Skip to main content
SpringerLink
Log in

Phobia: prevalence and risk factors

  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Summary

This article is the presentation of the main phobia data from the Epidemiologic Catchment Area (ECA) program, with a sample size ofn=18,571. Work on this article was initiated in 1981 at the beginning of the ECA study, but publication has been delayed a decade. Phobias are determined from information from the Diagnostic Interview Schedule (DIS), classified according to DSM III. Phobias are found to be the most common psychiatric disorder in the community, more common than major depression or alcohol abuse or dependence in the month prior to interview. The one month prevalence is between 4.0 and 11.1%, with the estimated prevalence in the United States being 6.2%. There were nine community surveys of the prevalence of phobia that pre-dated the ECA studies, which found a wide range of prevalence rates from 1.2% to 26.1%. By far the strongest risk factor associated with phobias is the presence of another psychiatric disorder. Prevalence rates of simple phobia and agoraphobia are found in the ECA studies to be significantly higher in women; social phobia, which is less prevalent, has no significant sex difference. The prevalence rates are higher in younger age groups, and in those with low socioeconomic status (SES). The onset of phobias occurs primarily in the childhood or teenage years, and they tend to be chronic conditions. Less than a quarter of phobics receive treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marks IM (1969) Fears and phobias. Academic Press, New York

    Google Scholar 

  2. Mavissakalian M, Barlow DH (eds) (1981) Phobia: psychological and pharmacological treatment. Guilford Press, New York, pp 1–33

    Google Scholar 

  3. DuPont RL (ed) (1982) Phobia: a comprehensive summary of modern treatments. Brunner/Mazel, New York

    Google Scholar 

  4. Chambless DL, Goldstein AJ (ed) (1982) Agoraphobia, multiple perspectives on theory and treatment, Wiley, New York

    Google Scholar 

  5. Sheehan DB (1982) Current concepts in psychiatry: panic attacks and phobias. N Engl J Med 307: 156–158

    Google Scholar 

  6. Klein DF (1982) Medication in the treatment of panic attacks and phobic states. Psychopharmacol Bull 18: 85–90

    Google Scholar 

  7. Marks IM, Gray S, Cohen D, Hill R, Mawson D, Ramm E, Stern RS (1983) Imipramine and brief therapist-aided exposure in agoraphobics having self-exposure homework. Arch Gen Psychiatry 40: 153–162

    Google Scholar 

  8. Marks I (1983) Are there anticompulsive or antiphobic drugs? Review of the evidence. Br J Psychiatry 43: 338–347

    Google Scholar 

  9. Mavissakalian M, Michelson L, Dealy RS (1983) Pharmacological treatment of agoraphobia: imipramine versus imipramine with programmed practice. Br J Psychiatry 143: 348–355

    Google Scholar 

  10. Zitrin CM, Klein DF, Woerner MG (1978) Behavior therapy, supportive psychotherapy, imipramine, and phobias. Arch Gen Psychiatry 35: 307–316

    Google Scholar 

  11. Sheehan DV, Ballenger J, Jacobsen G (1980) Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Arch Gen Psychiatry 37: 51–59

    Google Scholar 

  12. Sheehan DV, Sheehan KH (1982) The classification of anxiety and hysterical states: part 1, historical review and empirical delineation. J Clin Psychopharmacol 2: 235–244

    Google Scholar 

  13. Sheehan DV, Sheehan KH (1982) The classification of anxiety and hysterical states: part 2, toward a more heuristic classification. J Clin Psychopharmacol 2: 386–393

    Google Scholar 

  14. Zitrin CM, Klein DF, Woerner MG, Ross DC (1983) Treatment of phobias: 1. comparison of imipramine hydrochloride and placebo. Arch Gen Psychiatry 40: 125–138

    Google Scholar 

  15. Klein DF, Zitrin CM, Woerner MG, Ross DC (1983) Treatment of phobias: 2. Behavior therapy and supportive psychotherapy: are there any specific ingredients? Arch Gen Psychiatry 40: 139–145

    Google Scholar 

  16. Langner TS, Michael ST (1963) Life stress and mental health. Free Press of Glencoe, London, p. 407, Table 15-2

    Google Scholar 

  17. Agras S, Sylvester D, Oliveau D (1969) The epidemiology of common fears and phobia. Compr Psychiatry 10: 151–156

    Google Scholar 

  18. Warheit GJ, Schwab JJ, Holzer III CE, Nadean SE (1973) New data from the south on race, sex age & mental illness. Presented at the annual meeting of the American Sociological Association, Aug. 28–30, New York, NY

  19. Warheit GJ (Personal written communication April 1984)

  20. Williams BL (1976) The epidemiology of common fears and diffuse phobias: sociodemographic analysis. Dissertation Abstract International: Section A, 36: 5565-A (Order No. 76-4284)

    Google Scholar 

  21. Weissman MM, Myers JK, Harding PS (1978) Psychiatric disorders in a US urban population: 1975–76. Am J Psychiatry 135: 459–462

    Google Scholar 

  22. Costello CG (1982) Fears and phobias in women: a community study. J Abnorm Psychol 91: 280–286

    Google Scholar 

  23. Uhlenhuth EH, Balter MB, Mellinger GD, Cisin IH, Clinthorne J (1983) Symptom checklist syndromes in the general population. Arch Gen Psychiatry 40: 1167–1173

    Google Scholar 

  24. Myers JK, Weissman MM, Tischler GL, Holzer III CE, Leaf PJ, Orvaschel H, Anthony JC, Boyd JH, Burke JD, Kramer M, Stolzman R (1984) Six-month prevalence of psychiatric disorders in three communities: 1980–82. Arch Gen Psychiatry 41: 959–967

    Google Scholar 

  25. Binder J, Dobler-Mikola A, Angst J (1981) An epidemiological study of minor psychiatric disturbances: a field study among 20-year-old females and males in Zurich. Soc Psychiatry 16: 31–41

    Google Scholar 

  26. Regier DA, Boyd JH, Burke JD Jr, Rae DS, Myers JK, Kramer M, Robins LN, George LK, Karno M, Locke BZ (1988) Onemonth prevalence of mental disorders in the United States. Arch Gen Psychiatry 45: 977–986

    Google Scholar 

  27. Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WE, Locke BZ (1984) The NIMH Epidemiologic Catchment Area Program: historical context, major objectives, and study population characteristics. Arch Gen Psychiatry 41: 934–941

    Google Scholar 

  28. Eaton WW, Holzer CE, Vonkorff M, Anthony JC, Helzer JF, George L, Burnam MA, Boyd JH, Kessler LG, Locke BZ (1984) The design of the ECA surveys: the control and measurement of error. Arch Gen Psychiatry 41: 942–948

    Google Scholar 

  29. Bourdon KH, Boyd JH, Rae DS, Burns BJ, Thompson JW, Locke BZ (1988) Gender differences in phobias-results of the ECA community survey. J Anxiety Disord 2: 227–241

    Google Scholar 

  30. Thompson JW, Burns BJ, Bartko J, Boyd JH, Taube CA, Bourdon KH (1988) The use of ambulatory services by persons with and without phobia. Med Care 26: 183–198

    Google Scholar 

  31. Sartorius N (1980) Epidemiology of anxiety. Pharmakopsychiatr Neuropsychopharmacol 13: 249–253

    Google Scholar 

  32. Weissman MM, Myers JH, Thompson WD (1981) Depression and its treatment in a US urban community-1975–1976. Arch Gen Psychiatry 38: 417–421

    Google Scholar 

  33. Shapiro S, Skinner EA, Kessler LG, VonKorff M, German PS, Tischler GL, Leaf PJ, Benham L, Cottler L, Regier DA (1984) Utilization of health and mental health services, three epidemiologic catchment area sites. Arch Gen Psychiatry 41: 971–978

    Google Scholar 

  34. Marks IM, Herst ER (1970) A survey of 1,200 agoraphobics in Britain: features associated with treatment and ability to work. Soc Psychiatry 5: 16–24

    Google Scholar 

  35. Diagnostic and Statistical Manual, 3rd edn (1980) American Psychiatric Association, Washington D. C., pp 225–232

  36. Robins LN, Helzer JE, Croughan J, Williams JBW, Spitzer RL (1981) NIMH Diagnostic Interview Schedule, Version III. University School of Medicine, St. Louis

    Google Scholar 

  37. Robins LN, Helzer JE, Croughan J, Ratcliff KS (1981) National Institute of Mental Health Diagnostic Interview Schedule, its history, characteristics, and validity. Arch Gen Psychiatry 38: 381–389

    Google Scholar 

  38. Boyd JH, Robins LN, Holzer CE, VonKorff M, Jordan KB, Escobar JI (1985) Making diagnoses from DIS data. In: EAton WW, Kessler LG (eds) Epidemiologic field methods in psychiatry; the NIMH Epidemiologic Catchment Area Program. Academic Press, New York

    Google Scholar 

  39. Robins LN, Helzer JE, Ratcliff KS, Seyfriend W (1982) Validity of the Diagnostic Interview Schedule, Version II: DSM III diagnoses. Psychol Med 12: 855–870

    Google Scholar 

  40. Hesselbrock V, Stabenau J, Hesselbrock M, Mirkin P, Meyer R (1982) A comparison of two interview schedules: the Schedule for Affective Disorders and Schizophrenia-Lifetime and the National Institute of Mental Health Diagnostic Interview Schedule. Arch Gen Psychiatry 39: 674–677

    Google Scholar 

  41. Wittchen HU, Semler G, VonZerssen D (1985) A comparison of two diagnostic methods: clinical ICD diagnoses vs. DSM III and Research Diagnostic Criteria using the Diagnostic Interview Schedule (Version 2). Arch Gen Psychiatry 42: 677–684

    Google Scholar 

  42. Burnam MA, Karno M, Hough RL, Escobar JI, Forsythe AB (1983) The Spanish Diagnostic Interview Schedule: reliability and comparison with clinical diagnoses. Arch Gen Psychiatry 40: 1189–1196

    Google Scholar 

  43. Anthony JC, Folstein M, Romanoski AJ, VonKorff MR, Nestadt GN, Chahal R, Merchant A, Brown CH, Shapiro S, Kramer M, Gruenberg EM (1985) Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis: experience in Eastern Baltimore. Arch Gen Psychiatry 42: 667–675

    Google Scholar 

  44. Shah BV (1981) SESUDAAN: Standard Errors Program for Computing of Standardized Rates from Sample Survey Data. Research Triangle Institute, Research Triangle, NC

    Google Scholar 

  45. Shah BV, Folsom RE, Harrell FE, Dillard CN (1984) Survey Data Analysis Software for Logistic Regression. Research Triangle Institute, Research Triangle, NC

    Google Scholar 

  46. SAS Institute, Inc. (1986) SUGI Supplemental Library User's Guide, 5th edn. SAS Institute, Cary, NC, pp 269–293

    Google Scholar 

  47. Shah BV (1988) RTILOGIT. Research Triangle Institute, Research Triangle, NC

    Google Scholar 

  48. Nam CB, Powers MG (1965) Variations in socioeconomic structure by race, residence, and life cycle. Am Soc Rev 30: 97–103

    Google Scholar 

  49. Nam CB, Powers MG (1968) Changes in the relative status of workers in the United States, 1950–1960, Soc Forces 48: 158–177

    Google Scholar 

  50. Powers MG, Holmberg JJ (1978) Occupational status scores: changes introduced by the inclusion of women. Demography 15: 183–204

    Google Scholar 

  51. Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ (1988) Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. Am J Psychiatry 145: 971–975

    Google Scholar 

  52. Angst J, Dobler-Mikola A, Scheidegger P (1982) A panel study of anxiety states, panic attacks, and phobia among young adults. Paper read at the Research Conference on Anxiety Disorders, Panic Attacks, and Phobia, Key Biscayne, Fla., December 9

  53. Regier DA, Hirschfeld RMA, Goodwin FK, Burke JD Jr, Lazar JB, Judd LL (1988) the NIMH Depression Awareness, Recognition, and Treatment Program — structure, aims, and scientific basis. Am J Psychiatry 145: 1351–1357

    Google Scholar 

  54. Sheehan DV, Sheehan KE, Minichiello WE (1981) Age of onset of phobic disorders: a reevaluation. Compr Psychiatry 22: 544–553

    Google Scholar 

  55. Mendel JGC, Klein DF (1969) Anxiety attacks with subsequent agoraphobia. Compr Psychiatry 10: 190–195

    Google Scholar 

  56. Marks IM, Herst ER (1970) A survey of 1,200 agoraphobics in Britain—features associated with treatment and ability to work. Soc Psychiatry 5: 16–24

    Google Scholar 

  57. Marks IM, Gelder MG (1966) Different ages of onset in varieties of phobias. Am J Psychiatry 123: 218–221

    Google Scholar 

  58. Burns LE, Thorpe GL (1977) Fears and phobias: epidemiological aspects and the national survey of agoraphobics J Int Med Res 5: (Suppl) 132–139

    Google Scholar 

  59. Murphy GE (1982) The clinical management of hysteria. JAMA 247: 2559–2564

    Google Scholar 

  60. Smith GR, Jr, Monson RA, Ray DC (1986) Psychiatric consultation in somatization disorder—a randomized controlled study. N Engl J Med 314: 1407–1413

    Google Scholar 

  61. Barsky AJ, Klerman GL (1983) Overview—Hypochondriasis, bodily complaints and somatic styles. Am J Psychiatry 140: 273–283

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Clinical Research, National Institute of Mental Health, Room 10-C-09 Parklawn Building 5600 Fishers Lane, 20857, Rockville, MD, USA

    J. H. Boyd, D. S. Rae, K. Bourdon, B. Z. Locke & D. A. Regier

  2. Division of Biometry and Applied Science, National Institute of Mental Health, Room 10-C-09 Parklawn Building 5600 Fishers Lane, 20857, Rockville, MD, USA

    J. W. Thompson & B. J. Burns

Authors
  1. J. H. Boyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. S. Rae
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. W. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. J. Burns
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Bourdon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Z. Locke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. A. Regier
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boyd, J.H., Rae, D.S., Thompson, J.W. et al. Phobia: prevalence and risk factors. Soc Psychiatry Psychiatr Epidemiol 25, 314–323 (1990). https://doi.org/10.1007/BF00782887

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00782887

Keywords

Search

Navigation