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Phobias: Fear no more

As a child, John Greene looked forward to the day when the end-of-summer carnival rolled into his hometown. For months leading up to the highly anticipated event, he would set aside a portion of his total allowance – a mere 75 cents, he recalls – to spend on sticks of cotton candy, rigged games, and tickets to rides that would leave him wishing he refrained from eating so much of the spun sugar.

“It was always a great time,” he says, during a brief moment of reminiscence. “I mean, come on, what kid doesn’t love the carnival?”

Ironically, and to his bemusement, Kayla, Greene’s seven-year-old daughter.

“My wife and I thought it would be a good idea to take Kayla to her first carnival,” he says. “She was having a blast until she came face-to-face with a clown that happened to walk right by us. She stopped dead in her tracks, started to cry, and insisted on leaving.”

Since then, catching a glimpse of a clown on T.V. or in a book will leave her petrified and inconsolable.

“If we’re out together, I find myself consciously looking for anything that resembles a clown, hoping to spot it before she does,” says Greene. “What was supposed to be a fun day at the carnival for my little girl is now a full-fledged phobia.”

Rational fear vs. Irrational fear

Human beings instinctually seek protection from painful, dangerous, or even stressful situations. From a very early age, this basic survival mechanism, commonly referred to as rational fear, is hard-wired into our nervous system. This type of fear is considered healthy because it keeps us safe. For example, the fear of fire is a rational fear because we know fire can burn or potentially kill us.

But fear can be unhealthy, too.

An irrational fear, or phobia, is marked by an intense and highly emotional response in the presence of a specific object or situation, says Dr. Neil Rector. This type of fear is considered unhealthy because people often form strong escapist or avoidant tendencies around it, which can lead to significant distress and impairment.

“It activates the fight or flight system: the heart begins to beat rapidly, a person may feel tense and on edge, or they might start to shake or feel sweaty,” Dr. Rector adds. “In many cases, it can actually elevate to the level of having a panic attack.”

As the Director of the Mood and Anxiety Treatment and Research Program at Sunnybrook Health Sciences Centre in Toronto, Dr. Rector has helped many people overcome depression, anxiety, and persistent phobias. He is quick to point out that phobias are now the most common anxiety condition and one of the most common psychiatric conditions in general. In fact, anywhere from six to 23% of the population is living with a phobia, he says.

Treating phobias with behavioural therapy

Phobias typically begin in childhood, but the specific type of phobia varies with age, according to Dr. Katharina Manassis. For example, a fear of the dark is more common in younger children, while social phobia is more common in teens.

A psychiatrist at The Hospital for Sick Children (SickKids), Dr. Manassis reminds parents that the important thing is not the specific type of phobia, but how much the phobia interferes with day-to-day functioning and normal development. “A fear of roller-coasters,” she says, “may not be worth treating, as it’s not a daily event, but a fear of dogs that results in the child running into traffic at the site of a dog certainly is.”

In her book, Keys to Parenting Your Anxious Child, Dr. Manassis refers to a treatment called systematic desensitization, a form of behavioural therapy that has been used for decades to help both children and adults overcome their phobias. This method of treatment involves gradual, repeated exposure to a phobic stimulus, she says. “For example, in the case of dog phobia, start with pictures and information about dogs (perhaps videos), then pick a small, non-threatening dog on a leash to repeatedly approach, and eventually work up to larger dogs, pet stores, etc.”

Dr. Manassis has found that children often respond better to treatment when they have some say in the “steps” they practice, in addition to positive reinforcement from parents throughout the progression. 

“One really important thing is that parents remain calm despite the child’s fear,” she adds, “and provide empathetic encouragement, for example, ‘I know this is hard for you, but you can do it.’”

Parents are also encouraged to actively engage their children in conversation about their particular phobia. Talking to your child provides them with an opportunity to express their specific feelings and concerns. As a parent, it is important to remember to speak to your child on a level they understand and to never undermine what it is they’re feeling.

Types of phobias

According to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR) --  a reference used by clinicians and psychiatrists when diagnosing psychiatric illnesses -- there are five kinds, or subtypes, of phobias. Each is defined by the object or situation that triggers the fearful response in someone.

  • Animal Type: This subtype generally first appears in  childhood. Fear is cued by animals and/or insects.
  • Natural Environment Type: Also usually begins in childhood. Fear is cued by objects in the natural environment, such as storms, heights, or water.
  • Blood-Injection-Injury Type: This subtype often causes fainting. Fear is cued by seeing blood or by receiving an injection or other invasive medical procedure.
  • Situational Type: This subtype can appear in childhood and again in the mid-to-late 20s. Fear is cued by things such as bridges, tunnels, elevators, and confined spaces. The fear of flying is also a situational phobia.
  • Other Type: Fear is cued by a number of things including, but certainly not limited to, vomiting, choking, contracting an illness, loud noises, and costumed characters.

Some phobias you may not know even exist

There are thousands of defined phobias. Here is a short list of some the more unusual ones:

  • Allodoxaphobia – Fear of opinions
  • Arachibutyrophobia – Fear of peanut butter sticking to the roof of the mouth
  • Cathisophobia – Fear of sitting
  • Barophobia – Fear of gravity
  • Epistemophobia – Fear of wisdom or knowledge
  • Geliophobia – Fear of laughter
  • Kosmikophobia – Fear of cosmic phenomenon
  • Mageirocophobia – Fear of cooking
  • Omphalophobia – Fear of belly buttons
  • Optophobia – Fear of opening one’s eyes


Joel Tiller