Original Source: Journal of Clinical Psychiatry, all rights reserved. —
Specific phobia is among the most prevalent anxiety disorders in epidemiological surveys.1 The DSM-5 classifies specific phobias into 5 subtypes: animal, natural environment, blood-injection-injury, situational, and other. Within the natural environment subtype, acrophobia (fear of heights), astraphobia (fear of storms), and aquaphobia are recognized. However, a phobia specifically directed at white clouds has not, to our knowledge, been described in any indexed psychiatric literature. A systematic PubMed search using the terms nephophobia, cloud phobia, and fear of clouds yielded no results, confirming the absence of prior documentation. We report what is, to our knowledge, the first indexed case of nephophobia co-occurring with longstanding acrophobia.
Case Report
Mr A, a 38-year-old married male security guard, presented with 2 discrete, persistent specific phobias. Acrophobia had been present since age 22 (duration of 16 years). When approaching elevated floors or terrain, he experienced an intense catastrophic cognition that the floor would collapse and that he would fall, accompanied by dizziness and sweating, leading to progressive avoidance of upper floors, hilly regions, and enclosed vehicles (buses, cars, trains). Notably, he retained the ability to travel by two-wheelers, reflecting stimulus-specific rather than generalized avoidance. His occupational shift from cook to security guard was partly attributable to this limitation.
A second phobia emerged 8 years later at age 30. On seeing white clouds, Mr A experienced overwhelming dread with dizziness, sweating, and an undifferentiated apprehension of imminent harm. Merely thinking about clouds provoked anticipatory anxiety. On days when white clouds were visible, he chose to remain indoors for the remainder of that day. There was no fear of dark or storm clouds, no spontaneous panic attacks, and no obsessions, compulsions, or psychotic symptoms. He had type 2 diabetes mellitus managed with metformin for 2 years. Mental status examination revealed anxious affect, no formal thought disorder, and grade V insight. The diagnoses were ICD-10: F40.2 (acrophobia and nephophobia) and DSM-5: specific phobia, natural environment type (heights) and specific phobia, natural environment type (white clouds). He reported approximately 80% improvement in anticipatory anxiety and dizziness on escitalopram 10 mg/day, propranolol 20 mg/day, and clonazepam 0.5 mg/day, with no significant adverse effects.2
Discussion
The phenomenological novelty here is the phobic stimulus itself. Fear of dark or storm clouds might be conceptualized as a variant of astraphobia given the association with perceived meteorological threat. White clouds, however, carry no inherent danger signal; they are meteorologically neutral, nonthreatening stimuli. This makes nephophobia an evolutionarily incongruent fear, relevant to nonassociative models of fear acquisition that distinguish biologically prepared fears from those involving neutral stimuli.2,3 Nonassociative theory posits that evolutionarily neutral fears require a distinct etiologic pathway, likely conditioned or cognitively mediated, as opposed to the innate preparedness that underlies height or predator fear.
The temporal sequence, acrophobia preceding nephophobia by 8 years, raises the possibility of cross-stimulus fear generalization. The patient’s core catastrophic cognition in acrophobia centered on collapse and falling from height; white clouds occupy the same upward visuospatial field as elevated terrain. Shared visual context may have facilitated schema-level generalization of the threat representation from height to sky. Acrophobia is associated with altered spontaneous neural activity in frontal and visual processing regions,4 and disrupted visual-spatial threat appraisal may predispose to secondary elaboration of fear toward perceptually contiguous stimuli.
Clinically, this case underscores that specific phobias are markedly undertreated. Fewer than 1 in 5 patients receive appropriate intervention,5 and unusual phobic stimuli may go unrecognized in routine assessment. Exposure-based cognitive-behavioral therapy, including virtual reality variants, carries the strongest evidence for specific phobia,6 but this patient achieved meaningful improvement on pharmacotherapy alone, which may serve as a pragmatic first step for patients who decline or lack access to formal psychotherapy. Systematic inquiry into secondary phobias is warranted in patients with index-specific phobias, particularly when feared stimuli share spatial or contextual features.
Article Information
Published Online: November 3, 2026. https://doi.org/10.4088/PCC.26cr04287
© 2026 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2026;28(6):26cr04287
Submitted: May 25, 2026; accepted July 28, 2026.
To Cite: Chaudhary S, Garg S. Nephophobia: a case of specific phobia of white clouds coexisting with acrophobia.
Prim Care Companion CNS Disord 2026;28(6):26cr04287.
Author Affiliations: Department of Psychiatry, Shri Guru Ram Rai University & Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, India (Chaudhary, Garg).
Corresponding Author: Shobit Garg, MD, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, 248001, India ([email protected]).
Financial Disclosure: None.
Funding/Support: None.
Patient Consent: Consent was received from the patient to publish the case report, and information has been de-identified to protect patient anonymity.
ORCID: Shobit Garg: https://orcid.org/0000-0001-5913-9021
Journal of Clinical Psychiatry, all rights reserved.