DSM-5 Category: Anxiety Disorders

Introduction

Specific phobia is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) diagnosis assigned to individuals who suffer from intense fear or anxiety when exposed to specific objects or situations. A type of anxiety disorder, specific phobias may present in response to a range of stimuli, from animals to medical procedures.

Phobias are defined as extreme or irrational fears, often persistent, that compel sufferers to avoid the object or situation to which their fear is connected. A specific phobia relates to a particular stimulus that causes fear, anxiety or avoidance and results in intense distress for the sufferer.

According to estimates, around 19.2 million adult Americans are afflicted by specific phobias1, with women affected more often than men at an approximate rate of 2:1. Sufferers will often take measures to avoid the object or situation in question, although individuals are aware that their fears are usually greater than the threat itself.

Specific phobias fall under the heterogeneous disorders group, having no single universal cause or pattern of development. Most specific phobias develop during childhood and adolescence, although the disorder may present at any stage, often in connection with a traumatic experience2. Other factors that may be connected to the onset of specific phobia include genetic predisposition and familial influence.

Symptoms

Specific phobia is characterized by a deep and persistent fear of an object or situation, resulting in symptoms of anxiety. Symptoms may also arise from anticipating the presence of the stimulus. An individual displaying symptoms of anxiety may be experiencing:

• Increased heart rate (palpitations)
• Dizziness or unsteadiness
• Nausea
• Sweating
• Shaking or trembling
• An upset stomach
• Breathlessness3

 

Someone suffering from a specific disorder will also display avoidance behavior, meaning that they take steps to avoid having to confront the object or situation at the center of their disorder.

Diagnostic criteria for specific phobia

For a specific phobia to be diagnosed, a number of criteria need to be met, namely:

• The individual suffers from a persistent fear that is either unreasonable or excessive, caused by the presence or anticipation of a specific object or situation
• Exposure to the stimulus usually results in an anxiety response, often taking the form of a panic attack in adults, or a tantrum, clinging, crying or freezing in children
• The sufferer recognizes that their fear is disproportionate to the perceived threat or danger (not always present in children)
• Individuals take steps to avoid the object or situation they fear, or endure such experiences with intense distress or anxiety
• The phobic reaction, anticipation or avoidance interferes with the individual’s normal routine and relationships, or causes significant distress
• The phobia has persisted for a period of time, usually six months or longer
• The symptoms cannot be attributed to another mental condition, such as obsessive-compulsive disorder or post-traumatic stress disorder4

 

There is no single test to determine whether someone is suffering from a specific phobia; healthcare practitioners will form a diagnosis based on the patient’s account of their experiences and sometimes the results of clinical interviews with psychologists.

Types of specific phobias

Phobias can be categorized into simple/specific and complex groups. Types of phobia that fall under the simple/specific umbrella include:

• Environmental phobias - including deep water, heights and germs
• Animal phobias - including a fear of dogs, snakes or spiders
• Situational phobias - such as flying in an airplane or visiting the dentist
• Bodily phobias - including blood or having shots

 

Complex phobias are often more debilitating than simple/specific phobias, having more of a pronounced effect in terms of daily life. These include:

• Agoraphobia - fear of certain places, situations or open spaces
• Social phobia - fear of social situations3

 

Phobia subtypes are recognized differently around the world - in the USA, the DSM-5 recognizes animal, situational, natural and blood-injection-injury as specific phobias. A fifth category is known as ‘other’ - this includes fear of vomiting or choking.

Causes of specific phobia

Specific phobias have no single cause but a number of potentially contributing factors have been identified:

Traumatic experiences - Individuals who have a traumatic experience in childhood may begin to make associations with related situations or objects in adulthood. For example, someone who is bitten by a dog at a young age may develop a fear of dogs in later life.

Learned behavior - The family environment may be a cause of specific phobias - being around relatives who have particular fears, or deal with anxiety in a certain way, is thought to influence children and may contribute to the onset of phobias.

Genetics - Some individuals may be genetically predisposed to having an anxious personality, making them more prone to phobias.

Fear response - Having a panic attack or other pronounced response to fear or panic in a certain situation can lead to feelings of embarrassment or fear of a repeat episode, which over time may develop into a phobia.

Ongoing stress - Over the long term, stress can result in feelings of anxiety, depression and inability to cope in certain situations, which may progress into a phobia5.

Living with specific phobia

Depending on the type of phobia an individual suffers from, the effects on lifestyle, relationships and work may vary. Somebody who is afraid of snakes, for example, is unlikely to come across their phobic stimulus on a day-to-day basis, which means the phobia won’t have as much of an impact on their life as someone with a complex phobia like agoraphobia.

Agoraphobia, social phobia and other complex phobias, meanwhile, can affect individuals on a daily basis. Using the car, going shopping or being around groups of people can cause sufferers of these phobias to experience extreme anxiety and distress.

People with phobias will usually go out of their way to avoid the phobic stimulus - for someone with agoraphobia, they may stick to a set route every day to avoid the object of their fear, while an individual with a fear of heights may avoid specific excursions or activities so as not to experience the perceived threat.

Treatment for specific phobia

There is no single form of treatment for specific phobias and many people take no action to overcome their fear because the stimulus is rarely encountered.

In cases where treatment is appropriate, medical professionals may address the problem with various techniques. Most people can expect to benefit from treatment tailored to their specific needs, which can include:

Cognitive behavioural therapy (CBT) - A talking therapy designed to help individuals overcome problems with a tailored plan of action. As well as talking through issues, CBT challenges individuals to change patterns of thinking and behavior, often including exposure to the phobic stimulus in gradual stages.

Medication - Although specific phobias are anxiety disorders, the disorder itself cannot be treated with medication, although symptoms may be managed with tranquilizers (benzodiazepines), anti-anxiety drugs (beta-blockers) and/or antidepressants (selective serotonin reuptake inhibitors).

Hypnotherapy - While hypnotherapy may not be a standard method of treatment suggested by health practitioners, some individuals have found that it helps relieve symptoms of specific phobia.

Self-help - Individuals may be able to manage the symptoms of their phobia through various self-help methods, such as by practising relaxation techniques or mindfulness. Joining a support group is also an option6,7.

Treatments may be prescribed in isolation or as part of a combined approach. In time, and with the right treatment, most people can expect to make significant progress in managing or overcoming specific phobia.

 

References

1Kessler, Chui, Demler & Walters (2005) Arch Gen Psychiatry. 2005;62(6):617-627. doi:10.1001/archpsyc.62.6.617 Cited at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847357/ Date Accessed: 27/01/2017

2Alladin, A (2016) Integrative CBT for Anxiety Disorders: An Evidence-Based Approach to Enhancing Cognitive Behavioural Therapy with Mindfulness and Hypnotherapy West Sussex: Wiley Blackwell. Cited at: https://books.google.co.uk/books?id=EOTLCgAAQBAJ&pg=PA80&lpg=PA80&dq=Specific+phobias+affect+an+estimated+19.2+million+adult+Americans&source=bl&ots=ev7hTJDE5c&sig=3p1deRzzuIYt24gX0KPaP8ER3V8&hl=en&sa=X&ved=0ahUKEwjb6LuRgb_RAhUJshQKHXiWBCwQ6AEIKzAD#v=onepage&q=Specific%20phobias%20affect%20an%20estimated%2019.2%20million%20adult%20Americans&f=false Date Accessed: 27/01/2017

3NHS (2016) Phobias: Introduction http://www.nhs.uk/Conditions/Phobias/Pages/Introduction.aspx Date Accessed: 27/01/2017

4American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

5Mind (2013) Phobias: what causes phobias? http://www.mind.org.uk/information-support/types-of-mental-health-problems/phobias/causes/#.WItJjvmLTIU Date Accessed: 27/01/2017

6Mind (2013) Phobias: what treatments are available? http://www.mind.org.uk/information-support/types-of-mental-health-problems/phobias/treatments/#.WIugi_mLTIU Date Accessed: 27/01/2017

7Mind (2013) Phobias: how can I help myself? http://www.mind.org.uk/information-support/types-of-mental-health-problems/phobias/self-help/#.WIugMvmLTIU Date Accessed: 27/01/2017

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