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Specific Phobia

DSM IV Diagnostic Criteria

Marked and persistent fear that is excessive or unreasonable that is caused by the presence or anticipation of a specific object or situation.

Exposure to the feared stimulus provokes an immediate anxiety response which may take the form of a 

Recognition by the patient that the fear is excessive or unreasonable.

The phobic situation is avoided or endured with intense anxiety.

The avoidance, anxious anticipation, or distress in the feared situations interferes with functioning or produces marked phobea

In individuals under age 18, the duration must be at least

Symptoms are not caused by another mental disorder (e.g., fear of dirt in someone with OCD).

Specify Type of Phobias

  1. Animal (e.g., dogs)
  2. Natural Environmental (e.g., heights, storms, water)
  3. Blood-Injection-Injury
  4. Situational (e.g., airplanes, elevators, enclosed places)
  5. Other (e.g., situations that may lead to choking, vomiting)
Clinical Features of Specific Phobia
  1. It may result in significant restriction of life activities or occupation.
  2. Vasovagal fainting is seen in 75% of patients with blood-injection-injury phobias.
  3. Specific phobias often occur along with other anxiety disorders.
  4. Fear of animals and other objects is common in childhood, and it is not diagnosed unless the fear leads to significant impairment, such as unwillingness to go to school.
  5. Most childhood phobias are self limited and do not require treatment. Phobias that continue into 
Epidemiology of Specific Phobia
  1. Lifetime prevalence of phobias is 10%.
  2. Most do not cause clinically significant impairment or distress.
  3. Age of onset is variable and females with the disorder far outnumber males with the disorder.
Differential Diagnosis of Specific Phobia
  1. Substance Induced Anxiety disorder: Substances such as caffeine, amphetamines, and cocaine can mimic phobic symptoms. Alcohol or benzodiazepine withdrawal can also mimic phobic symptoms. These disorders should be ruled out with history and toxicology screen.
  2. Panic Disorder, Obsessive Compulsive Disorder, Social Phobia, Hypochondriasis or Anorexia Nervosa

Many psychiatric disorders present with marked anxiety, and the diagnosis of Specific Phobia should be made only if the anxiety is unrelated to

Treatment