| Individuals with specific phobias have unwarranted and intense fears of specific objects or situations. The most common phobias are of animals (zoophobia), blood (hemophobia), heights (acrophobia), travel by airplane (aerophobia), being closed in (claustrophobia), and thunderstorms (keraunophobia). Others include spiders (arachnophobia), strangers (xenophobia), and crowds (agoraphobia). Phobias may develop after a firsthand experience of being injured, or after witnessing another person become injured.
The anxiety produced by exposure to one of these objects or situations may be a panic attack or more generalized anxiety, but it is always directed at something specific. The individual imagines harmful consequences resulting from contact with the object. For example, those with a snake phobia are afraid of being bitten, while those with claustrophobia are afraid of suffocation or of being trapped forever. Individuals with this disorder also worry about what they might do (i.e., faint, panic, or lose control) if they have to confront the feared stimulus. The symptoms often get worse when the individual is closer to the source of their fear. Individuals with specific phobias involving blood, injury, or injection often faint because of a "vasovagal response" associated with reduced heart rate and blood pressure.
Although adolescents and adults may acknowledge that their fears are unrealistic, they may continue to be fearful. The fear usually compels them to avoid the situation, but it may sometimes be endured with great discomfort. Such fear and avoidance may lead to significant distress or impairment in personal, social, or occupational functioning.
The disorder has five subtypes: (1) "animal"; (2) "natural environment," which involves triggers such as thunderstorms or heights; (3) "blood/injection/injury"; (4) "situational," in which activities such as flying or driving causes fear; and (5) "other," which includes fears brought on by additional triggers such as emesis or becoming sick. Situational is the most frequently occurring subtype.
This diagnosis is not made if symptoms are part of another mental disturbance, such as panic disorder with or without agoraphobia, agoraphobia by itself, separation anxiety disorder, social phobia, post-traumatic stress disorder, or obsessive-compulsive disorder.Risk: Although fear of animals, heights, or water can begin in childhood, the onset peaks again in the early twenties. More women than men have specific phobias. Family members of people with specific phobias are at increased risk for developing them. Incidence and Prevalence: Among the general population, specific phobia is one of the most frequently reported of the anxiety disorders. Roughly 4% to 8.8% of adults in the US have suffered to some degree from a specific phobia, although they may not always meet criteria for clinical diagnosis (DSM-IV-TR 447). |
Source: Medical Disability Advisor
| History: According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision), the following criteria are necessary for this diagnosis to be made: The individual experiences a persistent and unreasonable fear, provoked by a specific situation or object. The fear stimulus almost always immediately provokes an anxiety response. The fear is out of proportion to the situation and unreasonable, and the individual realizes this. The individual either avoids the fear stimulus or endures it with severe anxiety or stress. Either there is marked distress about the fear, or the fear markedly impairs personal, social, academic, or occupational functioning. The symptoms are not better explained by another anxiety or mental disorder. For those younger than 18, the phobia must be present for at least 6 months for a diagnosis of phobia to be made. Physical exam: The physical exam, if done at the time of a phobic response to needle injections, can show a very slow heart rate and low blood pressure (vasovagal reaction). Vasovagal reaction can occur in about 75 % of people who present with a fear of blood, injection, or injury (DSM-IV-TR 446). Tests: Tests are not diagnostic for this disorder, although projection tests such as the Rorschach or Thematic Apperception Test, or personality inventories such as the Minnesota Multiphasic Personality Inventory, may assist in diagnosis. Blood tests can be performed to check thyroid function, glucose, and calcium. Cardiac enzymes can be checked to rule out heart attack. Imaging studies such as MRI and head CT will help eliminate the possibility of other medical problems. An echocardiogram can rule out any cardiac conditions that may be causing a problem, such as mitral valve prolapse. An ECG can detect irregular heart rhythms that may be causing the symptoms. |
Source: Medical Disability Advisor
| The treatment of choice is exposure therapy to the feared object or situation, which is also known as systematic desensitization. This therapy works for those who are truly committed to change. It involves specific objectives and strategies and could begin just by imagining contact with the source of fear and then proceeding to real-life contact. Exposure is usually gradually increased but can also be done suddenly ("flooding"). Exposure therapy is done individually or as a group. As expected, the treatment plan depends on the individual's specific phobia. For example, a claustrophobic person may need to practice being in a confined space, whereas an individual who is afraid of animals may be asked to own a pet during the course of therapy. Insight-oriented psychotherapy is used less frequently. If the phobic symptoms include panic attacks, anti-anxiety medication and selective serotonin reuptake inhibitors (SSRI), or tricyclic antidepressants may be used. |
Source: Medical Disability Advisor
| Even with proper treatment, only 1 of 5 phobias that begin in childhood and extend into adulthood resolve completely. |
Source: Medical Disability Advisor
| Individual who fear needles may neglect their medical and dental health. Suicidal thoughts are more common in individuals with specific phobias than in the general population, but actual suicide attempts suggest another accompanying psychiatric disorder. There can be impairments in personal, social, academic, or occupational functioning, and the individual may be unaware that the phobia causes them. The presence of a personality disorder may also complicate this disorder. |
Source: Medical Disability Advisor
| Time-limited restrictions and work accommodations should be individually determined based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of any restrictions or accommodations is to keep the worker at the workplace without disruption or to promote a timely, safe transition back to full work productivity. Specific accommodations may vary depending on the phobia, such as allowing individuals with claustrophobia to avoid cramped work environments or helping individuals with xenophobia deal with the public. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual fit the criteria of specific phobia?
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Has diagnosis been confirmed?
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If individual does not recognize that the fear is excessive or unreasonable, could individual have a delusional disorder instead?
Regarding treatment:
- Has current therapy helped individual confront and overcome his or her fear?
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Is therapist trained in cognitive-behavioral therapy?
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Is therapist experienced in working with individuals with phobias?
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Has individual been taught skills needed for other social situations?
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Is individual involved in behavioral group therapy as well as individual therapy?
Regarding prognosis:
- If current therapy does not appear to be effective, what changes can be made?
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Is individual's ability to function greatly impaired?
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Since specific phobias do not usually interfere with daily life or cause as much distress as most other anxiety disorders, should diagnosis be reviewed?
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Source: Medical Disability Advisor
| Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000. |
Source: Medical Disability Advisor
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