Specific phobias in adults and young people

A specific phobia is an extreme fear or anxiety over actual or anticipated exposure to a specific situation or object. Specific phobias are divided into 5 subgroups:

• animal (eg dogs, moths, birds)
• natural environment (eg heights, storms, water, lightning)
• blood-injection-injury (eg blood, needles, hospitals)
• situational (eg aeroplanes, lifts and enclosed spaces)
• other (eg situations that may lead to choking or vomiting).

For information on diagnosing and differentiating anxiety disorders, see Overview of anxiety disorders.

At the time of diagnosis, provide psychoeducation to the patient. Use psychological therapies (including behavioural therapy with a graded exposure component) as first-line treatment of a specific phobia. Exposure therapy (which may include relaxation strategies) is used to gradually reduce autonomic responses to feared stimuli. Virtual-reality exposure is emerging as a convenient approach, but it is not clear if it is superior to real-world exposure.

If a specific phobia needs to be managed for a particular event or at a particular time, or if psychosocial interventions alone are insufficient, consider adjunctive use of diazepam. Short-term use of diazepam can alleviate fear and anxiety, until the patient can achieve some control of the phobia using other methods. A common example is the need to manage a phobia of enclosed spaces (claustrophobia) in a patient who requires a magnetic resonance imaging (MRI) examination; in this situation, give a single dose of diazepam before the examination.

However, benzodiazepine use is associated with increased risk of falls, memory problems, motor vehicle accidents, daytime sedation and dependence. These risks are of particular concern in older people, in whom harms of benzodiazepine use may outweigh benefits (see Principles for the use of benzodiazepines in anxiety disorders).

If a benzodiazepine is considered appropriate for a specific phobia, use:

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

For considerations in managing anxiety disorders such as a specific phobia during the perinatal period, see here or for considerations in partners, see here.