Specific Phobia: Anxiety Disorder

Specific Phobia: Anxiety Disorder

DSM-V Diagnostic Criteria• A. Marked fear or anxiety about a specific object or

situation (in children the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging)

• B. The phobic object or situation almost always provokes immediate fear or anxiety

• C. The phobic object or situation is actively avoided or endured with intense fear or anxiety

• D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context

DSM-V Diagnostic Criteria• E. The fear, anxiety or avoidance is persistent, typically lasting

for 6 months or more• F. The fear, anxiety, or avoidance causes clinically significant

distress or impairment in social, occupational, or other important areas of functioning

• G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in OCD); reminders of traumatic events (as in PTSD); separation from home or attachment figures (as in SAD); or social situations (as in social anxiety disorder)

Specify if…• The code assigned is based on the phobic stimulus:• Animal (spiders, insects, dogs)• Natural environment (heights, storms, water)• Blood-injection-injury (needles, invasive medical

procedures)• Situational (airplanes, elevators, enclosed places)• Other (situations that may lead to choking or

vomiting; in children, loud sounds or costumed characters)

Diagnostic Features

• Phobic stimulus• For diagnosis, response must be different

from “normal, transient fears that commonly occur in the population”

• Amount of fear/anxiety experienced may vary with proximity to the phobic stimulus

• Fear/anxiety may happen in anticipation of or in presence of actual stimulus

Diagnostic Features

• Reaction may take form as a full or limited symptom panic attacks

• Fear/anxiety evoked nearly every time contact is made with phobic stimulus

• Fear/anxiety often expressed different in children and adults

• Immediate rather than delayed reaction when in contact with phobic stimulus

Diagnostic Features

• Individual actively avoids phobic stimulus (intentionally behaves in ways that are designed to prevent/decrease contact with phobic stimulus)

• Avoidance behaviors are obvious or less obvious

• Physiological Arousal • Amygdala and related structures

SP Prevalence

• 12 month community prevalence estimate for US ~7-9%

• European countries 6%• Asia, Africa, Latin American countries 2-4%• Children ~ 5% 13-17 year olds 16%• Older individuals 3-5%• Females > males, 2:1 (varies across phobic

stimulus)

Comorbidity

• Unlikely to only present SP without other psychopathology

• Frequently associated with range of disorders• Increased risk for developing other anxiety

disorders, depression, bipolar, substance related disorders, somatic symptom and related disorders, and personality disorders (dependent personality disorder)

Course of SP• SP can occur: after experiencing or observing a

traumatic event, informational transmission, unexpected panic reaction in presence of soon to be phobic stimulus

• Many individuals are unable to recall the reason for onset of SP

• Onset usually in early childhood, majority of cases develop before age 10, (type of SP varies onset)

• Early onset is usually associated with a wax and wane pattern

Risk and Prognostic Factors• Temperamental: Negative affectivity (neuroticism), behavioral

inhibition • Environmental: Parental over protectiveness, parental loss &

separation, physical/sexual abuse, negative or traumatic event• Genetic/Physiological: First degree relative with SP,

significantly more likely to have SAME SP, individuals with blood-injection-injury show unique propensity to fainting in presence of phobic stimulus

• Culture: Asians and Latinos report significantly lower rates of SP/ countries outside of US show differences in disorder

• Suicide: 60% more likely to make suicide attempt w/ SP diagnosis

Differential Diagnosis• Agoraphobia: If individual fears only ONE of the

agoraphobia situations- Specific Phobia-Situational • Social Anxiety Disorder: If situations are feared

because of negative evaluation – SAD not SP• Separation Anxiety Disorder: If situations are feared

because of separation from a primary caregiver or attachment figure- Separation Anxiety Disorder

• Panic Disorder: If the panic attacks only occur in response to the specific phobia stimulus- Specific Phobia

Differential Diagnosis• OCD: If fear or anxiety is result of obsessions and other

diagnostic criteria are met- OCD• Trauma- and stressor-related disorder: If phobia

develops after traumatic event, consider PTSD, only assign SP if ALL PTSD criteria are not met

• Eating disorders: If avoidance behavior is exclusively limited to avoidance of food and food-related cues, anorexia nervosa or bulimia considered

• Schizophrenia spectrum and other psychotic disorders: When fear/avoidance are due to delusional thinking- SP NOT WARRANTED

DSM-V ModelExperience or observation of traumatic event/information

transmission/ situation

Genetic predisposition: First degree relative risk/

amygdala and related structures

Parental environment: protectiveness, separation,

loss, physical or sexual abuse/ neglect

Temperamental: Negative affectivity

Behavioral Inhibition

Phobia Stimulus: Specific object or

situation

Specific phobia

Suicide

Comorbidity

Fears are Normal• Mild fears are fairly common among children (Craske,

1997)• Infancy: children become fearful of stimuli in their

immediate environment (Muris, Merckelbach, de Jong & Ollendick, 2002)

• As child develops, fears start to incorporate anticipatory events and stimuli of an imaginary or abstract nature (Muris et al., 2002)

• This developmental pattern is assumed to reflect everyday experiences and mediated by cognitive capacities (Muris et al., 2002)

Descriptives on SP (Essau, Conradt, & Petermann, 2000)

• Examined the frequency, comorbidity, & psychosocial impairment of SP and specific fears

• First wave of the Bremen Adolescent Study (BJS) (northern Germany)

• How frequent in 12-17 yr olds• Distribution according to sex and age• Comorbidity of other disorders• Level of impairment