Curing Phobias, Shyness and Obsessive Compulsive Disorders - by Doctor Howard Liebgold, aka Dr. Fear

The Phobia List Class Categories

Psychiatry identifies three different categories of phobias (DSM-IV,1994):

(with panic attacks): 300.21
(without panic attacks): 300.01
Irrational anxiety about being in places from which escape might be difficult or embarrassing.

Social phobia: 300.23
Irrational anxiety elicited by exposure to certain types of social or performance situations, also leading to avoidance behavior.

Specific phobia: 300.29
Persistent and irrational fear in the presence of some specific stimulus which commonly elicits avoidance of that stimulus, i.e., withdrawal.

By definition, phobias are IRRATIONAL, meaning that they interfere with one's everyday life or daily routine. For example, if your fear of high places prevents you from crossing necessary bridges to get to work, that fear is irrational. If your fears keep you from enjoying life or even preoccupy your thinking so that you are unable to work, or sleep, or do the things you wish to do, then it becomes irrational.

One key to diagnosing a phobic disorder is that the fear must be excessive and disproportionate to the situation. Most people who fear heights would not avoid visiting a friend who lived on the top floor of a tall building; a person with a phobia of heights would, however. Fear alone does not distinguish a phobia; both fear and avoidance must be evident. (Lefton, L. A., 1997)

The Freudians speculate that as young children agoraphobics may have feared abandonment by a cold or nonnurturing mother and the fear has generalized to a fear of abandonment or helplessness. By contrast, modern learning theory suggests that agoraphobia may develop because people avoid situations they have found painful or embarrassing. Also, failed coping strategies and low self-esteem have been implicated (Williams, Kinney, & Falbo, 1989). Other research (Ost & Hugdahl, 1981) suggests that almost half of all people with phobias have never had a painful experience with the object they fear. Perhaps we hear that someone has been injured by a snake, for example, and we become afraid too. Almost no one is afraid of cars, even though almost everyone has experienced or witnessed a car accident in which someone got injured. As Martin Seligman (1971) put it, people may be inherently "prepared" to learn certain phobias. For millions of years people who quickly learned to avoid snakes, heights, and lightning probably have had a good chance to survive and to transmit their genes. We have not had enough time to evolve a tendency to fear cars and guns.

Another possible explanation is that people generally develop phobias for objects they cannot predict or control. Danger is more stressful when it takes us by surprise (Mineka, 1985; Mineka, Cook, & Miller, 1984). Lightning is unpredictable and uncontrollable. In contrast, you don't have to worry that electric outlets will take you by surprise, so it's not likely that you'll have an "electric outlet phobia."

Humans seem biologically prepared to acquire fears of certain animals and situations that were important survival threats in evolutionary history (Seligman, 1971, McNally, 1987). People also seem predisposed to develop phobias toward creatures that arouse disgust, like slugs, maggots, rats, or cockroaches (Webb & Davey, 1993).

Neuroscientists are finding that biological factors, such as greater blood flow and metabolism in the right side of the brain than in the left hemisphere, may also be involved in phobias. Identical twins reared apart sometimes develop the same phobias; one pair independently becoming claustrophobic, for example (Eckert, Heston, & Bouchard, 1981).

There may be other reasons why some phobias are more common than others. One is that we have many safe experiences with cars and tools to outweigh any bad experiences. We have few safe experiences with snakes or spiders or with falling from high places (Kleinknecht, 1982). Cross-cultural psychologists point out that phobias are influenced by cultural factors. Agoraphobia, for example, is much more common in the United States and Europe than in other areas of the world (Kleinman, 1988). A social phobia common in Japan but almost nonexistent in the West is taijin kyofusho, an incapacitating fear of offending or harming others through one's own awkward social behavior or imagined physical defect (Kirmayer, 1991). The focus of cognition for a sufferer of this phobia is on the harm to others, not on embarrassment to the self as in social phobias in the West. Taijin kyofusho is described by Japanese psychiatrists as a pathological exaggeration of the modesty and sensitive regard for others that, at lower levels, is considered proper in Japan (Gray, 1994).

Most psychologists believe that people with panic disorder develop their social phobia or agoraphobia because they are afraid of being incapacitated or embarrassed by a panic attack in a public place. In a sense, they are afraid of their own fear (McNally, 1990).


American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.) (DSM-IV). Washington, DC: Author.

Eckert, E. D., Heston, L. L., & Bouchard, T. J. (1981). MZ twins reared apart. Preliminary findings of psychiatric disturbances and trait. In L. Gedda, P. Paris, & W. D. Nance (Eds.) Twin research (Vol. 1). New York: Alan Liss.

Gray, P. (1994) Psychology, 2nd ed. New York: Worth.

Kirmayer, L. J. (1991). The place of culture in psychiatric nosology: Taijin kyofusho and DSM-III-R. The Journal of Nervous and Mental Disease, 179, 19-28.

Kleinknecht, R. A. (1982). The origins and remission of fear in a group of tarantula enthusiasts. Behaviour Research & Therapy, 20, 437-443.

Kleinman, A. (1988). Rethinking psychiatry. New York: Macmillian.

Lefton, L.A. (1997) Psychology, 6th ed. Boston: Allyn & Bacon.

McNally, R. J. (1987). Preparedness and phobias: A review. Psychological Bulletin, 101, 283-303.

McNally, R. J. (1990). Psychological approaches to panic disorder: A review. Psychological Bulletin, 108, 403-419.

Mineka, S. (1985). The frightful complexity of the origin of fears. In F.R. Brush & J. B. Overmier (Eds.), Theoretical foundations of behavior therapy (pp. 81-111). New York: Plenum.

Mineka, S., Cook, M., & Miller, S. (1984). Fear conditioned with escapable and inescapable shock: The effects of a feedback stimulus. Journal of Experimental Psychology: Animal Behavior Processes, 10, 307-323.

Ost, L.-G. & Hugdahl, K. (1981). Acquisition of phobias and anxiety response patterns in clinical patients. Behaviour Research and Therapy, 19, 439-447.

Seligman, Martin E. P. (1971). Phobias and preparedness. Behavior Therapy, 2, 307-320.

Webb, K., & Davey, Graham C. L. (1993). Disgust sensitivity and fear of animals: Effect of exposure to violent or revulsive material. Anxiety, Coping and Stress, 5 329-335.

Williams, S. L., Kinney, P.J., & Falbo, J. (1989). Generalization of therapeutic changes in agoraphobia: The role of perceived self-efficacy. Journal of Consulting and Clinical Psychology, 57, 436-442.

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© 1997 Robert Rainey