Specific phobias are common in the community, and much is known from epidemiological surveys about their subtypes and sex ratio.

To determine the subtypes and sex ratio in a treatment-seeking sample of people with a specific phobia.

Patients with a specific phobia were identified by a retrospective search of clinical case records from patient notes in electronic health records at the South London and Maudsley NHS Foundation Trust (the largest secondary mental healthcare provider in Europe).

We identified 1017 patients over 5 years as having a specific phobia. The adult female to male sex frequency ratio for having any specific phobia was 3.9, with the ratio of specific phobia subtypes ranging from 2.4 (natural environment) to 8.2 (animal). The child female to male ratio of specific phobia subtypes ranged from 0.7 (natural environment) to 1.8 (other subtypes). Phobia of vomiting was the most common specific phobia presenting in both adults (n = 161, 17.8% of all specific phobias) and children (n = 26, 23.4%). In adults with a phobia of vomiting, the female to male ratio was 9.1 compared with 3.4 in all other specific phobias, and 4.2 versus 0.98 for children.

There is a stark contrast between the apparent prevalence of phobia of vomiting in epidemiological surveys and being the most common presentation clinically. A very high female to male ratio in phobia of vomiting and animals in adults seeking treatment is also in contrast to findings in the community. This has implications for clinician training and public education.