Are they beloved children’s entertainers or creepy characters? If you think of clowns as the latter, you might have coulrophobia.

Clowns have been a part of many cultures, dating back to 2,500 B.C. when they entertained Egyptian pharaohs and made them laugh. Before his death in 1837, English actor Joseph Grimaldi transformed clowns into the colorful leaping and stumbling characters we know today.

Clown humor is sometimes based in mischief, which can suggest that they have a dark side. Their makeup and eccentric outfits distract audiences from the true nature of the person underneath — another reason some people find clowns unsettling.

If clowns make you nervous, you’re not alone. People of all ages have shared this fear.

The definition of coulrophobia is more than just a mild aversion to or fear of clowns. True coulrophobia causes heightened anxiety and physical stress symptoms.

Coulrophobia doesn’t appear in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as a distinct condition. However, it could fall into the category of a specific phobia, in the class of anxiety disorders.

A 2016 study involving 1,160 hospitalized children and medical clowns revealed that 14 (or 1.2%) of the children experienced fear from the clowns.

This number increases when you include adults. A Chapman University survey from 2016 revealed that 7.8% of Americans report having a fear of clowns.

It’s theorized that movies and TV could be part of what causes fear of clowns. These costumed characters are often portrayed as being evil and frightening.

If you see enough of this type of media content during an impressionable time in your life, the effect could linger.

According to a 2013 review, twin studies suggest that all types of phobias might have an underlying genetic factor. Your chances of developing a specific phobia may be as high as 71% if you have a relative with a similar anxiety tendency.

Like most phobias, coulrophobia can cause both psychological and physical symptoms.

Psychological symptoms you may experience include:

  • a need to escape
  • a feeling of doom
  • loss of control
  • feeling disconnected from reality

Coulrophobia can also trigger physical symptoms, such as:

  • racing heart
  • trembling
  • perspiration
  • body temperature changes
  • nausea
  • chest pain
  • dizziness
  • lightheadedness
  • loss of consciousness

Since coulrophobia isn’t in the DSM-5 as a distinct condition, doctors can identify it using the criteria for specific phobia.

For a coulrophobia specific phobia diagnosis, your experience from clowns should meet certain criteria:

  • Clowns cause heightened fear or anxiety.
  • Fear or anxiety is almost always immediate.
  • Perception of danger is exaggerated beyond the actual risk.
  • You actively avoid clowns or situations in which they may be present.
  • Avoidance of or anxiety from the trigger causes impairment in important life areas like social and occupational.
  • Anxiety and avoidance have lasted at least 6 months or longer.
  • Symptoms can’t be explained by another situation or mental health condition.

If you’re experiencing any of these symptoms, you may want to consider talking with a mental health professional. They can do a further psychological assessment to determine the cause of your symptoms and recommend treatment, if needed.

Clowns are not something you usually see across multiple settings. Many people with coulrophobia may not need treatment.

However, if you work in a pediatric hospital setting or an entertainment environment that features clowns, you might want to consider treatment options — particularly if the phobia is causing you some distress.

A healthcare professional might recommend anxiety medications to help ease symptoms, but therapy is the main treatment for specific phobias. The most effective types of therapy are exposure therapy and cognitive behavioral therapy (CBT).

Exposure therapy

Exposure therapy is as the name suggests: You confront your specific phobia. In this case, you might be put into situations where you can see or be in the presence of clowns.

A therapist can support you through this process and help you choose the right approach.

For example, you might want to try graded exposure. This means starting with the least frightening element and gradually increasing the level of difficulty as you progress. The opposite approach is called flooding, where you begin with the most anxiety-provoking trigger.

Types of exposure therapy include:

  • In vivo exposure: direct exposure to the cause of your anxiety
  • Imaginal exposure: thinking in great detail about your fear
  • Virtual reality exposure: using virtual reality equipment to mimic exposure
  • Interoceptive exposure: recreating anxiety symptoms, like spinning in a chair to cause dizziness

A therapist might also suggest systematic desensitization, which combines exposure therapy with relaxation exercises.

Cognitive behavioral therapy

CBT is type of psychotherapy in which you identify thoughts that are causing you anxiety. A therapist then helps you replace those thoughts with helpful ones, so that they no longer work against you.


Although medication isn’t a treatment for phobias, options like beta-blockers, benzodiazepines, or antidepressants may help manage symptoms like anxiety.

Lifestyle changes can make it easier to live with a phobia. Self-care strategies like a balanced diet, regular exercise, and a consistent sleep schedule can help you manage your symptoms.

Relaxation activities — such as yoga and mindfulness meditation — can also help ease tension and stress.

Living with anxiety from coulrophobia can be challenging but treatment and support is available, whenever you’re ready to reach out for help.

If you’re interested in trying therapy as an option, you can check out our find a therapist page to find the right support near you or online.

Support groups can also help. They can connect you with other people who share similar experiences.