Diagnosing a Specific Phobia

Diagnostic Criteria for a Specific Phobia

Patient In Consultation with Doctor
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A specific phobia is an intense and irrational fear of a specified object or situation. This anxiety disorder affects about 19 million adults and women are two times more likely than men to have a specific phobia. Some patients suffer multiple specific phobias simultaneously.

There are four categories of specific phobia:

  1. natural, including a fear of thunder and lightning (astraphobia) or water (aquaphobia)
  1. mutilation, including a fear of the dentist (dentophobia),  or injections (trypanophobia)
  2. animal, including dogs (cynophobia), snakes (ophidiophobia), and insects (entomophobia)
  3. situational, including washing (ablutophobia) and enclosed spaces (claustrophobia)

What Are the Criteria for a Specific Phobia Diagnosis?

A fear and a phobia are not the same, so it's important to know the difference. Your therapist cannot use a lab test to make a diagnosis so she and other mental health professionals consult the DSM-V (Diagnostic and Statistical Manual, 5th Ed., 2013). This guide provides specific diagnostic criteria for specific phobia from the American Psychiatric Association:

  • Unreasonable, Excessive Fear: excessive or unreasonable, persistent and intense fear triggered by a specific object or situation.
  • Immediate Anxiety Response: The fear reaction must be out of proportion to the actual danger and appears almost instantaneously when presented with the object or situation.
  • Recognition the Fear Is Irrational Not Required: In previous DSM editions, adults with specific phobias had to recognize that their fears are out of proportion to reality, but children did not. The 2013 edition now says the adult patient no longer has to recognize the irrationality of their behavior to receive a diagnosis.
  • Avoidance or Extreme Distress: The sufferer goes out of her way to avoid the object or situation, or endures it with extreme distress.
  • Life-Limiting: The phobia significantly impacts the sufferer’s school, work or personal life.
  • Six Months Duration: In children and adults, the duration of symptoms must last for at least six months.
  • Not Caused by Another Disorder: Many anxiety disorders have similar symptoms. Therefore, your therapist must rule out other disorders before diagnosing a specific phobia.

Preparing for the Specific Phobia Intake Interview

Have decided you it's time to seek professional help for your fear? In order to make the most of your appointment, and help your therapist determine if you have a fear or a phobia, you can prepare three lists:

  1. Symptoms: Make a list of physical and psychological symptoms, including your trigger, how you cope with your fear, and things that make your anxiety better or worse.
  2. Personal life: Make a list of anything stressful going on in your life, including a divorce or trouble at work. Listing new situations that seem like a positive thing, including a promotion or a budding romantic relationship, is also important as good news can cause anxiety too.
  1. Medication and supplements: Make a list of all medication and supplements you take regularly, such as vitamins and herbal teas. These substances can affect your mental state and interfere with treatment.

Ask Questions During Your Visit

While you're in the therapist's office to determine if your fear is a specific phobia, use your time wisely and ask any questions you have. Worried you won't be able to think of any on the spot? Here are some you can use:

  • What options for treatment do you recommend?
  • How can I best manage my other health conditions while in treatment?
  • If I follow the recommended treatment plan, how much improvement can I expect to see?

Sources:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author.

Anxiety and Depression Association of America: Facts and Statistics

Mayo Clinic: Phobias (2014)

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