Phobias

Specific phobia is the most common anxiety disorder in the United States. NIMH estimates that 9.1% of U.S. adults had one in the past year and 12.5% meet criteria at some point in their lives, with past-year rates higher in women (12.2%) than men (5.8%). Around 22% of past-year cases are classed as seriously impairing — which is the number that matters, because the rest of the time phobias are treated as quirks.

The cost is almost always avoidance rather than fear itself. A flying phobia becomes a career ceiling. A driving phobia shrinks where you can live. A needle or procedure phobia keeps people out of medical care entirely, which is the version with the most serious downstream consequences and the one least likely to be mentioned to a doctor.

Treatment is unusually clear here: exposure-based cognitive behavioural therapy has the strongest evidence, and it is the treatment, not an adjunct to one. Medication does not cure a phobia. What it can do is make exposure work possible where avoidance is pervasive, or where a co-occurring depressive or anxiety disorder is blocking engagement.

Where situational medication is considered for genuinely infrequent, unavoidable exposures — an MRI, a surgical procedure, a single necessary flight — the criteria need to be strict. Sedating as-needed agents blunt the learning that exposure therapy depends on, which means the short-term relief can come at the cost of the long-term fix. That trade-off should be explicit, not discovered later.

One subtype behaves differently. Blood-injection-injury phobia characteristically produces a drop in heart rate and blood pressure and a tendency to faint, rather than the racing heart seen in other phobias, and is managed differently as a result. It's also the phobia most likely to interfere with necessary healthcare, which makes identifying it worth the time.

Dr. Farkas brings MD/PhD neuroscience training, NIH research center experience, and board-certified psychiatric practice to that assessment — including an honest account of what medication will and won't do here.

A new patient evaluation with Dr. Farkas runs 30–60 minutes. It covers what you fear and what happens in your body when you face it, how long this has been going on, exactly what you avoid and what that has cost, other anxiety or mood conditions, and every medication tried.

You'll leave with a specific diagnosis, a clear account of what exposure therapy involves and a referral if it's indicated, and an honest answer about whether medication has a part to play. Telehealth is available throughout South Carolina and New York. In-person appointments are available at the Bluffton, SC office.