Summary
Definition
History and exam
Key diagnostic factors
- anticipatory anxiety
- behavioral avoidance
Other diagnostic factors
- onset during childhood
- onset during early adulthood
- nausea
- dizziness
- disgust
- fainting
- tachycardia
- hyperventilation
- exaggerated startle
- sleep disruption
Risk factors
- somatization disorder
- anxiety disorders
- mood disorders
- first-degree relative with phobia
- twin with phobia
- aversive experiences
- stress and negative life events
- female sex
- white ethnicity
- parental anxiety and overprotectiveness
- negative affectivity and behavioral inhibition
- cognitive/attentional bias
Diagnostic tests
1st tests to order
- self-report
- behavioral observation and approach tests
Tests to consider
- structured/semi-structured clinical interview
Treatment algorithm
adults with subclinical symptoms and infrequent interference with usual activities
adults with frequent symptoms interfering with usual activities
children with ongoing symptoms interfering with usual activities
Contributors
Authors
Amy Huberman, MD
Instructor of Psychiatry
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
AH declares that she has no competing interests.
Acknowledgements
Dr Amy Huberman would like to gratefully acknowledge Dr Eve Friedl, Dr E. Blake Zakarin, Dr Craig N. Sawchuk, and Dr Bunmi O. Olatunji, previous contributors to this topic.
Disclosures
EKF and EBZ declare that they have no competing interests. CNS is an author of a reference cited in this topic. BOO is an author of a reference cited in this topic.
Peer reviewers
Jeffrey M. Lohr, PhD
Professor
Clinical Training Program
Department of Psychology
University of Arkansas
Fayetteville
AR
Disclosures
JML declares that he has no competing interests.
David F. Tolin, PhD
Associate Professor
Institute of Living
Yale University
New Haven
CT
Disclosures
DFT declares that he has no competing interests.
Differentials
- Agoraphobia
- Panic disorder
- Social anxiety disorder (social phobia)
More DifferentialsGuidelines
- Anxiety disorders in adults: screening
- Anxiety in children and adolescents: screening
More GuidelinesPatient information
Phobias
More Patient information- Log in or subscribe to access all of BMJ Best Practice
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