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The term is of recent origin, probably dating from the 1980s,[1] and according to one analyst, "has been coined more on the Internet than in printed form because it does not appear in any previously published, psychiatric, unabridged, or abridged dictionary." However, the author later notes, "regardless of its less-than-verifiable etymology, coulrophobia exists in several lists."[2]

The prefix coulro- may be a neologism derived from the Ancient Greek word κωλοβαθριστής (kōlobathristēs) meaning "stilt-walker."[nb 1] Although the concept of a clown as a figure of fun was unknown in classical Greek culture,[4] stiltwalking was practiced. The Online Etymology Dictionary states that the term "looks suspiciously like the sort of thing idle pseudo-intellectuals invent on the Internet and which every smarty-pants takes up thereafter".[5]

A study conducted by the University of Sheffield found that the children did not like clown décor in the hospital or physicians' office settings. The survey was about children’s opinions on décor for an upcoming hospital redesign. Dr Penny Curtis, a researcher, stated "We found that clowns are universally disliked by children. Some found the clown images to be quite frightening and unknowable."[8][9] In other studies playing with therapeutic clowns reduced anxiety in children and improved healing in children with respiratory illness. [10]

It is argued that notorious clown figures in literature (Pennywise in It) and real life (John Wayne Gacy) have contributed to adults being averse to clowns. Additionally, the fact that much clown behavior is "transgressive" (anti-social behavior) can create feelings of unease.[11]

Coulrophobia can be a plot device used to show how the protagonist must overcome his fears in order to vanquish the enemy. Examples include the 2009 film Zombieland, in which a character must overcome his fear in order to kill a zombie clown.[12]

In Stephen King's It, the eponymous menace is a being that preys on, and by unknown mechanism, manifests his victims' worst fears. When in the presence of multiple other beings, It takes the form of a clown, suggesting that the clown is the "lowest common denominator" for the irrational fears of all the protagonists.[citation needed]

In American Horror Story: Freak Show, John Carroll Lynch portrays Twisty the Clown. He is a murderous clown with a mask and overall dirty appearance who is killing people, leading the authorities of Jupiter, Florida to believe that the troupe of freaks are committing the crimes. Lynch says that Twisty has "strangely pure" motives in the show. Creator Ryan Murphy says that the crew of American Horror Story wanted to create the "scariest clown of all time"

^Author Michael Quinion suggests that the prefix "coulro-" derives from the Greek kolobathristes, meaning "stilt-walker" [1] The Oxford Dictionary of English alternatively suggests that it derives from kolobatheron, meaning "stilt."[3]