An intense, irrational, persistent fear that interferes with normal functioning or creates significant distress.
Ordinary fears are a normal part of childhood and can actually help children work through certain developmental issues. Universal fears in infancy include fear of strangers and of loud noises. Fear of certain animals is common between the ages of two and three, and subsequent years often bring fears of imaginary creatures (such as monsters under the bed) and of the dark. However, when fears cause a child to repeatedly avoid certain situations or when they persist for an unusually long time or occur at an inappropriate age, they are considered to be phobias. For clinical diagnosis of a phobia in a child or adolescent, the fear must persist for a period of at least six months. While adults with phobias are aware that their fears are exaggerated and unfounded, this is not always the case with children.
Phobias are the most common anxiety disorder in the United States, affecting an estimated 5-12% of the population. They can have a variety of possible causes. Some children have anxious temperaments that make them prone to develop phobias even when there is no discernible external cause, a fact that today's researchers and clinicians often view in terms of brain chemistry. Debilitating fears can also be learned. It is easy for parents to pass on their own fears to their children: parents who fear airplanes or thunderstorms often have children who do, too. Fear can also be directly learned through a traumatic incident: a child who has been bitten by a dog may come to fear all dogs.
There are many kinds of phobias. Specific phobias (formerly called simple phobias) involve a particular object, situation, or activity. These phobias fall into several categories: animal phobia (often involving dogs, snakes, or insects); blood-injection-injury phobia (fear of injections or of injuries that cause bleeding); situational
In addition to specific phobias, the other type of phobia that affects children is social phobia (also called social anxiety disorder), fear of social situations because of an irrational dread of embarrassing oneself. The phobia may be generalized, extending to all social interactions, or limited to specific situations. Often, the feared situation involves some type of performance, such as playing music or speaking in public. Some persons develop a phobia about performing certain commonplace activities, including eating and writing, when others are present; even using a public lavatory may become a cause of apprehension. The exaggerated fear of humiliating oneself by doing something stupid or embarrassing is so strong that it can make people afraid to take part in the most ordinary social exchange. As with specific phobias, persons with social phobia suffer anxiety severe enough to generate physical symptoms and often cope by avoiding the source of the anxiety (although this option is generally less available to children than to adults—often they have no choice and simply have to suffer through an anxiety-producing situation, whether it be a competition, music recital, or simply day-to-day school attendance.) The most widespread form of social phobia is fear of public speaking, followed by fear of dealing with strangers. Other types of fears, such as the fear of eating in front of strangers, are less common. Social phobia usually begins in adolescence, often preceded by a childhood history of shyness. While the shyness may have been manageable earlier in life, the increased social demands and stresses that beset even the average teenager can lead to phobia in those whose social skills were fragile to begin with. True social phobia, as opposed to mere shyness, is quite rare in young people, affecting only about 1% of children and adolescents.
Agoraphobia—the fear of being separated from a safe place or trusted person, or of being trapped in a place or situation from which a person fears it would be difficult to escape—is not a phobia of childhood or adolescence, except when it occurs in conjunction with panic disorder, which is itself rare in these age groups (it is thought to affect about 0.6% of high school students). The central feature of agoraphobia with panic disorder is avoidance of situations because it is feared they will bring on a panic attack (an episode of acute anxiety in which people experience an uncontrollable sense of impending disaster, often fearing that they are going to die or lose their minds). Physical symptoms include dizziness, nausea, a pounding heart, hyperventilation, and profuse sweating. A hallmark of panic disorder is fear of future attacks, and a person who has panic disorder with agoraphobia generally avoids public places that draw crowds, such as malls, theaters, and restaurants, fearing that escape in the event of an attack will be both difficult and embarrassing.
The most popular and effective treatment for phobias is behavior therapy, which approaches the phobia as an undesirable behavior to be unlearned. Most often it takes the form of systematic desensitization, a technique by which the phobic person is exposed to the feared stimulus in an extremely mild form and then with gradually increasing degrees of intensity. For example, a child who fears dogs may first be asked to look at pictures of dogs, then perhaps play with a stuffed dog or view a dog from afar, ultimately getting to the point when she is able to pet and play with dogs up close. Phobias also respond to treatment by medication, including anti-anxiety drugs such as Xanax and BuSpar and selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft. Medication is especially helpful for social phobia, where it can help the child overcome her aversion to social interaction sufficiently to work with a therapist. When agoraphobia accompanies panic attacks, it also responds to cognitive-behavioral treatment for panic disorder, often in conjunction with anti-anxiety and anti-depressant medications similar to those prescribed for other phobias.
Gold, M. S. The Good News About Panic, Anxiety, and Phobias. New York: Bantam Books, 1989.
Hecker, J. E., and G. L. Thorpe. Agoraphobia and Panic: A Guide to Psychological Treatment. Needham Heights, MA: Allyn and Bacon, 1992.
Peurifoy, Reneau. Anxiety, Phobias, and Panic: Taking Charge and Conquering Fear, 2nd ed. Citrus Heights, CA: LifeSkills Publications, 1992.
Markway, B. G., et. al. Dying of Embarrassment: Help for Social Anxiety and Phobias. Oakland, CA: New Harbinger Publications, 1992.
Ross, Jerilyn. Triumph Over Fear. New York: Bantam Books, 1994.
Anxiety Disorders Association of America
Address: 6000 Executive Blvd. #513
Rockville, MD 20852
Telephone: (301) 231-9350
American Academy of Child and Adolescent Psychiatry
Address: 3615 Wisconsin Avenue NW
Washington, DC 20016-3007
Telephone: toll-free (800) 333-7636; (202) 966-7300
Council on Anxiety Disorders
Address: P.O. Box 17011
Winston-Salem, NC 27116
Telephone: (910) 722-7760