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Health Articles : Phobias


The current DSM IV definition of specific phobia is:
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). 2) Exposure to the phobic stimulus which almost invariably provokes an immediate anxiety response, which may take the form of panic attack. In children, anxiety may be expressed by crying, tantrums, freezing or clinging. 3) The person recognises that the fear is excessive or unreasonable, although this feature may be absent with children. 4) The phobic situation(s) is avoided or else 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, occupation, academic functioning, social activities, relationships, or there is marked distress about having the phobia. 6) In individuals under 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), post traumatic 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. There are certain physiological sensations that often accompany phobic reactions and include increased rate of respiration and heart beat, muscle tension, weakness, nausea and, with some phobias, even fainting. The intensity of these responses can vary from discomfort to severe situational panic attack.
DSM IV subdivides specific phobias into 5 types
  • Animal Phobias
  • Natural Environment Phobias
  • Blood, Injection and Injury Phobias
  • Situation Phobias — e.g. claustrophobia, social phobia
  • Miscellaneous Phobias — e.g. vomit phobia
It is a very important to construct a proper assessment of specific phobia, phobic like phenomena or even normal fear. The key to differential diagnosis is in identifying the focus of client´s fear that motivates their avoidance (CCBH notes 2010)

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