In a community mental health survey in India, 250 patients with primary anxiety disorders were screened. Among those with specific phobias (n=60), the most common phobic stimulus was identified. Which is the most common type of specific phobia?

Explanation

## Most Common Type of Specific Phobia **Key Point:** Animal phobia is the most common subtype of specific phobia, accounting for approximately 40–50% of all specific phobia cases globally and in Indian populations. ### Classification of Specific Phobias by Type | Phobia Type | Common Examples | Prevalence | Key Features | |-------------|-----------------|-----------|---------------| | **Animal** | Dogs, snakes, spiders, insects | 40–50% (most common) | Evolutionary preparedness; childhood onset | | **Natural environment** | Heights, water, storms, thunder | 15–20% | Often develops after traumatic exposure | | **Blood-injury-injection** | Blood, needles, medical procedures | 10–15% | Unique vasovagal response; fainting common | | **Situational** | Flying, driving, enclosed spaces | 10–15% | Often develops in adulthood; agoraphobia-like | | **Other** | Choking, vomiting, dental work | 5–10% | Heterogeneous group | **High-Yield:** In the Indian context, **snake phobia** is particularly prevalent due to cultural and environmental factors (high incidence of snake encounters in rural areas). This falls under the animal phobia category. ### Why Animal Phobia is Most Common 1. **Evolutionary preparedness:** Humans are biologically predisposed to fear animals that posed ancestral threats (snakes, spiders, large predators) 2. **Early onset:** Often develops in childhood (mean age 7–8 years) 3. **Observational learning:** Children learn fear from parental modeling or peer reactions 4. **Environmental exposure:** Animals are ubiquitous in the environment, making conditioning more likely **Clinical Pearl:** Animal phobias typically have **better prognosis** than situational phobias. They respond well to exposure therapy and often show spontaneous remission if avoidance is not reinforced. ### Distinguishing Features of Each Subtype **Animal phobia:** - Triggered by specific animals (dogs, snakes, spiders) - Childhood onset typical - Avoidance is often feasible - Good response to exposure therapy **Blood-injury-injection phobia:** - Unique **biphasic vasovagal response** (initial tachycardia → sudden bradycardia and hypotension → fainting) - Often runs in families - Avoidance of medical care can be dangerous **Situational phobia:** - Triggered by specific situations (flying, driving, elevators) - Often adult onset (after a traumatic event) - Can severely impair functioning and occupational capacity **Natural environment phobia:** - Triggered by natural phenomena (heights, water, storms) - Often develops after a frightening experience - May overlap with panic disorder symptoms **Mnemonic: AINS** — **A**nimal (most common) **I**njection-blood **N**atural environment **S**ituational