Caulrophobia: An investigation of clinical features

Abstract

Background: Coulrophobia describes the experience of significant distress, fear and/ or revulsion when exposed to the image and/or person of a clown (Stevenson, 2010). It may start in childhood and continue into adulthood (Spratley, 2009). There is limited scientific literature on this topic despite multiple online support groups attesting to the reality of this condition. Methods: Data collection using a self-administered online questionnaire from Surveymonkey was made available via a link on the larger of these online support groups on Facebook. It explored socio-demographic information and symptom phenomenology -symptom severity, course, duration, comorbid illnesses, and extent of psychological distress and functional impairment - in individuals who self-report coulrophobia. Fear of clowns is more commonly associated with fear (45.3%) than disgust (37.9%). The possibility that fear of clowns comprises a specific phobia was also examined. Those from the fear predominant group are also more likely to fulfill DSM-5 criteria for specific phobia. Extent of psychological distress and functional impairment were measured and compared to symptom severity and duration. Results: There were 95 respondents to the online survey, of which 79 were female and 16 male showing it to be more common in females. The mean age of participants was 39.82 ±12.60 years, mean age of symptom onset 9.02 ±6.12 years and mean duration of 30.44 ±12.94years. It appears to have a chronic course from onset with 30.53% identifying a specific trigger and 22.11% a positive family history of coulrophobia. It is more commonly associated with fear than disgust (45.3%). Those from the fear predominant group are also more likely to fulfill DSM-5 criteria for specific phobia. The most common comorbid disorders are major depressive disorder, obsessive compulsive disorder, panic disorder and social anxiety disorder. Use of the Kessler Psychological Distress Scale indicated a significant level of psychological distress associated with coulrophobia. The greatest area of impairment in coulrophobia was in social functioning, measured by the Sheehan Disability Scale Functional impairment was strongly associated with severity of symptoms, but not with symptom duration. Conclusion: Coulrophobia is a phenomenon that warrants clinical attention, as it is associated with significant comorbidity, psychological distress, and impaired functioning.