Last reviewed: 25 Aug 2022
Last updated: 18 May 2022



History and exam

Key diagnostic factors

  • anticipatory anxiety
  • behavioral avoidance
More key diagnostic factors

Other diagnostic factors

  • onset during childhood
  • onset during early adulthood
  • nausea
  • dizziness
  • disgust
  • fainting
  • tachycardia
  • hyperventilation
  • exaggerated startle
  • sleep disruption
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • self-report
  • behavioral observation and approach tests
More 1st investigations to order

Investigations to consider

  • structured/semi-structured clinical interview
More investigations to consider

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



Amy Huberman, MD

Instructor of Psychiatry

Johns Hopkins University School of Medicine




AH declares that she has no competing interests.


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.


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


Clinical Training Program

Department of Psychology

University of Arkansas




JML declares that he has no competing interests.

David F. Tolin, PhD

Associate Professor

Institute of Living

Yale University

New Haven



DFT declares that he has no competing interests.

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