Specific Phobias

A phobia is a fear which is caused by a specific object or situation. The fear may be by the actual presence of, or by, the anticipation of the presence of that object or situation. Anxiety, triggered by the fear, may approach the intensity of panic. See Phobia Listing.

The patient experiences a strong, persistent fear that is excessive or unreasonable. It is cued by a specific object or situation that is either present or anticipated.

The phobic stimulus almost always immediately provokes an anxiety response, which may be either a panic attack or symptoms of anxiety that do not meet criteria for a panic attack.

The fear is unreasonable or out of proportion, and the patient realizes this.

The patient either avoids the phobic stimulus or endures it with severe anxiety or distress.

Patient is under the age of 18, but must have had the symptoms for 6 months or longer.

Either there is marked distress about this fear or it markedly interferes with the patient's usual routines or social, job or personal functioning.

The symptoms are not better explained by a different mental disorder, including Anxiety Disorders, Dysmorphic Disorder, Pervasive Developmental Disorder or Schizoid Personality Disorder.

Specify type:

Situational Type (airplane travel, being closed in)
Natural Environment Type (thunderstorms, heights, for example)
Blood, Injection, Injury Type
Animal Type (spiders, snakes)
Other Type (situations that might lead to illness, choking, vomiting)

Associated Features:

Depressed Mood.
Anxious or Fearful or Dependent Personality.

Differential Diagnosis:

Some disorders have similar or even the same symptom. The clinician, therefore, in his 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.
Hypochondrias.
Anorexia Nervosa.
Bulimia Nervosa.
Schizophrenia or another Psychotic Disorder.

Cause:

Phobias frequently begin in childhood. Personal trauma and stress can sometimes trigger a phobia in children and adults. As an example, a person who was once trapped in a small room might later become frightened of closed spaces. Genetic factors have also been associated with phobias. Many people who have phobias have relatives with similar phobias or symptoms such as fears and/or a tendency to avoid certain situations.

Treatment:

The treatment of phobias usually has a behavior therapy focus. In some instances drug therapy may also be tried.

Counseling and Psychotherapy [ See Therapy Section ]:

In the safety of the therapeutic situation, people with phobias are gradually introduced into the very situation that normally causes them anxiety. They learn that they can control their anxiety while gaining greater and greater exposure to their phobic situation. Cognitive or behavior therapy may also be extremely effective when used in conjunction with relaxation training.

Pharmacotherapy [ See Psychopharmacology Section ] :

Certain people do well on medications such as monoamine oxidase inhibitors (MAOIs) or imipramine. Also, mild tranquilizers, like benzodiazepines, can be effective in helping people control the anxiety caused by their phobia.