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Ask the Mental Health Expert Archives 2001-2004

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Afraid of Clowns

Q. I have a patient (young adult) who is fearful of clowns. I am able to see some literal interpretations of how a clown is really someone else hiding behind grease paint, a wig, etc. Also there has been a variety of horror movies where clowns have been the bad guy. The person denies knowing why they are afraid. Do you have any thoughts on this?

A. My first thought is that I'm puzzled why this is a major problem for your patient (if it is). Unless she works in a circus, it hardly seems like the sort of anxiety that would cause her to seek professional help. So, I'm guessing there are broader underlying issues for her--perhaps some sort of social phobic anxiety, or post-traumatic experiences?

In any case, the particular phobia you describe--fear of clowns--is quite rare, and little has been written on it in the professional literature. Technically termed coulrophobia, fear of clowns is said to be related to negative circus experiences in early childhood, and to inconsistent parenting. One writer notes that whereas children are cautioned to avoid strangers, they are often obliged to spend birthday parties and other special events with clowns, whose behavior may be strange and frightening to them.

Interestingly, clowns seem to evoke unexpectedly negative reactions among some people--I found one website called ihateclowns.com! I suppose that if your patient is really interested in ferreting out the unconscious dynamics of her fear, you might consider a psychoanalytic form of psychotherapy. Alternatively, if this fear truly interferes with her ability to function in everyday life, you might take a cognitive-behavioral approach, utilizing de-sensitization techniques, in vivo exposure, etc.

But again--why is this patient really in treatment? If there is suggestive evidence of childhood trauma, then you might consider consulting with an expert in PTSD to see how you should proceed--and the watch-word here should be "cautiously". I believe many patients with PTSD are actually worsened by inappropriate and overly-suggestive therapeutic techniques. Finally, though I have not read it, you may want to look at the letter by Austin & McCann on this subject (Anxiety 1996;2(6):305). Good luck!

February 2003

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