humans, like other animals, have a natural readiness for cer-
tain stimuli to produce certain conditioned responses. This preparedness means that
less learning from experience is needed to produce the conditioning (Öhman et al.,
1976). Young children, for example, typically go through a period when they are
easily afraid of the dark or of storms, which may suggest that such fears can more
readily become specifi c phobias. In contrast, a fear of fl owers is extremely unusual.
Some psychologists (Menzies & Parker, 2001; Öhman, 1986; Stein & Matsunaga,
- propose that such preparedness has an evolutionary advantage—people are
more readily afraid of objects or situations that could lead to death, such as being too
close to the edge of a cliff (and falling off) or being bitten by a poisonous snake or spi-
der. According to this view, those among our early ancestors who were afraid of these
stimuli and avoided them were more likely to survive and reproduce—and thus pass
on genes that led them to be prepared to fear these stimuli.
Table 7.11 • Specifi c Phobia
Facts at a GlancePrevalence- Approximately 10% of Americans will
experience in their lifetime a fear severe
enough to meet the criteria for specifi c
phobia (Stinson et al., 2007).
Comorbidity- Only a quarter of those with a diagnosis
of specifi c phobia have a single specifi c
phobia; 50% have three or more pho-
bias. In addition, the more phobias a
person has, the more likely he or she is
to have another type of anxiety disorder
(Curtis et al., 1998; Stinson et al., 2007).
Onset- There are different ages of onset for
the various types of specifi c phobias,
although the average age is about 10
years (Stinson et al., 2007). - Specifi c phobias that arise after trauma
can occur at any age.
Course- Specifi c phobias that arise during ado-
lescence are likely to persist through
adulthood; only 20% of persistent
phobias that begin in adolescence will
improve without treatment.
Gender Differences- Twice as many women are diagnosed
with specifi c phobias as men, although
this ratio varies across type of specifi c
phobias (Stinson et al., 2007). The
gender difference in prevalence rates is
more pronounced with animal, natural
environment, and situational phobias.
Men and women are equally likely to
report blood-injection-injury phobia
(Fredrikson et al., 1996). - Gender differences may refl ect a report-
ing bias: Women may be more likely to
report symptoms, but not necessarily
more likely to have them (Hartung &
Widiger, 1998).
Cultural Differences- The prevalence rates of the various types
of specifi c phobias vary across countries,
suggesting that cultural factors, such as
the likelihood of coming into contact with
various stimuli, affect the form that spe-
cifi c phobias take (Chambers, Yeragani, &
Keshavan, 1986).
Source: Unless otherwise noted, information in the
table is from American Psychiatric Association, 2000.