Coulrophobia (Fear of Clowns)

What is coulrophobia?

Coulrophobia (COOl-ruh-FOE-bee-uh) is a fear (phobia) of clowns. Children and adults who fear clowns may experience extreme, irrational reactions when they see clowns in person or view pictures or videos of clowns. Someone with a fear of clowns is coulrophobic. They may go out of their way to avoid any exposure to clowns.

Awareness of coulrophobia is relatively new. The term coulrophobia first appeared in the late 1990s. “Coulro” is the Greek word for stilt walkers. Recent movies featuring creepy-looking clowns, like “It” and “Joker,” made people more aware of this phobia.

What are coulrophobia triggers?

Any event with a clown may trigger coulrophobia, such as:

• Birthday parties, Halloween parties and trick-or-treating.
• Circuses, fairs or festivals.
• Fast-food restaurants that use clowns as mascots.
• Movies, TV shows, commercials, billboards and advertisements.

How common is fear of clowns?

There are few studies on coulrophobia. Some experts believe as many as 1 in 10 adults have a fear of clowns. One study on hospitalized children found that approximately 10 out of 1,000 children, most of them children assigned female at birth (AFAB), were afraid of the clowns the hospital brought in to cheer them up.

Who is at risk for coulrophobia?

Coulrophobia affects all ages and genders, although people AFAB may be more likely to be afraid of clowns. Researchers have noted signs of coulrophobia in children as young as 3. You may be more at risk for developing this specific phobic disorder if you already have an anxiety disorder or other phobias.

What causes coulrophobia?

People with coulrophobia may be reacting to a clown’s colorful makeup. This disguise hides a clown’s facial features and distorts facial expressions, creating feelings of distrust.

What are coulrophobia symptoms?

Children and adults with coulrophobia may try to get away from a clown, hide behind a person or object, or cover their eyes so that they don’t have to see the clown. A child may cry. Sometimes, just the possibility of seeing a clown causes an anxious response.

Other signs of coulrophobia include:

• Fast breathing and heart rate.
• An intense feeling of terror.
• Pale skin.
• Profuse sweating (hyperhidrosis).
• Nausea.
• Trembling or shaking.

How is coulrophobia diagnosed?

The American Psychiatric Association (APA) doesn’t recognize coulrophobia as a phobic disorder in its Diagnostic and Statistical Manual of Mental Disorders (DSM). There are no set criteria for diagnosing it.

A healthcare provider may recommend an evaluation with a mental health professional like a psychologist. This provider may diagnose coulrophobia after evaluating symptoms, including the impact of the phobia on daily life.

You or your child may have a specific phobic disorder like coulrophobia if the fear:

• Occurs when you see a clown or its image.
• Causes you to avoid certain situations like parties or the movies.
• Brings on intense distress that doesn’t match the actual danger.
• Lasts six months or longer.
• Affects your quality of life.

How is coulrophobia managed or treated?

There isn’t a specific coulrophobia treatment. If the phobia disrupts your quality of life, exposure therapy with a mental health professional may help. Exposure therapy is a type of psychotherapy or talk therapy. It can help as many as 9 in 10 people overcome specific phobias.

Exposure therapy involves gradual and repeated exposures to images or situations that trigger coulrophobia symptoms. The process involves:

• Learning breathing and relaxation techniques to use before and during exposure.
• Viewing images or videos of clowns. (A child may benefit from watching a person put on clown makeup and transform into a clown.)
• Gradually progressing to being in the same area as a clown.
• Eventually, being next to a clown or holding and viewing a clown image.

Your provider may combine exposure therapy with cognitive-behavioral therapy (CBT). This therapy helps you change how you perceive and respond to situations that trigger anxiety.

Anti-anxiety medications generally aren’t helpful or needed for specific phobic disorders. In certain situations, like during Halloween when many people dress up as clowns, an anti-anxiety drug may help you feel calmer.

What are the complications of coulrophobia?

Some people with coulrophobia have panic attacks when they see clowns. You may have noncardiac chest pain, a fast heart rate and feel like you’re having a heart attack. Persistent worries about having panic attacks can lead to panic disorder. You may need long-term anti-anxiety medication therapy.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Panic attacks.
• Persistent anxiety that interferes with daily life or sleeping.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• What’s causing this phobia?
• What’s the best treatment for me?
• Should I try exposure therapy?
• How long will I need therapy?
• Should I watch for signs of complications?

A note from Cleveland Clinic

Many children and adults express a fear of clowns. People with coulrophobia go out of their way to avoid any exposure to clowns or clown images. Fortunately, running into clowns isn’t a typical, everyday occurrence. You or your child can take steps to avoid seeing clowns and clown images. If the fear becomes too great, don’t hesitate to talk to your healthcare provider. Exposure therapy with a mental health professional can help you manage this phobia.