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Phobia
A phobia is a type of anxiety disorder, defined by a persistent
Phobia
and excessive fear of an object or situation.[1] The phobia
typically results in a rapid onset of fear and is present for more
than six months.[1] The affected person goes to great lengths to
avoid the situation or object, to a degree greater than the actual
danger posed.[1] If the feared object or situation cannot be
avoided, the affected person experiences significant distress.[1]
With blood or injury phobia, fainting may occur.[1]
Agoraphobia is often associated with panic attacks.[6] Usually a
person has phobias to a number of objects or situations.[1]

Phobias can be divided into specific phobias, social phobia, and

agoraphobia.[1][2] Types of specific phobias include those to
certain animals, natural environment situations, blood or
injury, and specific situations.[1] The most common are fear of
spiders, fear of snakes, and fear of heights.[7] Occasionally they
are triggered by a negative experience with the object or
situation.[1] Social phobia is when the situation is feared as the
person is worried about others judging them.[1] Agoraphobia is
when fear of a situation occurs because it is felt that escape
would not be possible.[1]
The fear of spiders is one of the most common
It is recommended that specific phobias be treated with phobias
exposure therapy where the person is introduced to the Specialty Psychiatry
situation or object in question until the fear resolves.[2] Symptoms Fear of an object or situation[1]
Medications are not useful in this type of phobia.[2] Social
Complications Suicide[1]
phobia and agoraphobia are often treated with some
combination of counselling and medication.[4][5] Medications Usual onset Rapid[1]
used include antidepressants, benzodiazepines, or beta- Duration More than six months[1]
blockers.[4] Types Specific phobias, social
phobia, agoraphobia[1][2]
Specific phobias affect about 6–8% of people in the Western
world and 2–4% of people in Asia, Africa, and Latin America in Causes Unknown, some genetic
a given year.[1] Social phobia affects about 7% of people in the effects[3]
United States and 0.5–2.5% of people in the rest of the Treatment Exposure therapy,
world.[6] Agoraphobia affects about 1.7% of people.[6] Women counselling, medication[4][5][2]
are affected about twice as often as men.[1][6] Typically onset is
Medication Antidepressants,
around the age of 10 to 17.[1][6] Rates become lower as people
benzodiazepines, beta-
get older.[1][6] People with phobias are at a higher risk of
blockers[4]
suicide.[1]
Frequency Specific phobias: ~5%[1]
Social phobia: ~5%[6]
Agoraphobia: ~2%[6]
Contents
Classification
Specific phobias

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Social phobia
Causes
Environmental
Mechanism
Amygdala
Diagnosis
Treatments
Therapy
Systematic desensitization
Medications
Hypnotherapy
Epidemiology
Society and culture
Terminology
Non-medical use
References
External links

Classification
Most phobias are classified into three categories and, according to the Diagnostic  and  Statistical  Manual  of  Mental
Disorders, Fifth Edition (DSM-V), such phobias are considered sub-types of anxiety disorder. The categories are:

1. Specific phobias: Fear of particular objects or social situations that immediately results in anxiety and can sometimes
lead to panic attacks. Specific phobia may be further subdivided into four categories: animal type, natural environment
type, situational type, blood-injection-injury type.[8]

2. Agoraphobia: a generalized fear of leaving home or a small familiar 'safe' area, and of possible panic attacks that
might follow. It may also be caused by various specific phobias such as fear of open spaces, social embarrassment
(social agoraphobia), fear of contamination (fear of germs, possibly complicated by obsessive-compulsive disorder) or
PTSD (post traumatic stress disorder) related to a trauma that occurred out of doors.

3. Social phobia, also known as social anxiety disorder, is when the situation is feared as the person is worried about
others judging them.[1]

Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer
relatively mild anxiety over that fear. Others suffer full-fledged panic attacks with all the associated disabling
symptoms. Most individuals understand that they are suffering from an irrational fear, but are powerless to override
their panic reaction. These individuals often report dizziness, loss of bladder or bowel control, tachypnea, feelings of
pain, and shortness of breath.[9]

Specific phobias
A specific phobia is a marked and persistent fear of an object or situation. Specific phobias may also include fear of
with losing control, panicking, and fainting from an encounter with the phobia.[10] Specific phobias are defined in
relation to objects or situations whereas social phobias emphasize social fear and the evaluations that might
accompany them.

The DSM breaks specific phobias into five subtypes: animal, natural environment, blood-injection-injury, situation and
other.[11] In children, blood-injection-injury phobia and phobias involving animals, natural environment (darkness)
usually develop between the ages of 7 and 9, and these are reflective of normal development. Additionally, specific
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phobias are most prevalent in children between ages 10 and 13.[12]

Social phobia
Unlike specific phobias, social phobias include fear of public situations and scrutiny, which leads to embarrassment or
humiliation in the diagnostic criteria.

Causes

Environmental
Rachman proposed three pathways to acquiring fear conditioning: classical conditioning, vicarious acquisition and
informational/instructional acquisition.[13]

Much of the progress in understanding the acquisition of fear responses in phobias can be attributed to classical
conditioning (Pavlovian model).[14] When an aversive stimulus and a neutral one are paired together, for instance
when an electric shock is given in a specific room, the subject can start to fear not only the shock but the room as well.
In behavioral terms, this is described as a conditioned stimulus (CS) (the  room) that is paired with an aversive
unconditioned stimulus (UCS) (the  shock), which leads to a conditioned response (CR) (fear  for  the  room)
(CS+UCS=CR).[14] For instance, in case of the fear of heights (acrophobia), the CS is heights such as a balcony on the
top floors of a high rise building. The UCS originates from an aversive or traumatizing event in the person's life, such as
almost falling down from a great height. The original fear of almost falling down is associated with being on a high
place, leading to a fear of heights. In other words, the CS (heights) associated with the aversive UCS (almost  falling
down) leads to the CR (fear). This direct conditioning model, though very influential in the theory of fear acquisition,
is not the only way to acquire a phobia.

Vicarious fear acquisition is learning to fear something, not by a subject's own experience of fear, but by watching
others reacting fearfully (observational learning). For instance, when a child sees a parent reacting fearfully to an
animal, the child can become afraid of the animal as well.[15] Through observational learning, humans can to learn to
fear potentially dangerous objects—a reaction also observed in other primates.[16] In a study focusing on non-human
primates, results showed that the primates learned to fear snakes at a fast rate after observing parents’ fearful
reactions.[16] An increase of fearful behaviors was observed as the non-human primates continued to observe their
parents’ fearful reaction.[16] Even though observational learning has been proven effective in creating reactions of fear
and phobias, it has also been shown that by physically experiencing an event, chances increase of fearful and phobic
behaviors.[16] In some cases, physically experiencing an event may increase the fear and phobia more so than observing
a fearful reaction of another human or non-human primate.

Informational/instructional fear acquisition is learning to fear something by getting information. For instance, fearing
electrical wire after having heard that touching it causes an electric shock.[17]

A conditioned fear response to an object or situation is not always a phobia. To meet the criteria for a phobia there
must also be symptoms of impairment and avoidance. Impairment is defined as being unable to complete routine tasks
whether occupational, academic or social. In acrophobia an impairment of occupation could result from not taking a
job solely because of its location at the top floor of a building, or socially not participating in a social event at a theme
park. The avoidance aspect is defined as behavior that results in the omission of an aversive event that would otherwise
occur, with the goal of preventing anxiety.[18]

Mechanism

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Beneath the lateral fissure in the cerebral cortex, the insula, or insular
cortex, of the brain has been identified as part of the limbic system, along
with cingulated gyrus, hippocampus, corpus callosum and other nearby
cortices. This system has been found to play a role in emotion
processing[20] and the insula, in particular, may contribute through its role
in maintaining autonomic functions.[21] Studies by Critchley et al. indicate
the insula as being involved in the experience of emotion by detecting and
interpreting threatening stimuli.[22] Similar studies involved in monitoring
the activity of the insula show a correlation between increased insular
activation and anxiety.[20]

In the frontal lobes, other cortices involved with phobia and fear are the
Regions of the brain associated with
anterior cingulate cortex and the medial prefrontal cortex. In the
phobias[19]
processing of emotional stimuli, studies on phobic reactions to facial
expressions have indicated that these areas are involved in processing and
responding to negative stimuli.[23] The ventromedial prefrontal cortex has been said to influence the amygdala by
monitoring its reaction to emotional stimuli or even fearful memories.[20] Most specifically, the medial prefrontal
cortex is active during extinction of fear and is responsible for long-term extinction. Stimulation of this area decreases
conditioned fear responses, so its role may be in inhibiting the amygdala and its reaction to fearful stimuli.[24]

The hippocampus is a horseshoe-shaped structure that plays an important part in the brain’s limbic system because of
its role in forming memories and connecting them with emotions and the senses. When dealing with fear, the
hippocampus receives impulses from the amygdala that allow it to connect the fear with a certain sense, such as a smell
or sound.

Amygdala
The amygdala is an almond-shaped mass of nuclei that is located deep in the brain’s medial temporal lobe. It processes
the events associated with fear and is linked to social phobia and other anxiety disorders. The amygdala's ability to
respond to fearful stimuli occurs through the process of fear conditioning. Similar to classical conditioning, the
amygdala learns to associate a conditioned stimulus with a negative or avoidant stimulus, creating a conditioned fear
response that is often seen in phobic individuals. In this way, the amygdala is responsible for not only recognizing
certain stimuli or cues as dangerous but plays a role in the storage of threatening stimuli to memory. The basolateral
nuclei (or basolateral amygdala) and the hippocampus interact with the amygdala in the storage of memory, which
suggests why memories are often remembered more vividly if they have emotional significance.[25]

In addition to memory, the amygdala also triggers the secretion of hormones that affect fear and aggression. When the
fear or aggression response is initiated, the amygdala releases hormones into the body to put the human body into an
"alert" state, which prepares the individual to move, run, fight, etc.[26] This defensive "alert" state and response are
known as the fight-or-flight response.[27]

Inside the brain, however, this stress response can be observed in the hypothalamic-pituitary-adrenal axis (HPA). This
circuit incorporates the process of receiving stimuli, interpreting it and releasing certain hormones into the
bloodstream. The parvocellular neurosecretory neurons of the hypothalamus release corticotropin-releasing hormone
(CRH), which is sent to the anterior pituitary. Here the pituitary releases adrenocorticotropic hormone (ACTH), which
ultimately stimulates the release of cortisol. In relation to anxiety, the amygdala is responsible for activating this
circuit, while the hippocampus is responsible for suppressing it. Glucocorticoid receptors in the hippocampus monitor
the amount of cortisol in the system and through negative feedback can tell the hypothalamus to stop releasing
CRH.[21]

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Studies on mice engineered to have high concentrations of CRH showed higher levels of anxiety, while those
engineered to have no or low amounts of CRH receptors were less anxious. In phobic patients, therefore, high amounts
of cortisol may be present, or alternatively, there may be low levels of glucocorticoid receptors or even serotonin (5-
HT).[21]

Disruption by damage
For the areas in the brain involved in emotion—most specifically fear— the processing and response to emotional
stimuli can be significantly altered when one of these regions becomes lesioned or damaged. Damage to the cortical
areas involved in the limbic system such as the cingulate cortex or frontal lobes have resulted in extreme changes in
emotion.[21] Other types of damage include Klüver–Bucy syndrome and Urbach–Wiethe disease. In Klüver–Bucy
syndrome, a temporal lobectomy, or removal of the temporal lobes, results in changes involving fear and aggression.
Specifically, the removal of these lobes results in decreased fear, confirming its role in fear recognition and response.
Bilateral damage to the medial temporal lobes, which is known as Urbach–Wiethe disease, exhibits similar symptoms
of decreased fear and aggression, but also an inability to recognize emotional expressions, especially angry or fearful
faces.[21]

The amygdala’s role in learned fear includes interactions with other brain regions in the neural circuit of fear. While
lesions in the amygdala can inhibit its ability to recognize fearful stimuli, other areas such as the ventromedial
prefrontal cortex and the basolateral nuclei of the amygdala can affect the region's ability to not only become
conditioned to fearful stimuli, but to eventually extinguish them. The basolateral nuclei, through receiving stimulus
info, undergo synaptic changes that allow the amygdala to develop a conditioned response to fearful stimuli. Lesions in
this area, therefore, have been shown to disrupt the acquisition of learned responses to fear.[21] Likewise, lesions in the
ventromedial prefrontal cortex (the area responsible for monitoring the amygdala) have been shown to not only slow
down the speed of extinguishing a learned fear response, but also how effective or strong the extinction is. This
suggests there is a pathway or circuit among the amygdala and nearby cortical areas that process emotional stimuli and
influence emotional expression, all of which can be disrupted when an area becomes damaged.[20]

Diagnosis
It is recommended that the terms distress and impairment take into account the context of the person's environment
during diagnosis. The DSM-IV-TR states that if a feared stimulus, whether it be an object or a social situation, is absent
entirely in an environment, a diagnosis cannot be made. An example of this situation would be an individual who has a
fear of mice but lives in an area devoid of mice. Even though the concept of mice causes marked distress and
impairment within the individual, because the individual does not usually encounter mice, no actual distress or
impairment is ever experienced. It is recommended that proximity to, and ability to escape from, the stimulus also be
considered. As the phobic person approaches a feared stimulus, anxiety levels increase, and the degree to which the
person perceives they might escape from the stimulus affects the intensity of fear in instances such as riding an
elevator (e.g. anxiety increases at the midway point between floors and decreases when the floor is reached and the
doors open).[28]

Treatments
There are various methods used to treat phobias. These methods include systematic desensitization, progressive
relaxation, virtual reality, modeling, medication and hypnotherapy.

Therapy
Cognitive behavioral therapy (CBT) can be beneficial by allowing the patient to challenge dysfunctional thoughts or
beliefs by being mindful of their own feelings, with the aim that the patient will realize that his or her fear is irrational.
CBT may be conducted in a group setting. Gradual desensitization treatment and CBT are often successful, provided
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the patient is willing to endure some discomfort.[29][30] In one clinical trial, 90% of patients were observed to no longer
have a phobic reaction after successful CBT treatment.[30][31][32][33]

CBT is also an effective treatment for phobias in children and adolescents, and has been adapted for use with this age.
One example of a CBT program targeted towards children is the Coping Cat. This treatment program can be used with
children between the ages of 7 and 13 to treat social phobia. This program works to decrease negative thinking,
increase problem solving and provide a functional coping outlook in the child.[34] Another CBT program was
developed by Ann Marie Albano to treat social phobia in adolescents. This program has five stages: Psychoeducation,
Skill Building, Problem Solving, Exposure and Generalization and Maintenance. Psychoeducation focuses on
identifying and understanding symptoms. Skill Building focuses on learning cognitive restructuring, social skills and
problem solving skills. Problem Solving focuses on identifying problems and using a proactive approach to solving
them. Exposure involves exposing the adolescent to social situations in a hierarchical approach. Finally, Generalization
and Maintenance involves practicing the skills learned.[35]

Peer-reviewed clinical trials have demonstrated that eye movement desensitization and reprocessing (EMDR) is
effective in treating some phobias. Mainly used to treat post-traumatic stress disorder, EMDR has been demonstrated
as effective in easing phobia symptoms following a specific trauma, such as a fear of dogs following a dog bite.[36]

Another method used to treat patients with extreme phobias is prolonged exposure, in which the patient is exposed to
the object of their fear over a long period of time. This technique is only tested when a person has overcome avoidance
of, or escape from, the feared object or situation. People with slight distress from their phobias usually do not need
prolonged exposure to their fear.[37]

Systematic desensitization
A method used in the treatment of a phobia is systematic desensitization, a process
in which the patients seeking help slowly become accustomed to their phobia, and
ultimately overcome it. Traditional systematic desensitization involves a person
being exposed to the object they are afraid of over time, so that the fear and
discomfort do not become overwhelming. This controlled exposure to the anxiety-
provoking stimulus is key to the effectiveness of exposure therapy in the treatment
of specific phobias. It has been shown that humor is an excellent alternative when
traditional systematic desensitization is ineffective.[38] Humor systematic
desensitization involves a series of treatment activities that consist of activities that
elicit humor with the feared object.[38] Previously learned progressive muscle
relaxation procedures can be used as the activities become more difficult in a
person’s own hierarchy level. Progressive muscle relaxation helps patients relax
their muscles before and during exposure to the feared object or phenomenon.
A soldier stomping his foot
Participant modeling, in which the therapist models how the patient should respond to put out the fire rising up
his leg during military fire-
to fears, has been proven effective for children and adolescents.[39] This encourages
phobia training
patients to practice the behavior and reinforces their efforts. In a manner similar to
systematic desensitization, phobic patients are gradually introduced to their feared
objects. The main difference between participant modeling and systematic desensitization involves observations and
modeling; participant modeling encompasses a therapist modeling and observing positive behaviors over the course of
gradual exposure to the feared object.[39]

Virtual reality therapy is another technique that helps phobic people confront a feared object. It uses virtual reality to
generate scenes that may not have been possible or ethical in the physical world. It offers some advantages over
systematic desensitization therapy. People can control the scenes and endure more exposure than they might handle in

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reality. Virtual reality is more realistic than simply imagining a scene—the therapy occurs in a private room and the
treatment is efficient.[40]

Medications
Medications can help regulate apprehension and fear of a particular fearful object or situation. Antidepressant
medications such as SSRIs or MAOIs may be helpful in some cases of phobia. SSRIs (antidepressants) act on
serotonin, a neurotransmitter in the brain. Since serotonin impacts mood, patients may be prescribed an
antidepressant. Sedatives such as benzodiazepines may also be prescribed, which can help patients relax by reducing
the amount of anxiety they feel.[41] Benzodiazepines may be useful in acute treatment of severe symptoms, but the risk-
benefit ratio is against their long-term use in phobic disorders.[42] This class of medication has recently been shown as
effective if used with negative behaviors such as alcohol abuse.[41] Despite this positive finding, benzodiazepines are
used with caution. Beta blockers are another medicinal option as they may stop the stimulating effects of adrenaline,
such as sweating, increased heart rate, elevated blood pressure, tremors and the feeling of a pounding heart.[41] By
taking beta blockers before a phobic event, these symptoms are decreased, making the event less frightening.

Hypnotherapy
Hypnotherapy can be used alone and in conjunction with systematic desensitization to treat phobias.[43] Through
hypnotherapy, the underlying cause of the phobia may be uncovered. The phobia may be caused by a past event that
the patient does not remember, a phenomenon known as repression. The mind represses traumatic memories from the
conscious mind until the person is ready to deal with them. Hypnotherapy may also eliminate the conditioned
responses that occur during different situations. Patients are first placed into a hypnotic trance, an extremely relaxed
state[44] in which the unconscious can be retrieved. This state makes patients more open to suggestion, which helps
bring about desired change.[44] Consciously addressing old memories helps individuals understand the event and see it
in a less threatening light.

Epidemiology
Phobias are a common form of anxiety disorder, and distributions are heterogeneous by age and gender. An American
study by the National Institute of Mental Health (NIMH) found that between 8.7 percent and 18.1 percent of
Americans suffer from phobias,[45] making it the most common mental illness among women in all age groups and the
second most common illness among men older than 25. Between 4 percent and 10 percent of all children experience
specific phobias during their lives,[12] and social phobias occur in one percent to three percent of children and
adolescents.

A Swedish study found that females have a higher incidence than males (26.5 percent for females and 12.4 percent for
males).[46] Among adults, 21.2 percent of women and 10.9 percent of men have a single specific phobia, while multiple
phobias occur in 5.4 percent of females and 1.5 percent of males.[46] Women are nearly four times as likely as men to
have a fear of animals (12.1 percent in women and 3.3 percent in men) — a higher dimorphic than with all specific or
generalized phobias or social phobias.[46] Social phobias are more common in girls than in boys,[47] while situational
phobia occurs in 17.4 percent of women and 8.5 percent of men.[46]

Society and culture

Terminology
The word phobia comes from the Greek: φόβος (phóbos), meaning "aversion", "fear" or "morbid fear". In popular
culture, it is common for specific phobias to have names based on a Greek word for the object of the fear, plus the
suffix ­phobia. Creating these terms is something of a word game. Few of these terms are found in medical
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literature.[48] In ancient Greek mythology Phobos was the twin brother of Deimos (terror).

The word phobia may also refer to conditions other than true phobias. For example, the term hydrophobia is an old
name for rabies, since an aversion to water is one of that disease's symptoms. A specific phobia to water is called
aquaphobia instead. A hydrophobe is a chemical compound that repels water. Similarly, the term photophobia usually
refers to a physical complaint (aversion to light due to inflamed eyes or excessively dilated pupils), rather than an
irrational fear of light.

Non-medical use
A number of terms with the suffix -phobia are used non-clinically to imply irrational fear or hatred. Examples include:

Chemophobia – Negative attitudes and mistrust towards chemistry and synthetic chemicals.
Xenophobia – Fear or dislike of strangers or the unknown, sometimes used to describe nationalistic political
beliefs and movements.
Homophobia – Negative attitudes and feelings toward homosexuality or people who are identified or perceived as
being lesbian, gay, bisexual or transgender (LGBT).
Usually these kinds of "phobias" are described as fear, dislike, disapproval, prejudice, hatred, discrimination or
hostility towards the object of the "phobia".[49] Homophobia is used for irrational hate rather than fear, and therefore
cannot be pathologized as a mental disorder. Xenophobia is often used for irrational hate as well.

References
1. American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.),
Arlington: American Psychiatric Publishing, pp. 190, 197–202, ISBN 978-0890425558
2. Hamm, AO (September 2009). "Specific phobias". The Psychiatric Clinics of North America. 32 (3): 577–91.
doi:10.1016/j.psc.2009.05.008 (https://doi.org/10.1016%2Fj.psc.2009.05.008). PMID 19716991 (https://www.ncbi.
nlm.nih.gov/pubmed/19716991).
3. Straight A's in Psychiatric and Mental Health Nursing (https://books.google.fr/books?id=w4QUuONGqmkC&pg=PT
172). Lippincott Williams & Wilkins. 2006. p. 172. ISBN 9781582554488.
4. "Anxiety Disorders" (http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml). NIMH. March 2016.
Archived (https://web.archive.org/web/20160727230427/http://www.nimh.nih.gov/health/topics/anxiety-disorders/in
dex.shtml) from the original on 27 July 2016. Retrieved 27 July 2016.
5. Perugi, G; Frare, F; Toni, C (2007). "Diagnosis and treatment of agoraphobia with panic disorder". CNS Drugs. 21
(9): 741–64. doi:10.2165/00023210-200721090-00004 (https://doi.org/10.2165%2F00023210-200721090-00004).
PMID 17696574 (https://www.ncbi.nlm.nih.gov/pubmed/17696574).
6. American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.),
Arlington: American Psychiatric Publishing, pp. 204, 218–219, ISBN 978-0890425558
7. "Specific Phobias" (http://www.mentalhealth.va.gov/specificphobias.asp). USVA. Archived (https://web.archive.org/
web/20160714221652/http://www.mentalhealth.va.gov/specificphobias.asp) from the original on 14 July 2016.
Retrieved 26 July 2016.
8. LeBeau RT, Glenn D, Liao B, Wittchen HU, Beesdo-Baum K, Ollendick T, Craske MG (2010). "Specific phobia: a
review of DSM-IV specific phobia and preliminary recommendations for DSM-V". Depress Anxiety. 27 (2): 148–67.
CiteSeerX 10.1.1.590.6020 (https://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.590.6020).
doi:10.1002/da.20655 (https://doi.org/10.1002%2Fda.20655). PMID 20099272 (https://www.ncbi.nlm.nih.gov/pub
med/20099272).
9. Tamparo, Carol; Lewis, Marcia (2011). Diseases of the Human Body. Philadelphia, PA: F.A. Davis Company.
p. 153. ISBN 9780803625051.
10. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington D.C.: American Psychiatric
Association. 1994. p. 405. ISBN 978-0-89042-062-1.
11. "Archived copy" (http://www.dsm5.org/proposedrevision/pages/proposedrevision.aspx?rid=162). Archived (https://
web.archive.org/web/20121031102839/http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=
162) from the original on 2012-10-31. Retrieved 2012-11-12.
https://en.wikipedia.org/wiki/Phobia 8/12
01/06/2019 Phobia - Wikipedia

12. Bolton, D.; Eley, T. C.; O'Connor, T. G.; Perrin, S.; Rabe-Hesketh, S.; Rijsdijk, F.; Smith, P. (2006). "Prevalence and
genetic and environmental influences on anxiety disorders in 6-year-old twins". Psychological Medicine. 36 (3):
335–344. doi:10.1017/S0033291705006537 (https://doi.org/10.1017%2FS0033291705006537). PMID 16288680
(https://www.ncbi.nlm.nih.gov/pubmed/16288680).
13. Rachman, S.J. (1978). Fear and Courage. San Francisco: WH Freeman & Co.
14. Myers; Davis, K. M. (2007). "Mechanisms of fear extinction" (http://proquest.umi.com.libris.mtsac.edu/pqdweb?ind
ex=51&did=1201968761&SrchMode=1&sid=1&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS
=1303294470&clientId=132). Molecular Psychiatry. 12 (2): 120–150. doi:10.1038/sj.mp.4001939 (https://doi.org/1
0.1038%2Fsj.mp.4001939). PMID 17160066 (https://www.ncbi.nlm.nih.gov/pubmed/17160066). Retrieved
April 25, 2011.
15. "vicarious conditioning" (http://behavenet.com/vicarious-conditioning). BehaveNet. Archived (https://web.archive.or
g/web/20131029202904/http://www.behavenet.com/vicarious-conditioning) from the original on 2013-10-29.
Retrieved 2013-06-21.
16. Mineka, S.; Davidson, M.; Cook, M.; Keir, R. (1984). "Observational conditioning of snake fear in rhesus
monkeys". Journal of Abnormal Psychology. 93 (4): 355–372. doi:10.1037/0021-843x.93.4.355 (https://doi.org/10.
1037%2F0021-843x.93.4.355). PMID 6542574 (https://www.ncbi.nlm.nih.gov/pubmed/6542574).
17. Andreas Olsson; Elizabeth A. Phelps (2004). "Learned Fear of Unseen Faces After Pavlovian, Observational, and
Instructed Fear" (http://www.psych.nyu.edu/phelpslab/papers/OlssonPhelps_PsychSc.pdf) (PDF). Psychological
Science. 15 (12): 822–828. doi:10.1111/j.0956-7976.2004.00762.x (https://doi.org/10.1111%2Fj.0956-7976.2004.0
0762.x). PMID 15563327 (https://www.ncbi.nlm.nih.gov/pubmed/15563327). Archived (https://web.archive.org/we
b/20131109133316/http://www.psych.nyu.edu/phelpslab/papers/OlssonPhelps_PsychSc.pdf) (PDF) from the
original on 2013-11-09.
18. Bolles, R. C. (1970). "Species-specific Defense Reactions and Avoidance Learning". Psychological Review. 77:
32–38. doi:10.1037/h0028589 (https://doi.org/10.1037%2Fh0028589).
19. "NIMH · Post Traumatic Stress Disorder Research Fact Sheet" (http://www.nimh.nih.gov/health/publications/post-tr
aumatic-stress-disorder-research-fact-sheet/index.shtml). National Institutes of Health. Archived (https://web.archi
ve.org/web/20140123205303/http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-research-
fact-sheet/index.shtml) from the original on 2014-01-23.
20. Tillfors, Maria (15 March 2003). "Why do some individuals develop social phobia? A review with emphasis on the
neurobiological influences". Nord J Psychiatry. 58 (4). doi:10.1080/0839480410005774 (https://doi.org/10.1080%2
F0839480410005774) (inactive 2019-02-22).
21. Mark F. Bear; Barry W. Connors; Michael A. Paradiso, eds. (2007). Neuroscience: Exploring the Brain (3rd ed.).
Lippincott Williams & Wilkins. ISBN 9780781760034.
22. Straube, T.; Mentzel, H.; Miltner, W. R. (2005). "Neuropsychobiology". Common and District Brain Activation to
Threat and Safety Signals in Social Phobia. 52 (3): 163–8. doi:10.1159/000087987 (https://doi.org/10.1159%2F00
0087987). PMID 16137995 (https://www.ncbi.nlm.nih.gov/pubmed/16137995).
23. Etkin, Amit; Tobias Egner; Raffael Kalisch (February 2011). "Emotional processing in the anterior cingulate and
medial prefrontal cortex" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035157). Trends Cogn Sci. 15 (2): 85–
93. doi:10.1016/j.tics.2010.11.004 (https://doi.org/10.1016%2Fj.tics.2010.11.004). PMC 3035157 (https://www.ncb
i.nlm.nih.gov/pmc/articles/PMC3035157). PMID 21167765 (https://www.ncbi.nlm.nih.gov/pubmed/21167765).
24. Akirav, Irit; Mouna Maroun (15 May 2006). "The Role of the Medial Prefrontal Cortex-Amygdala Circuit in Stress
Effects on the Extinction of Fear" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838961). Neural Plasticity.
2007: 30873. doi:10.1155/2007/30873 (https://doi.org/10.1155%2F2007%2F30873). PMC 1838961 (https://www.n
cbi.nlm.nih.gov/pmc/articles/PMC1838961). PMID 17502909 (https://www.ncbi.nlm.nih.gov/pubmed/17502909).
25. Paul J. Whalen; Elizabeth A. Phelps, eds. (2009). The Human Amygdala. New York: The Guilford Press.
26. Winerman, Lea. "Figuring Out Phobia" (http://www.apa.org/monitor/julaug05/figuring.html) Archived (https://web.ar
chive.org/web/20071005171325/http://www.apa.org/monitor/julaug05/figuring.html) 2007-10-05 at the Wayback
Machine, American Psychology Association: Monitor on Psychology, August 2007.
27. Rogers, Kara. "Fight-or-flight response" (https://www.britannica.com/science/fight-or-flight-response).
Britannica.com. Retrieved 19 February 2019.
28. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington D.C.: American Psychiatric
Association. 1994. p. 406. ISBN 978-0-89042-062-1.

https://en.wikipedia.org/wiki/Phobia 9/12
01/06/2019 Phobia - Wikipedia

29. Hall, Lynne L. Fighting Phobias, the Things That Go Bump in the Mind (http://www.fda.gov/fdac/features/1997/297
_bump.html) Archived (https://web.archive.org/web/20060515155851/http://www.fda.gov/fdac/features/1997/297_
bump.html) 2006-05-15 at the Wayback Machine, FDA Consumer Magazine, Volume 31 No. 2, March 1997.
30. Wolpe, Joseph (1958). "Psychotherapy by reciprocal inhibition" (http://www.springerlink.com/index/8452N0KP134
NK203.pdf) (PDF). Conditional Reflex : A Pavlovian Journal of Research & Therapy. 3 (4): 234–240.
doi:10.1007/BF03000093 (https://doi.org/10.1007%2FBF03000093) (inactive 2019-02-22).
31. E. B., Foa; Blau, J. S.; Prout, M.; Latimer, P. (1977). "Is horror a necessary component of flooding (implosion)?".
Behaviour Research and Therapy. 15 (5): 397–402. doi:10.1016/0005-7967(77)90043-2 (https://doi.org/10.1016%
2F0005-7967%2877%2990043-2).
32. Craske, Michelle; Martin M. Antony; David H. Barlow (2006). Mastering your fears and phobias (https://books.goog
le.com/?id=ndcxMZ7NEcsC&dq=Foa;+Blau,+J.+S.,+Prout,+M.,+%26+Latimer,+P.+(1977).+%22Is+horror+a+nece
ssary+component+of+flooding+(implosion)%3F%22). US: Oxford University Press. ISBN 978-0-19-518917-9.
33. Eysenck, Hans (1977). You and Neurosis.
34. Kendall, P. C., Aschenbrand, S. G., & Hudson, J. L. (2003). Child-focused treatment of anxiety. In A. E. Kazdin, J.
R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 81–100). New York, NY US:
Guilford Press
35. Albano, A. (2003). Treatment of social anxiety disorder. In M. A. Reinecke, F. M. Dattilio, A. Freeman (Eds.),
Cognitive therapy with children and adolescents: A casebook for clinical practice (2nd ed.) (pp. 128–161). New
York, NY US: Guilford Press.
36. De Jongh, A; Ten Broeke, E; Renssen, M R. (1999). "Treatment of specific phobias with Eye Movement
Desensitization and Reprocessing (EMDR): protocol, empirical status, and conceptual issues". Journal of Anxiety
Disorders. 13 (1–2): 69–85. doi:10.1016/S0887-6185(98)00040-1 (https://doi.org/10.1016%2FS0887-6185%289
8%2900040-1). PMID 10225501 (https://www.ncbi.nlm.nih.gov/pubmed/10225501).
37. Watson, J.P.; Marks (2 January 1971). "Prolonged Exposure: A Rapid Treatment For Phobias" (https://www.ncbi.nl
m.nih.gov/pmc/articles/PMC1794779). British Medical Journal. 1 (5739): 13–15. doi:10.1136/bmj.1.5739.13 (http
s://doi.org/10.1136%2Fbmj.1.5739.13). JSTOR 25413031 (https://www.jstor.org/stable/25413031). PMC 1794779
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1794779).
38. Ventis, L.B; Higbee, G; Murdock, S.A. (2001). "Using humor in systematic desensitization to reduce fear". Journal
of General Psychology. 128 (2): 241–253. doi:10.1080/00221300109598911 (https://doi.org/10.1080%2F0022130
0109598911). PMID 11506052 (https://www.ncbi.nlm.nih.gov/pubmed/11506052).
39. Love, S.R; Matson, J.L.; West, D (1990). "Mothers as effective therapists for autistic children's phobias" (https://w
ww.ncbi.nlm.nih.gov/pmc/articles/PMC1286250). Journal of Applied Behavior Analysis. 23 (3): 379–385.
doi:10.1901/jaba.1990.23-379 (https://doi.org/10.1901%2Fjaba.1990.23-379). PMC 1286250 (https://www.ncbi.nl
m.nih.gov/pmc/articles/PMC1286250). PMID 2249973 (https://www.ncbi.nlm.nih.gov/pubmed/2249973).
40. North, M.M.; North, S.M.; Coble, J.R. (1997). Virtual reality therapy: An effective treatment for psychological
disorders. Amsterdam, Netherlands: IOS Press.
41. Marshall (1995). "Integrated treatment of social phobia". Bulletin of the Menninger Clinic. 59(2, Suppl A): A27–
A37.
42. Stein, Dan J. (16 February 2004). "Specific Phobia" (https://books.google.com/?id=44reFIgFDBMC&pg=PA53).
Clinical Manual of Anxiety Disorders (1st ed.). USA: American Psychiatric Press Inc. p. 53. ISBN 978-1-58562-
076-0. "Fears are common in children and adolescents. However, for some youth, these fears persist and develop
into specific phobias. A specific phobia is an intense, enduring fear of an identifiable object or situation that may
lead to panic symptoms, distress, and avoidance (e.g., fears of dogs, snakes, storms, heights, costumed
characters, the dark, and similar objects or situations). Moreover, phobias can affect a youngster's quality of life by
interfering with school, family, friends, and free-time. It is estimated that 5% to 10% of youth will develop a phobia
before reaching the age of 16."
43. Iglesias, Alex; Iglesias, Adam (2013). "I-95 Phobia Treated With Hypnotic Systematic Desensitization: A Case
Report". American Journal of Clinical Hypnosis. 56 (6): 143–151. doi:10.1080/00029157.2013.785930 (https://doi.
org/10.1080%2F00029157.2013.785930). PMID 24665816 (https://www.ncbi.nlm.nih.gov/pubmed/24665816).
44. Vickers, A.; Zollman, C.; Payne, D.K. (1990). "Hypnosis and relaxation therapies" (https://www.ncbi.nlm.nih.gov/p
mc/articles/PMC1071579). Western Journal of Medicine. 175 (4): 269–272. doi:10.1136/ewjm.175.4.269 (https://d
oi.org/10.1136%2Fewjm.175.4.269). PMC 1071579 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071579).
PMID 11577062 (https://www.ncbi.nlm.nih.gov/pubmed/11577062).

https://en.wikipedia.org/wiki/Phobia 10/12
01/06/2019 Phobia - Wikipedia

45. Kessler et al., Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity
Survey Replication, June 2005, Archive of General Psychiatry, Volume 20
46. Fredrikson, M; Annas, P; Fischer, H; Wik, G (1996). "Gender and age differences in the prevalence of specific
fears and phobias". Behaviour Research and Therapy. 34 (1): 33–9. doi:10.1016/0005-7967(95)00048-3 (https://d
oi.org/10.1016%2F0005-7967%2895%2900048-3). PMID 8561762 (https://www.ncbi.nlm.nih.gov/pubmed/856176
2).
47. Essau, C. A.; Conradt, J.; Petermann, F. (1999). "Frequency and comorbidity of social phobia and social fears in
adolescents". Behaviour Research and Therapy. 37 (9): 831–843. doi:10.1016/S0005-7967(98)00179-X (https://d
oi.org/10.1016%2FS0005-7967%2898%2900179-X). PMID 10458047 (https://www.ncbi.nlm.nih.gov/pubmed/1045
8047).
48. Abbasi, Jennifer (25 Jul 2011), "Is Trypophobia a real phobia?" (http://www.popsci.com/trypophobia), Popular
Science, archived (https://web.archive.org/web/20160407215939/http://www.popsci.com/trypophobia) from the
original on 2016-04-07, retrieved 10 Apr 2016
49. "homophobia" (http://dictionary.reference.com/browse/homophobia). Dictionary.com. Dictionary.com. 2008.
Archived (https://web.archive.org/web/20160304210844/http://dictionary.reference.com/browse/homophobia) from
the original on 2016-03-04. Retrieved 2017-03-30.

External links
Media related to Phobias at Wikimedia Commons
Classification ICD-10: F40.9 (htt D
Social Anxiety (https://curlie.org/Health/Mental_Health/Disorders/Anxiety/
Social_Anxiety) at Curlie
p://apps.who.int/cla
Diagnostic criteria for specific phobia (https://web.archive.org/web/20041 ssifications/icd10/br
205053330/http://www.behavenet.com/capsules/disorders/specphob.htm) owse/2016/en#/F4
in the DSM-IV
0.9) · ICD-9-CM:
300.20 (http://www.i
cd9data.com/getIC
D9Code.ashx?icd9
=300.20) · OMIM:
608251 (https://omi
m.org/entry/60825
1) · MeSH:
D010698 D010698,
D010698 (https://w
ww.nlm.nih.gov/cgi/
mesh/2015/MB_cg
i?field=uid&term=D
010698,)
External MedlinePlus:
resources 000956 (https://ww
w.nlm.nih.gov/medli
neplus/ency/article/
000956.htm) ·
eMedicine:
article/288016 (htt
p://www.emedicine.
com/article/topic288
016.htm)

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