SPECIFIC PHOBIA

Specific phobia is an anxiety disorder characterized by intense fear of particular objects or situations (e.g., snakes, heights). It is the most common psychiatric disorder.

Epidemiology

Specific phobias are more prevalent in women than men and occur with a lifetime prevalence of 25%.
Typical onset is in childhood, with most cases occurring before age 12.

Etiology

phobic disorders, including specific phobia, tend to run in families. Behavioral theorists argue that phobias are learned by being paired with traumatic events.

Clinical Manifestations

History and Mental Status Examination
A phobia is an irrational fear of a specific object, place, activity, or situation that is out of proportion to any actual danger. To meet the DSM-[V criteria for specific phobia, a patient must experience a marked, persistent fear that is recognized by the patient to be excessive or unreasonable and is cued by the presence or anticipation of a specific object or situation. In addition, exposure to the stimulus must almost invariably provoke the anxiety reaction, and the avoidance of or distress over the feared situation must impair everyday activities or relationships. For those younger than age 18, symptoms must persist for at least 6 months.

Differential Diagnosis
The principal differential diagnosis is another mental disorder (such as avoidance of school in separation anxiety disorder) presenting with anxiety or fearfulness.

Management

Specific childhood phobias tend to remit spontaneously with age. When they persist into adulthood, they often become chronic. However, they rarely cause disability. Exposure therapy in the form of systematic desensitization or flooding is the treatment of choice. There is no role for medication.