Why Isn’t Specific Phobia Sexy?

Specific phobia is the most common mental disorder in adolescents, and yet it is greatly overlooked by both clinicians and researchers. This condition is likely overlooked by clinicians because it is rarely patients’ primary motive for consultation and may be considered inconsequential given that the distress that it causes is circumscribed to specific objects or situations that can often (but not always) be avoided. In children and adolescents in particular, clinicians may find it difficult to differentiate specific phobia from normal and adaptive fear, and parents and clinicians may believe that young patients will simply grow out of these fears.

Researchers appear to share the same disinterest in the disorder. Boschen reported publication trends in the study of individual anxiety disorders over the past 25 years. Results showed growth in the number of publications for all individual anxiety disorders except specific phobia and agoraphobia. The little research that exists, however, suggests that specific phobia can have high comorbidity with other disorders, a chronic course, and serious impairment in different areas of life.

Because of this paradox of high prevalence but low treatment-seeking and professional interest in the disorder, we thought it was important to address whether clinicians and researchers should be concerned about specific phobia in adolescence, and, if so, why. In a recent study with colleagues, we used data from the Mexican Adolescent Mental Health Survey prospective cohort to evaluate 3 topics:

• The persistence of specific phobia in an 8-year period from adolescence to young adulthood (in other words, do they simply grow out of it?)
• Predictors of persistence (can we identify who will not grow out of it?)
• Other mental health outcomes related to adolescent specific phobia (what is the future impact of having specific phobia?)

While we found that persistence of specific phobia from adolescence to adulthood is low (17%), there are reasons to be concerned about specific phobia in adolescence. First, specific phobia in adolescence increased the risk for developing a substance use disorder and other anxiety disorders in early adulthood regardless of whether the specific phobia persisted. Second, adolescent-onset specific phobia was more likely to be persistent than childhood-onset specific phobia. Previous research has found that adolescents have attenuated fear-extinction learning compared with children and adults, meaning that they may benefit less from exposure-based treatment (the only evidence-based treatment for specific phobia). These findings suggest that (1) clinicians should treat children with specific phobia before they reach adolescence when it will be more difficult to treat, and (2) researchers should investigate new therapeutic techniques, specifically developed for adolescents, that do not rely on extinction principles. Whether treating specific phobia in adolescence can prevent or diminish the increased risk for future substance use disorders and other anxiety disorders is unknown but a relevant research avenue to pursue.

Finally, our study indicated that we can predict who is more likely to have a persistent course of the disorder by not only age at onset but also whether patients have a family member with specific phobia or have experienced neglect and economic hardship.

So, should professionals be concerned about a highly prevalent disorder that is seemingly transitory in youth? The answer is yes.

Financial disclosure:Dr Benjet and Ms Albor have no relevant personal financial relationships to report.