Conditions + Treatments

Phobias Symptoms & Causes

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Many kids (and adults, too) are afraid of the same things that children with phobias fear. But the difference between a “normal” fear and a phobia is the degree of anxiety involved, and the length of time that a high level of anxiety persists. A child with a phobia has a high level of anxiety and dread—and even abject terror—when he comes into contact with the object of their phobia. If a child has a phobia, he experiences this level of fear for a period of six months or more.

What is a phobia?
A phobia is an extreme fear of something specific, such as:

  • a person or type of person
  • an animal or insect
  • an object
  • a place or type of place
  • a situation

Phobias create feelings of fear so intense that they disrupt the child’s daily life and routine.  They go far beyond the ordinary fears of childhood,and do not subside even with reassurance from parents or other caregivers.

Some common phobias in children include:

  • animals
  • blood
  • the dark
  • enclosed spaces
  • flying
  • getting sick
  • having a parent, sibling, or pet get sick or hurt
  • heights
  • insects and spiders
  • needles (“getting shots” at the doctor’s office)
  • thunder and lightning

Many kids struggle with a specific fear of being physically separated from their parents or other family members. This is known as separation anxiety disorder (SAD).

Children with phobias might worry about the same subjects as children who don’t have an anxiety disorder. The difference is that for a phobic child, there is no “on-off” switch for the fear: It’s ever-present and so extreme that it interferes with her ability to relax, concentrate and enjoy activities.

Causes

What causes a phobia?
A phobia is a type of anxiety disorder, a condition that activates the “fight or flight” response and creates feelings of imminent danger that are out of proportion to the reality of the situation. Kids can develop anxiety disorders for many reasons, including:

  • biological factors: The brain has special chemicals, called neurotransmitters, that send messages back and forth to control the way a person feels. Serotonin and dopamine are two important neurotransmitters that, when “out of whack,” can cause feelings of anxiety.
     
  • family factors: Anxiety and fear can be inherited. Just as a child can inherit a parent’s brown hair, green eyes and nearsightedness, a child can also inherit that parent’s tendency toward excessive anxiety. In addition, anxiety may be learned from family members and others who are noticeably stressed or anxious around a child. For example, a child whose parent shows immense fear of spiders may learn to fear spiders, too.
     
  • environmental factors: A traumatic experience (such as a divorce, illness or death in the family) or even just a major life event like the start of a new school year may also trigger the onset of an anxiety disorder.

Types

What types of phobias do children experience?
Children may experience specific phobia, panic disorder (with or without agoraphobia) or social phobia.

Specific phobia
A child with specific phobia feels and exhibits intense fear of a particular person or type of person, place, object, activity, or situation.

Panic disorder
Panic disorder
can develop at any age, though it most often emerges in adolescence or young adulthood. This disorder causes unexpected, unpredictable periods of intense fear and anxiety, often in response to “triggers” that may not be readily apparent.

Agoraphobia
Some children and adolescents experience panic disorder combined with agoraphobia, an intense fear of the outside world. In these cases, children are so terrified of encountering or experiencing the object of their fear that they feel unsafe anywhere but at home, and will resist venturing out for any reason.

Social phobia, also known as social anxiety disorder, is rare, estimated to occur in only 1.4 percent of children and adolescents. Symptoms typically emerge during early adolescence, but can develop in younger children, as well.

Children with social phobia experience intense fear of one or more social or performance situations. While specific fears may vary, at the root of any case of social phobia is the child’s overwhelming dread of being humiliated.

Here are some Q & A about social phobia with Joseph Gonzalez-Heydrich, MD, chief of Boston Children's Hospital's Psychopharmacology Clinic:

What are the typical features of social anxiety disorder?
Those with social anxiety disorders have an intense and persistent fear of situations in which they're exposed to unfamiliar people or scrutiny. In social situations, they're afraid that people are looking at them, and overestimate the chances that people are going to reject them or that they're going to be embarrassed. Exposure to these situations provokes anxiety responses like panic, freezing, blushing, tantrums, crying and clinging. People with social anxiety disorder tend to avoid these situations for obvious reasons. Over time, this gets in the way of social development and can become a real cost to them in terms of education, family functioning, employment and overall happiness.

How are children affected by social anxiety disorder?
The rate in children is thought to be 0.5 percent to 4 percent. In adolescents, it may be as high as 7 percent. It's not known why certain children are affected, but it's thought that it may be hereditary. Parents with panic disorder, for example, have a higher rate of children who have social anxiety disorder.

Read more.

Signs and symptoms 

What are the symptoms of a specific phobia?
Symptoms of specific phobia can include any or all of the following:

  • avoiding the object of the phobia
  • fearfully anticipating an encounter or experience with the phobic object
  • enduring an encounter or experience with the phobic object while feeling such a high level of anxiety that the child’s normal routines and activities are significantly disrupted

What are the symptoms of panic disorder?
The extreme fear and anxiety caused by panic disorder can manifest in such physical symptoms as:

  • increased heart rate
  • sweating
  • trembling or shaking
  • shortness of breath
  • a “choking” feeling
  • chest pain or discomfort
  • upset stomach
  • feeling dizzy or faint
  • a feeling of losing control or “going crazy”
  • an “I’m going to die” feeling
  • numbness
  • chills or hot flashes 

Experiencing four or more of these symptoms in a single episode is referred to as a panic attack. While panic attack symptoms can last for several hours at a time, they usually peak and then subside after 10 minutes.

What are the symptoms of agoraphobia?
Children with agoraphobia will resist or outright refuse to leave home (or another place deemed “safe”) for any reason.

What are the symptoms of social phobia?
Children with social phobia experience intense fear of one or more social or performance situations, including:

  • being introduced to new people (whether peers or authority figures like teachers)
  • interacting at parties or other gatherings
  • giving a speech or presentation in front of the class
  • asking questions in class
  • being onstage for a school play or recital
  • going out to eat at a restaurant
  • using a public restroom when others are around
  • talking on the phone

While specific fears may vary, at the root of any case of social phobia is the child’s overwhelming dread of being humiliated. Children with social phobia:

  • feel extreme levels of anxiety while anticipating or experiencing a situation that may cause them embarrassment

  • usually will seek to avoid potentially embarrassing situations at any cost

  • often resort to drastic measures to avoid or escape these situations (for example, refusing to go to school on the day of a book report or feigning illness when invited to a social gathering)

FAQ

Q: How common are phobias in children?
A: Up to 9.2 percent of children and adolescents are believed to experience some type of phobia.

Q: How can I tell if my child is experiencing a phobia or just going through a phase?
A: It’s important to distinguish phobias from normal childhood fears, also known as transient fears, which are temporary. 

Nearly all infants and toddlers go through phases of one or more of the following at some point:

  • demonstrating anxiety around strangers or in unfamiliar settings 
  • clinging to parents when introduced to new people
  • becoming emotionally distressed when separated from a parent

Many kids struggle with a specific fear of being physically separated from their parents or other family members. This is known as separation anxiety disorder (SAD).            

Similarly, most older children go through periods of fearing and worrying about:

  • imaginary things, such as ghosts and monsters
  • getting sick, hurt or dying
  • having a parent, sibling, or pet get sick, get hurt or die
  • thunderstorms, fires and other natural disasters

However, your child may be suffering from a phobia, and not a transient fear, if she:

  • experiences a particular fear for six months or longer
  • feels such an extreme degree of fear and anxiety that daily activities, school life, family relationships and friendships are disrupted

Q: How can I tell if my child is suffering from social phobia, or is just shy?
A: A shy child may feel uneasy when meeting new people or getting up in front of the class, but won’t take extreme measures to avoid these situations and won’t experience significant disruptions in their day-to-day lives. 

By contrast, a child with social phobia has a degree of fear and anxiety so severe that it:

  • limits or otherwise interferes with daily activities
  • affects family relationships
  • damages or impedes friendships
  • impacts ability to function at school

Q: Can I prevent my child from developing a phobia?
A: There’s no known way to prevent phobias. However, you can make a significant difference for your child by being proactive and seeking the help of a trained clinician at the first sign of symptoms. The sooner you seek professional treatment, the better your child’s chances of successfully overcoming the phobia.

Here's some advice from Gary Gosselin, MD, medical director of the Psychiatry Inpatient Service at Children's:

"The signs of anxiety in a child can be difficult to pinpoint because all children should have a certain amount of normal anxiety. Beyond basic fears of the dark or strangers, younger children are exquisitely sensitive to their caregivers and environments. A child’s danger warning circuits signal them when things are unsafe. For example, the distress call of “Ma!” by the toddler unable to locate their mother quickly in an unfamiliar situation.

Absence of caregivers, neglect of basic emotional and physical needs and exposure to other stressful environments can push a child’s anxiety response too far. This is not to say that a child from a perfectly happy environment is immune to anxiety. In anxiety disorders, warning circuits in the brain can be too sensitive, causing worry or fear responses in safe situations.

There are signs of anxiety difficulties that parents can notice when a child’s fears seem out of proportion to reality and begin to interfere with life. Do they interfere with your child’s ability to go to bed, get in the car or go to school? Is anxiety consistently undercutting your child’s ability to function in social settings? School work and the social aspects of school can cause anxiety, especially when a child is being bullied." Read more.

Q: What is the long-term outlook for a child with a phobia?
A: Your child may continue to have some symptoms of fear and anxiety and have difficulty with treatment at times—but the majority of children with phobias see substantial improvement when treated with talk therapy or a combination of therapy and medication. By closely working with the treatment team, you can help your child go on to enjoy a fulfilling family, school and community life.

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- Sandra L. Fenwick, President and CEO

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