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The cross-national epidemiology of specific phobia in the World Mental Health Surveys
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Background: Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries. Method: Data came from 25 representative population-based surveys conducted in 22 countries (2001–2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview. Results: The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3–21.9% across income groups) and 23.1% reported any treatment (9.6–30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes. Conclusions: Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.
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“However, most patients with specific phobias, including AP, do not seek treatment for this condition [9], possibly owing to fears about what treatment will involve [10].”
From Virtual reality exposure therapy for fear of spiders: an open trial and feasibility study of a new treatment for arachnophobia (2024) · cites this paper as [9]
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“Second, though patient characteristics match many of the typical BII phobia demographic criteria (10, 12, 29, 32), severity was very high and combined with probable panic-triggered PNES.”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [12]
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“Compared to other specific phobias, FP presents the highest rates of treatment-seeking (Wardenaar et al., 2017), which makes it clear that there is a need for well-established evidence-based treatments for this problem.”
From An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study (2021) · cites this paper as Wardenaar et al., 2017
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Community aquatic therapy for Parkinson’s disease: an international qualitative study
Carroll, L. M., Morris, M. E., O'Connor, W. T., & Clifford, A. M. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1906959 · Cited by 15
Electrophysiological correlates of in vivo and virtual reality exposure therapy in spider phobia
Wiens, S., Eklund, R., Szychowska, M., Miloff, A., Cosme, D., Pierzchajlo, S., & Carlbring, P. (2022) · Psychophysiology · doi:10.1111/psyp.14117 · Cited by 16
Domain Adaptation for Fear of Heights Classification in a VR Environment Based on EEG and ECG
Apicella, A., Arpaïa, P., Barbato, S., D’Errico, G., Mastrati, G., Moccaldi, N., Vallefuoco, E., & Wriessnegger, S. C. (2024) · Information Systems Frontiers · doi:10.1007/s10796-024-10484-z · Cited by 16
Ausín, B., Muñoz, M., Castellanos, M. Á., & García, S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17061915 · Cited by 14
“The restricted lifestyle resulting from fear and avoidance in specific phobia is likely to contribute to functional impairment [31].”
BackgroundInfluentialMor, S., Grimaldos, J., Tur, C., Miguel, C., Cuijpers, P. J., Botella, C., & Quero, S. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100462 · Cited by 18
Wannemueller, A., Gruszka, P., Chwalek, S., Fröhlich, S., Mulders, M., Schaumburg, S., Schöttes, J., Wiederhold, S., & Margraf, J. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02411 · Cited by 13
An exploration of the nomological network of trypophobia
Mayor, E., Meyer, A. H., Miani, A., & Lieb, R. (2021) · PLoS ONE · doi:10.1371/journal.pone.0257409 · Cited by 13
“Most individuals in this support group reported suffering from mild to severe psychological distress and impairment [14], which is higher than what was found in individuals with specific phobias [15].”
ResultLandová, E., Rádlová, S., Pidnebesna, A., Tomeček, D., Janovcová, M., Peléšková, Š., Sedláčková, K., Štolhoferová, I., Polák, J., Hlinka, J., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1196785 · Cited by 13
A review of the phenomenology, aetiology and treatment of animal phobia and insights for biophobia
Norberg, M. M., Visvalingam, S., Stevenson, R. J., & Saluja, S. (2023) · People and Nature · doi:10.1002/pan3.10514 · Cited by 15
Hilbert, K., Boeken, O., Langhammer, T., Groenewold, N., Bas-Hoogendam, J., Aghajani, M., Zugman, A., Åhs, F., Arolt, V., Beesdo-Baum, K., et al. (2024) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20230032 · Cited by 12
“Three further preregistered analyses examined dimensional associations by using phobia severity, trait anxiety, and depression severity as variables of interest (hypotheses 3 and 4).”
Augmented reality exposure treatments in anxiety and related disorders: A systematic review
Grimaldos, J., Fernández-Buendía, S., Bretón-López, J., Miguel, C., Cuijpers, P., & Quero, S. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100812 · Cited by 12
“This result is consistent with the fact that specific phobias are one of the most prevalent anxiety disorders (Wardenaar et al., 2017), which may have driven greater research focus in this area compared to other anxiety disorders.”
Snakes vs. Guns: a Systematic Review of Comparisons Between Phylogenetic and Ontogenetic Threats
Shapouri, S., & Martin, L. L. (2021) · Adaptive Human Behavior and Physiology · doi:10.1007/s40750-021-00181-5 · Cited by 16
“While animals are not the most important threat to our survival in the modern world, animal phobia is the most prevalent subtype of specific phobias worldwide (Wardenaar et al., 2017).”
Backgroundde Vries, Y. A., Bos, E. H., Roest, A. M., & de Jonge, P. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_89-1 · Cited by 12
Leuchter, M. K., Rosenberg, B. M., Schapira, G., Wong, N. R., Leuchter, A. F., McGlade, A. L., Krantz, D. E., Ginder, N. D., Lee, J. C., Wilke, S. A., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.823158 · Cited by 10
Investigating the Psychometric Properties of the Severity Measure for Specific Phobia
MacLeod, S., Schneider, L. H., & McCabe, R. E. (2022) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-022-09976-6 · Cited by 15
“Importantly, it has been reported that over 60% of individuals with specific phobia will experience an additional mental health disorder over the course of their life, with the highest rates of comorbidity occurring with other mood and anxiety disorders (Wardenaar et al., 2017).”
BackgroundKiss, B. L., Birkás, B., Zilahi, L., & Zsido, A. N. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e11839 · Cited by 13
“BII phobia is among the most prevalent specific phobias with a lifetime prevalence of approximately 3% (Fredrikson et al., 1996; Wardenaar et al., 2017).”
BackgroundMethodLee, J., Kim, H., Chang, S. M., Hong, J. P., Lee, D. W., Hahm, B., Cho, S., Park, J., Jeon, H. J., Seong, S. J., et al. (2021) · Journal of Korean Medical Science · doi:10.3346/jkms.2021.36.e240 · Cited by 12
Wannemueller, A., Schaumburg, S., Tavenrath, S., Bellmann, A., Ebel, K., Teismann, T., Friedrich, S., & Margraf, J. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103735 · Cited by 12
“though prevalence rates are smaller than those reported for other specific phobias (Wardenaar et al., 2017).”
BackgroundResultWannemueller, A., Fasbender, A., Kampmann, Z., Weiser, K., Schaumburg, S., Velten, J., & Margraf, J. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01534 · Cited by 10
“Moreover, considering the early onset of SPs, its high comorbidity and persistence (Wardenaar et al., 2017) as well as its common harmful consequences, such as more annual work loss days associated with SPs than chronic heart- or lung disease (Alonso et al.”
BackgroundThe role of self-efficacy in specific fears
Lipp, A., Zhang, X. C., Dere, E., & Zlomuzica, A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0283660 · Cited by 10
Behluli, E., Preuer, H. M., Schiefermeier-Mach, N., Hornung, R., Küchler, M., & Prokopetz, M. (2024) · Radiography · doi:10.1016/j.radi.2024.06.021 · Cited by 10
Fear of clowns: An investigation into the prevalence of coulrophobia in an international sample
Tyson, P. J., Davies, S. K., Scorey, S., & Greville, W. J. (2022) · International Journal of Mental Health · doi:10.1080/00207411.2022.2046925 · Cited by 9
“%) as identified by Wardenaar et al. (2017).”
BackgroundResultInfluentialKılıç, C., Yıldız, M. İ., Emekli, E., Gülşen, G., & Alp, A. (2022) · BJPsych Open · doi:10.1192/bjo.2022.603 · Cited by 10
Ribé-Viñes, J. M., Gutiérrez‐Maldonado, J., Zabolipour, Z., & Ferrer‐García, M. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101915 · Cited by 12
de Vries, Y. A., Al-Hamzawi, A., Alonso, J., Andrade, L. H., Benjet, C. L., Bruffaerts, R., Bunting, B., de Girolamo, G., Florescu, S., Gureje, O., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291720004031 · Cited by 10
“The former may be related to the specific disorders present in childhood-onset v. adult-onset classes [e.g. specific phobia, a highly persistent disorder (Wardenaar et al., 2017) v .”
Self-citationThe Burden of Mental Disorders
Eaton, W. W., Bienvenu, O. J., Nestadt, G., Volk, H. E., & Anthony, J. C. (2019) · Oxford University Press eBooks · doi:10.1093/oso/9780190916602.003.0002 · Cited by 9
Interoception and Mental Health
Khalsa, S. S., & Verdonk, C. (2024) · Springer eBooks · doi:10.1007/978-3-031-68521-7_9 · Cited by 9
Jung, J. T. K., Marques, L. S., Brambila, C. A., Fulco, B. C. W., Nogueira, C. W., & Zeni, G. R. (2024) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2024.111021 · Cited by 9
Psychological effects of COVID-19 phobia on industrial consumers: a case study in Turkey
Değirmenci, B., Durmaz, Y., Fidanoğlu, A., & Değirmenci, S. (2022) · Journal of Business and Industrial Marketing · doi:10.1108/jbim-04-2021-0221 · Cited by 10
Mohammadi-Farani, A., Farhangian, S., & Shirooie, S. (2022) · Research in Pharmaceutical Sciences · doi:10.4103/1735-5362.359435 · Cited by 9
“Knowing that PTSD is about three times more prevalent in women than men (17) and considering the role of the amygdalar cholinergic system in controlling the extinction process, we hypothesize that gender variation in amygdalar cholinergic regulation plays a role in the different sexual prevalence of the disease.”
BackgroundPhobia-specific patterns of cognitive emotion regulation strategies
Zsido, A. N., Láng, A., Lábadi, B., & Deák, A. (2023) · Scientific Reports · doi:10.1038/s41598-023-33395-6 · Cited by 12
The cross-national epidemiology of specific phobia in the World Mental Health Surveys – CORRIGENDUM
Wardenaar, K. J., Lim, C. C. W., Al-Hamzawi, A. O., & Alonso, J. (2017) · Psychological Medicine · doi:10.1017/s0033291717002975 · Cited by 9
Self-citationCole, G. G. (2024) · BJPsych Open · doi:10.1192/bjo.2023.621 · Cited by 9
“For example, in a worldwide sample of over 7000 participants with specific phobia, Wardenaar et al 19 found that only 10.3% scored at least seven ( ‘ severe impairment ’ ) on the work subscale of the SDS.”
BackgroundInfluentialMohlman, J., Lauderdale, S. A., & Wuthrich, V. M. (2019) · Clinical Gerontologist · doi:10.1080/07317115.2019.1571554 · Cited by 10
“More recently, epidemiological data from across 22 countries found that lower education and income were associated with increased risk for specific phobias (Wardenaar et al., 2017), while others have shown that lower education specifically predicts Blood-Injury-Injection (B-I-I) Specific Phobia (Bienvenu & Eaton, 1998…”
BackgroundInfluentialFumero, A., Marrero, R. J., Rivero, F., Álvarez‐Pérez, Y., Pérez, J. M. B., Rodríguez, M. G., & Castro, W. P. (2021) · Life · doi:10.3390/life11040275 · Cited by 8
“Females show higher specific phobia lifetime prevalence compared to males [43].”
BackgroundRaeder, F., Merz, C. J., Tegenthoff, M., Dere, E., Wolf, O. T., Margraf, J., Schneider, S., & Zlomuzica, A. (2023) · Psychopharmacology · doi:10.1007/s00213-023-06345-3 · Cited by 8
Zsido, A. N., Inhóf, O., Kiss, B. L., Bali, C., & March, D. S. (2023) · People and Nature · doi:10.1002/pan3.10500 · Cited by 9
Coronaphobia in patients with fibromyalgia
Külekçioğlu, S., AKYÜZ, M. Ö., İnan, Ö., & Çetin, A. (2021) · Archives of Rheumatology · doi:10.46497/archrheumatol.2022.8664 · Cited by 8
An internet-based treatment for flying phobia using 360° images: A feasibility pilot study
Mor, S., Botella, C., Campos, D., Carlbring, P., Tur, C., & Quero, S. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100510 · Cited by 7
Metadata
- Authors
- Wardenaar, K. J., Lim, C. C. W., Al-Hamzawi, A. O., Alonso, J., Andrade, L. H., Benjet, C., Bunting, B., de Girolamo, G., Demyttenaere, K., Florescu, S. E., Gureje, O., Hisateru, T., Hu, C., Huang, Y., Karam, E., Kiejna, A., Lepine, J. P., Navarro-Mateu, F., Oakley Browne, M., Piazza, M., Posada-Villa, J., ten Have, M. L., Torres, Y., Xavier, M., Zarkov, Z., Kessler, R. C., Scott, K. M., & de Jonge, P.
- Affiliations
- University Medical Center Groningen (NL)
- University of Otago (NZ)
- University of Al-Qadisiyah (IQ)
- Hospital Del Mar (ES)
- Universidade de São Paulo (BR)
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
- University of Ulster (GB)
- Universitair Ziekenhuis Leuven (BE)
- National School of Public Health, Management and Professional Development (RO)
- University of Ibadan (NG)
- National Center of Neurology and Psychiatry (JP)
- Shenzhen KangNing Hospital (CN)
- Peking University (CN)
- University of Balamand (LB)
- Wroclaw Medical University (PL)
- Universidad Peruana Cayetano Heredia (PE)
- Universidad El Bosque (CO)
- Universidad CES (CO)
- Universidade Nova de Lisboa (PT)
- National Center of Public Health and Analyses (BG)
- Harvard University (US)
- Corresponding author
- Wardenaar, K. J.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-02-22
- Volume
- 47
- Issue
- 10
- Pages
- 1744-1760
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC5674525
- OpenAlex
- W2590938221
- Cited by
- 227
- References
- 54
- Citations by year
- 2026: 19 · 2025: 28 · 2024: 30 · 2023: 37 · 2022: 36 · 2021: 31 · 2020: 22 · 2019: 12 · 2018: 9 · 2017: 3
- FWCI
- 17.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- Funders
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, R01MH061905, R01MH059575, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- National Institute of General Medical Sciences (R01GM061905)
- Fogarty International Center (R03TW006481)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- specific phobia, prevalence, cross-national comparison, income level, sex differences, age of onset, role impairment, treatment utilization, comorbidities, vulnerability to psychopathology, low- and middle-income countries
- MeSH terms
- Adolescent, Adult, Employment, Female, Health Surveys, Humans, Male, Mental Health, Middle Aged, Phobic Disorders, Sex Factors, Socioeconomic Factors, Global Health, World Health Organization, Comorbidity, Prevalence, Age of Onset, Young Adult
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