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Specific Phobia

Specific Phobia Diagnostic Criteria

  1. Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
  2. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack.
    Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging
  3. The person recognizes that the fear is excessive or unreasonable.
    Note: In children, this feature may be absent.
  4. The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
  5. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
  6. In individuals under age 18 years, the duration is at least 6 months.
  7. The anxiety, Panic Attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder.

Specify Type:

  • Animal Type
  • Natural Environment Type (e.g., heights, storms, water)
  • Blood-Injection-Injury Type
  • Situational Type (e.g., airplanes, elevators, enclosed places)
  • Other Type (e.g., phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds or costumed characters)

Treatment

  1. Systematic desensitization and exposure (for specific phobias) and cognitive behavioral therapy (for social phobias).
  2. Beta-blockers may be effective in treating performance-anxiety symptoms.
  3. Drugs used in generalized social phobias include SSRIs (doses higher than those used in depression) or an MAOI (such as phenelzine). See also Panic Disorder for detailed description of medication issues.

Associated Feature

  • Depressed Mood
  • Anxious or Fearful or Dependent Personality

Differential Diagnosis

Some disorders have similar or even the same symptom. The clinician, therefore, in his/her diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

  • Panic Disorder With Agoraphobia;
  • Social Phobia;
  • Posttraumatic Stress Disorder;
  • Obsessive-Compulsive Disorder;
  • Separation Anxiety Disorder;
  • Hypochondriasis;
  • Anorexia Nervosa;
  • Bulimia Nervosa;
  • Schizophrenia or another Psychotic Disorder.