Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Fear About Flying – Is it OCD, Anxiety or a Specific Phobia?

By Andrea Fine

Feb 27, 20237 minute read

Reviewed byPatrick Carey

What is a fear about flying?

Fear of flying can present at any age and involves a chronic, persistent fear of flying because of a number of different reasons. This fear can present on its own as in a Specific Phobia or as an obsession in obsessive-compulsive disorder (OCD). It is important to recognize some key differences between OCD, a Specific Phobia, and Generalized Anxiety to better know with which you may struggle.  

Do you have intrusive thoughts about flying? 

“If I get on an airplane it will crash and I will not be there for my family” or “I can’t ride on any airplane that was built before 2000, because that is the year I was born, and airplanes before that are not safe.” Intrusive thoughts are one of the key identifiers for the presence of OCD as opposed to a Specific Phobia where intrusive thoughts may not be present. This person may engage in compulsions to reduce their fear of flying such as: avoiding flying, rituals when flying to make it “safe” like praying, listening to a certain song every time, seeking reassurance from loved ones, the flight attendant, even passengers on a plane, and researching statistics about plane crashes. 

When you see a plane do you have a physical reaction even though no intrusive thoughts are present?

“Everytime I’m at the airport or see a plane I get weak in the knees, feel sweaty, my heart races,feel sweaty, feel faint, and feel intense nausea. I don’t really have any other fears, but airplanes are my worst nightmare!”  This may be an example of a specific phobia.  No intrusive thoughts are present, but the person is certainly having an intense reaction to being in the airport and even seeing an airplane. The airport or the plane is what we call a phobic stimulus in this situation.  

Here is another example

 “I’ve never really liked flying.  I always feel nervous the morning of my trip.  I worry that I may forget to bring something I want on the plane.  I worry that my baggage may get lost and it will ruin my vacation.  Sometimes, I worry that there will be a cranky flier sitting next to me, or a baby that won’t stop crying. It’s not just flying.  Lots of things make me feel worried.  I can pretty much find anything to worry about, whether it’s my bills, relationships, health, or needing to travel somewhere for work or fun.” This could be an example of generalized anxiety. Sounds like this person will worry about anything and everything.  orry may present as situational. On a travel day, this person will worry about flying. 

These fears could be a sign of OCD

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Obsessive Compulsive Disorder (OCD) is characterized primarily by two components: obsessions and compulsions

What are obsessions?

Obsessions are defined as “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals caused marked anxiety or distress.” Someone with OCD focused on a fear of flying may experience persistent obsessions about this topic. 

Common obsessions experienced by people with a fear of flying in OCD include:

  • This plane is going to crash
  • If I see anything about a plane crash on the news it will jinx my upcoming trip.
  • Thinking about my plane crashing will make it happen.
  • I am going to get air sick if I fly on a plane. 
  • I will be trapped if I fly. 
  • I may have a panic attack if I fly. 
  • My pilot is too young (or too old), on drugs, or suicidal and may kill all the passengers by crashing accidentally. 
  • The weather is too bad
  • I can’t fly internationally because this means flying over the ocean.  
  • If I can’t make calls while on the plane, something bad will happen to my loved one.
  • I will survive a plane crash and no one will find me.  
  • I’ll need medical attention on the plane and I won’t get to a hospital in time. 
  • There are too many germs in this enclosed airplane and I may get Covid. 

What are compulsions?

Compulsions are “repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.” Compulsions are done in an attempt to relieve the anxiety that comes from obsessions or to prevent a feared outcome. Consider some examples for people with fears of flying: 

  • Avoiding flying and driving instead despite time and cost.
  • Saying a certain prayer repetitively while flying
  • Seeking reassurance that everything is okay from loved ones, other passengers, or the flight attendant. 
  • Repeatedly checking seatbelt while on the flight
  • Researching plane crash statistics.
  • Researching about how medical emergencies are handled in the air.
  • Taking benzodiazepines to fall asleep during flying

How can I tell if it’s OCD, anxiety, or something else?

In addition to the presence of obsessions, compulsions, or both, a person with OCD will engage in these behaviors for a significant amount of time. These behaviors will also cause a significant amount of distress and will interfere with a person’s daily life and ability to function. Someone with a fear of flying as part of OCD will likely have other OCD fears.  Someone with a fear of flying may also struggle with magical thinking, harm, or contamination fears in addition to the fear of flying. 

On the other hand, if a person struggles with a fear of flying but does not engage in compulsive behavior or their symptoms don’t interfere in their life, it may be better described as one of several anxiety disorders, or just general worry. A specific phobia diagnosis may be adequate if there are no intrusive thoughts present, there is a phobic stimulus(flying, airplane), and there are no other fears present that would be better explained by an OCD diagnosis. A person with a fear of flying who has OCD may be obsessing about flying all day long, even when there is no trip planned or flight in the near future.  

How the fear of flying can be treated

A fear of flying in OCD, a Specific Phobia, or Generalized Anxiety Disorder can be treated with a particular form of therapy called exposure and response prevention (ERP) therapy. This evidence-based treatment has shown to be highly effective in treating all forms of OCD. Most individuals who do ERP with a trained therapist experience a decrease in symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears. 

By doing ERP therapy with a trained therapist, individuals can find relief from the cycle of OCD. In ERP, people will work with their therapist to build an exposure hierarchy and begin working on one trigger at a time. Usually an ERP therapist will start with an exposure that is predicted to bring about a low level of fear and anxiety and work up to the harder exposures as confidence is built. 

When doing exposures, the goal is always response prevention: your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions or avoiding triggers. Over time, this allows you to tolerate anxiety without relying on compulsions or avoidance to feel better. Example exposures done to treat OCD centered around a fear of flying may include:

  • Writing a script about getting sick (vomiting) on an airplane. 
  • Writing a script about catching Covid on an Airplane
  • Reading about plane crashes
  • Reading about outbreaks in airplanes
  • Looking at pictures of airplanes
  • Going to an air museum to look at old airplanes.
  • Watching flying simulations and imagining being on a plane
  • Doing a flying simulation at an arcade.
  • Planning a trip where flying is necessary.
  • Researching Airlines and flying on one that is rated lower or has had more crashes.
  • Actually flying on an airplane without engaging in compulsions or prayer, checking, reassurance seeking, or researching.  

If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

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