It’s normal for teens to experience a bit of anxiety or fear in certain situations, such as giving a presentation at school or going to the dentist. However, a surprising number of teens – more than 10% – suffer from what’s known as a specific phobia (or simple phobia). This common anxiety disorder involves having an extreme and irrational fear of an object or situation such as spiders, blood, getting an injection, or being in an elevator or other confined space.
The accompanying distress is so intense that teens with this disorder will go to great lengths to avoid the source of their fear. They may also become anxious just thinking about having to face it. Having a specific phobia can significantly interfere with an adolescent’s life and may impair his or her ability to function normally. Without treatment, specific phobias generally persist into adulthood.
As a parent, it can be difficult to distinguish the difference between “normal” bouts of anxiety in your teen and an anxiety disorder. This brief guide is designed to help you know the signs of a specific phobia and what steps to take if this disorder is affecting your teen.
Specific Phobias Statistics and Facts
Following are some statistics and facts about specific phobias:
- Specific phobias often first appear during childhood or adolescence
- Females are twice as likely as males to suffer from specific phobias according to NIMH (the National Institute of Mental Health)
- Specific phobias that develop during a person’s youth typically continue into adulthood and have the potential to be debilitating or at least significantly restrictive
- A study of 1035 adolescents in Germany, diagnosed with specific phobia, found that approximately one third also suffered from depression or a somatoform disorder
- According to Boston University’s Center for Anxiety and Related Disorders, specific phobia affects at least 1 out of every 10 adolescents
- Approximately 19.2 million adults in the U.S. suffer from specific phobias
Phobias usually develop during childhood or adolescence, and often involve animals, particular situations, or the natural environment. Although people can develop a phobia of just about anything, following is a list of some of the more common phobias.
- Heights (acrophobia)
- Confined places (claustrophobia)
- Social situations (social phobia)
- Spiders, scorpions, and other arachnids (arachnophobia)
- Snakes (ophidiophobia)
- Dogs (cynophobia)
- Dirt and germs (mysophobia)
- Doctors (iatrophobia)
- Blood (hemophobia)
- Injections (tryphanophobia)
- Public spaces, crowds, open areas (agoraphobia*)
- Storms (astrophobia)
- Water (aquaphobia)
- Flying (aviophobia or aerophobia)
*It should be noted that both agoraphobia and social phobia are diagnosed as distinct disorders rather than as specific phobias.
Following are several risk factors for the development of a specific phobia:
- Being female
- Having a parent or sibling with a specific phobia increases the risk of developing a similar type of phobia
- A frightening or traumatic experience (e.g. almost drowning) can contribute to the development of a related phobia
- Being inhibited or prone to anxiety and worry can increase the risk
Some individuals with specific phobias also have another psychiatric disorder. A few of the most common co-occurring disorders include:
- Somatoform disorders
- Other anxiety disorders, such as panic disorder with agoraphobia
- Substance use disorders
Looking for and Recognizing the Signs of Specific Phobia
As a parent, it’s important to recognize the signs of a specific phobia in your teen. Following is a list of signs to watch for:
- Intense anxiety or a full-blown panic attack* when confronted with (or thinking about facing) a specific situation or thing (e.g. riding in an elevator, spiders, or getting an injection)
- Extreme avoidance of a particular situation or thing (e.g. abruptly turning around, taking a different, but much longer route, or running back into the house if a dog is seen or heard barking down the street)
- Recognition that the fear is irrational or excessive (younger children often don’t realize this)
- Avoiding or cancelling activities they normally enjoy to prevent contact with the feared thing or situation
- Worry or anxiety due to anticipating or thinking about the feared object or situation (e.g. becoming increasingly anxious several hours or days prior to a trip to the doctor or an upcoming flight)
- Anxiety or panic attacks don’t occur in the absence of the feared situation or object, or when there’s no anticipation of being confronted with it
- Use of alcohol, nicotine, or drugs to cope with the anxiety
- Suicidal thoughts or behaviors**
*Symptoms of a panic attack often include:
- Fast, shallow breathing / shortness of breath
- Pounding heart
- Sense of danger or impending doom
- Shaking or trembling
- Intense fear that one is dying, losing control, and / or “going crazy”
- Chest tightness or heaviness
- Hot flashes or chills
- The sense that nothing is real
- Feeling as if you’re outside your body or in a dream
- Dizziness or feeling faint
- Numbness or tingling
**Suicidal thoughts or behaviors should never be ignored. Don’t assume your teen is just being “dramatic” or manipulative. Some individuals with specific phobias have an increased risk of suicide. This risk is even greater if they also abuse substances or suffer from depression or an additional anxiety disorder.
Knowing the First Steps to Take
If you have reason to suspect your teen is struggling with social anxiety disorder, the first steps to take towards handling the situation are:
1 – Talk to your teen. A heart to heart conversation is a crucial first step in addressing your concerns with your teen. Be empathetic and compassionate, and refrain from lecturing or judging. Be open and honest about your observations. Assure your teen that you want to help in any way you can.
Your teen may not feel comfortable opening up, and may try to convince you that you’re worrying too much and that “everything’s fine”. Teens often feel embarrassed or ashamed if they realize their fear is abnormal or excessive, even though they have no idea how to conquer it. Your teen may perceive the anxiety as a sign of weakness.
2 – Set up an appointment for an evaluation. Adolescent anxiety disorders should be treated by a mental health professional, such as a psychiatrist or psychologist who specializes in working with children and adolescents. However, you may prefer to have your family doctor or your teen’s pediatrician conduct an initial evaluation. A physical examination can rule out any underlying medical issues that may be causing your teen’s symptoms or contributing to his or her anxiety.
Anxiety disorders such as specific phobia should be treated by an experienced mental health professional. Ask your doctor for a referral or recommendation for a psychologist or psychiatrist to treat your teen’s anxiety, preferably one who specializes in treating children and adolescents.
3 – Get your teen into treatment. As with all adolescent psychiatric disorders, early intervention is always best. Without treatment, your teen’s anxiety may become increasingly disruptive and will likely continue into adulthood.
Specific phobias are typically treated with psychotherapy, or a combination of psychotherapy and medication. Medication as the sole form of treatment isn’t recommended, as it doesn’t address the underlying issue or help your teen learn healthy coping skills.
- Individual psychotherapy – Psychotherapy, or “talk therapy”, can help your teen learn how to manage his or her anxiety, and, hopefully, overcome the phobia that’s creating obstacles in his or her life. The therapy used most frequently used to treat specific phobias is Cognitive Behavioral Therapy (CBT).
Cognitive behavioral therapy focuses on identifying and changing irrational beliefs and thought patterns that create the intense anxiety your teen is experiencing. Exposure and response prevention (ERP) therapy is a specific type of CBT that often works especially well for the treatment of specific phobias. It involves gradually desensitizing your teen to the situation or thing that triggers the intense fear while teaching him or her to learn to manage the anxiety effectively.
- Medication – In some cases, medication may be beneficial as part of the treatment for specific phobias. Although no medications have been approved by the FDA for the treatment of specific phobias, medications that may be prescribed include:
Benzodiazepines – Medications in this category, such as Valium or Ativan, are minor tranquilizers. The calming effects are usually felt relatively quickly (e.g. within a couple hours), making them particularly beneficial for occasional use (e.g. when flying or a trip to the dentist can’t be avoided). Overuse or extended use may lead to dependence, so benzodiazepines must always be used with caution.
SSRIs – SSRIs (selective serotonin reuptake inhibitors) are antidepressants that are frequently also prescribed for anxiety disorders. Paxil, Celexa, and Zoloft are just a few examples of medications in this category. They have been found to help some individuals with specific phobias.
Beta-blockers – These blood-pressure medications are occasionally prescribed for temporary relief from the anxiety caused by a specific phobia. They reduce physical symptoms such as sweating, pounding or racing heart, and shaking or trembling.
If your teen requires medication for his or her social anxiety, it’s highly recommended that the medication be managed by a psychiatrist. Always carefully weigh the costs (e.g. potential side effects) against the benefits of medication for your teen.
- Hypnotherapy – Usually regarded as a complimentary or alternative treatment, hypnotherapy is sometimes used in addition to psychotherapy in the treatment of specific phobias. If hypnotherapy is used, be sure the individual providing it is a licensed mental health professional who has received specialized training in hypnotherapy.
Supporting and Encouraging Your Teen
It can be challenging to know the best ways to support and encourage your teen who’s struggling with a specific phobia. You want to help, but you don’t want to enable. Following are some helpful tips:
- Educate yourself about specific phobias so you can have a better understanding about what your teen is going through
- Reassure your teen that his or her fear isn’t an indication of a flaw or personal weakness
- Never ridicule, criticize, or admonish your teen about his or her specific phobia; it may seem absurd to you – and thus, just a simple matter of willpower or determination when dealing with it – but it’s very real to your teen and not something he or she can simply overcome
- Practice using relaxation techniques, such as deep breathing exercises, with your teen
- Pay attention to signs that your teen is using alcohol or other substances to self-medicate his or her anxiety; the temporary relief substances may provide can lead to serious problems, including eventual addiction. Substance use can also hinder treatment
- Be willing and available to listen and talk to your teen regarding his or her fears and anxiety
- Pay attention to how you express and manage your own anxiety, as your teen will look to you as a role model. If you struggle with anxiety, seek professional help. If you’re often anxious or fearful, that can reinforce your teen’s anxiety
- Don’t assume your teen’s specific phobia is something he or she will eventually grow out of with time. Specific phobias rarely go away on their own and they typically continue long into adulthood without proper treatment
- Reassurance about the feared object or situation won’t help your teen. It won’t alleviate the anxiety caused by a specific phobia
- Don’t enable your teen’s avoidant behavior by lowering your expectations or constantly “rescuing” or protecting him or her from the feared object or situation. It’s okay if your teen experiences some anxiety. Every time you do this you’ll inadvertently reinforce your teen’s avoidant behavior and lack of confidence in being able to handle it
- Do your best to remain calm when your teen is feeling anxiety; if you become anxious or frustrated it will feed into your teen’s anxiety
- If your teen starts to become anxious or feels a panic attack coming on, encourage and instruct him or her to use the coping skills learned in treatment
What to Do When Things Escalate
With specific phobias, things may escalate if your teen:
- Is abusing alcohol or drugs
- Is being bullied or ridiculed by peers due to the specific phobia
- Is going through a particularly stressful time or experienced a recent trauma
- Is also suffering from an additional anxiety disorder, depression, or another serious mental health condition
- Is manic, suicidal, or psychotic
- Is engaging in any type of self-destructive behavior, such as cutting or other forms of non-suicidal self harm.
- Is becoming increasingly avoidant or unable to function due to his or her anxiety
If things start to escalate and your teen’s safety or wellbeing is at risk, don’t hesitate to reach out for help. You can:
- Contact your child’s treatment provider asap
- Enlist the help of a close family member or friend for immediate support or assistance
- Call an emergency suicide or mental health hotline
- Take your child to the nearest hospital emergency room (if you can do so safely)
- Call 911
When Individual Therapy isn’t Enough
Although most teens respond well to individual therapy (or a combination of therapy and medication) for specific phobias, there are always exceptions. If your teen’s symptoms are severe or if he or she has an untreated substance use disorder or another psychiatric disorder for which individual therapy isn’t sufficient, a higher level of treatment will likely be required – at least temporarily. More intensive treatment options include:
- Intensive outpatient treatment (IOP) / Psychiatric day treatment
- Dual Diagnosis Treatment
- Residential treatment
- Inpatient psychiatric treatment
Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how many times a week your teen is required to go. These programs are typically the next step up from regular outpatient treatment.
Dual diagnosis treatment is typically indicated for teens who have a substance use problem in addition to their anxiety disorder. Alcohol or drug abuse almost always hinders the effectiveness of individual therapy alone, and can be dangerous when combined with certain medications, such as benzodiazepines. A dual diagnosis program addresses both the substance use and the anxiety disorder (and any other psychiatric issues) simultaneously.
Residential treatment requires having your teen live at a non-hospital treatment facility that specializes in treating adolescents with anxiety disorders and other mental health issues. Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and how well your teen is progressing in treatment.
Inpatient psychiatric treatment isn’t usually required with specific phobias. However, it may be necessary your teen is suicidal or needs to be stabilized due to severe depression, mania, psychosis, or another psychiatric disorder. Patients are monitored 24/7 and hospitalization is usually relatively brief.
Taking Care of Yourself
Having a teen with a mental health issue can take a toll on you, as well as the entire family. Trying to help your anxious teen can be stressful, frustrating, and even exhausting at times. Making self-care a priority will enhance your ability to help your struggling teen. A few things you can do include:
- Surround yourself with support
- Make time for yourself, even if it’s just a few minutes a day
- Learn to manage your stress in a healthy way
- Get adequate sleep (sleep-deprivation makes everything more challenging)
Fortunately, specific phobias often respond well to proper treatment. But even if your teen is facing additional challenges, your support, love, and guidance will help increase the odds of a successful recovery!