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.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
Stinson FS, Dawson DA, Chou SP, et al. The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2007 Jul;37(7):1047-59. Abstract
Wolitzky-Taylor KB, Horowitz JD, Powers MB, et al. Psychological approaches in the treatment of specific phobias: a meta-analysis. Clin Psychol Rev. 2008 Jul;28(6):1021-37. Abstract
Katzman MA, Bleau P, Blier P, et al; Anxiety Disorders Association of Canada; McGill University. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14 Suppl 1:S1.Full text Abstract
McMurtry CM, Taddio A, Noel M, et al. Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research. Cogn Behav Ther. 2016 Apr;45(3):217-35.Full text Abstract
Grös DF, Antony MM. The assessment and treatment of specific phobias: a review. Curr Psychiatry Rep. 2006 Aug;8(4):298-303. Abstract
Antony MM, Barlow DH. Specific phobias. In: Barlow DH, ed. Anxiety and its disorders: the nature and treatment of anxiety and panic. 2nd ed. New York, NY: Guilford Press; 2002:380-417.
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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
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