Specific phobia

Specific phobia
Classification and external resources
ICD-10	F40.2
ICD-9-CM	300.29
MeSH	C562465

A specific phobia is any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations. As a result, the affected person tends to actively avoid direct contact with the objects or situations and, in severe cases, any mention or depiction of them. The fear can, in fact, be disabling to their daily lives.^[1]

The fear or anxiety may be triggered both by the presence and the anticipation of the specific object or situation. A person who encounters that of which they are phobic will often show signs of fear or express discomfort. In some cases, it can result in a panic attack. In most adults, the person may logically know the fear is unreasonable but still find it difficult to control the anxiety. Thus, this condition may significantly impair the person's functioning and even physical health.

Specific phobia affects up to 12% of people at some point in their life.^[2]

Diagnosis

Main features of diagnostic criteria for specific phobia in the DSM-IV-TR:

• 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).
• 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. In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
• The person recognizes that the fear is excessive or unreasonable. In children, this feature may be absent.
• The phobic situation(s) is avoided or else is endured with intense anxiety or distress.

Specific Phobia – DSM 5 Criteria^[3]

• Fear or anxiety about a specific object or situation (In children fear/anxiety can be expressed by crying, tantrums, freezing, or clinging)
• The phobic object or situation almost always provokes immediate fear or anxiety
• The phobic object or situation is actively avoided or endured with intense fear or anxiety
• The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
• The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
• The disturbance is not better explained by symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms; objects or situations related to obsessions; reminders of traumatic events; separation from home or attachment figures; or social situations

Types

According to the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders, phobias can be classified under the following general categories:

• Animal type – Fear of dogs, cats, rats and/or mice, pigs, cows, birds, spiders, or snakes.
• Natural environment type – Fear of water (aquaphobia), heights (acrophobia), lightning and thunderstorms (astraphobia), or aging (gerascophobia).
• Situational type – Fear of small confined spaces (claustrophobia), or the dark (nyctophobia).
• Blood/injection/injury type – this includes fear of medical procedures, including needles and injections (trypanophobia), fear of blood (hemophobia) and fear of getting injured.^[4]
• Other – children's fears of loud sounds or costumed characters.^[5]

Treatment

The following are two therapies normally used in treating specific phobia:

Cognitive behavioral therapy (CBT), a short term, skills-focused therapy that aims to help people diffuse unhelpful emotional responses by helping people consider them differently or change their behavior, is effective in treating specific phobias.^[6] Exposure therapy is a particularly effective form of CBT for specific phobias.^[6] Medications to aid CBT have not been as encouraging with the exception of adjunctive D-clycoserine.^[7][8]

In general anxiolytic medication is not seen as helpful in specific phobia but benzodiazepine is sometimes used to help resolve acute episodes; as 2007 data were sparse for efficacy of any drug.^[9]

Epidemiology

Specific phobias have a one-year prevalence of 8.7% in the USA with 21.9% of the cases being severe, 30.0% moderate and 48.1% mild.^[10][11] The usual age of onset is childhood to adolescence. Women are twice as likely to suffer from specific phobias as men.^[12]

Evolutionary theory argues that infants or children develop specific phobias to things that could possibly harm them, so their phobias alert them to the danger. The most common co-occurring disorder for children with a specific phobia is another anxiety disorder. Although comorbidity is frequent for children with specific phobias, it tends to be lower than for other anxiety disorders. Onset is typically between 7 and 9 years of age. Specific phobias can occur at any age but seem to peak between 10 and 13 years of age.

See also

• List of phobias

References

1. "Phobias: Specific Phobias Types and Symptoms." WebMD. WebMD, n.d. http://www.webmd.com/anxiety-panic/specific-phobias
2. Craske, MG; Stein, MB (24 June 2016). "Anxiety.". Lancet (London, England). PMID 27349358.
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
4. ^ a b c d e "Oxford Textbook of Psychopathology" by Theodore Millon, Paul H. Blaney, Roger D. Davis (1999) ISBN 0-19-510307-6, p. 82
5. DSM-IV-TR 300.29, p. 445.
6. Kaczkurkin, AN; Foa, EB (September 2015). "Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence.". Dialogues in clinical neuroscience. 17 (3): 337–46. PMC 4610618. PMID 26487814.
7. Choy, MD, Yujuan; Fyer, Abby J.; Lipsitz, Josh D. (2007). "Treatment of specific phobia in adults". Clinical Psychology Review. 27 (3): 266–286. doi:10.1016/j.cpr.2006.10.002.
8. Ori, R; Amos, T; Bergman, H; Soares-Weiser, K; Ipser, JC; Stein, DJ (10 May 2015). "Augmentation of cognitive and behavioural therapies (CBT) with d-cycloserine for anxiety and related disorders.". The Cochrane database of systematic reviews (5): CD007803. PMID 25957940.
9. Choy, Y; Fyer, AJ; Lipsitz, JD (April 2007). "Treatment of specific phobia in adults.". Clinical psychology review. 27 (3): 266–86. PMID 17112646.
10. Kessler, PhD, Ronald; Chiu, AM, Wai Tat; Demler, Olga; Walters, Ellen (2005). "Prevalence, Severity and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication". Archives of General Psychiatry. 62 (6): 617–709. doi:10.1001/archpsyc.62.6.617. PMC 2847357. PMID 15939839.
11. Narrow; et al. (2002). "Revised prevalence estimates of mental disorders in the United States". Archives of General Psychiatry. 59 (2): 115–123. doi:10.1001/archpsyc.59.2.115. PMID 11825131.
12. Cameron, Alasdair (2004). Crash Course Psychiatry. Elsevier Ltd. ISBN 0-7234-3340-2.

External links

• Encyclopedia of Mental Disorders – Specific phobias