Diagnosis of Phobias

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There is no diagnostic laboratory test for phobias. Diagnosis is based on the patient's account of their experiences. The American Psychiatric Association provides criteria for the diagnoses of agoraphobia, social phobia, and specific phobia in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.

Diagnostic Criteria for Agoraphobia
- The person experiences anxiety about being trapped in places or situations that might be difficult or embarrassing or that might trigger a panic attack.
- Situations are avoided or endured with great distress or anxiety about having a panic attack.
- Avoidance is not caused by another disorder such as social phobia, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, or separation anxiety.
Diagnostic Criteria for Social Phobia
- The person fears or is anxious about experiencing public embarrassment or humiliation in social or performance situations.
- Being in such situations creates intense anxiety and possibly a panic attack.
- The person knows that the fear is excessive and irrational.
- Social or performance situations are avoided or endured with great distress.
- The condition disrupts their ability to function at work or school and causes them to withdraw from social activities and/or relationships, or the fact that they have the phobia causes them distress.
- The condition persists for at least 6 months in people over the age of 18.
- Fear and avoidance are not caused by other mental disorders, a medical condition, or the effects of a drug.
Diagnostic Criteria for Specific Phobia
- The person experiences excessive or irrational fear of a specific object or situation.
- Exposure to the object or situation causes an immediate anxiety response or a panic attack.
- The person knows that the fear is excessive and irrational.
- The object or situation is endured with distress or avoided.
- Avoidance, anticipatory anxiety, or distress during exposure to the feared object or situation interferes with the person's ability to function in normal daily activities. The person may have distress about having the phobia.

Differential Diagnosis
The most difficult aspect of diagnosing phobias is sorting them out from other psychiatric disorders (e.g., paranoia, schizophrenia, obsessive-compulsive disorder) in which fear is associated with situations or specific objects.

Paranoia and schizophrenia can cause social withdrawal and isolation, as both agoraphobia and social phobia do. The fear in paranoia is usually associated with the perceived malevolent intent of another person or persons. In schizophrenia, delusions and hallucinations may produce irrational and excessive fear of objects or situations. The major distinction between the fear experienced in these disorders and the phobias is this: People with paranoia and schizophrenia are convinced that the causes of their fears are real and that their fears are rational, while adults with phobias know that the symptoms of fear and anxiety that they experience are excessive and irrational responses to essentially benign objects and situations.

A person with obsessive-compulsive disorder can fear objects, situations, or events (e.g., contamination). Avoiding the thing that causes their fear is common among people with OCD and specific phobias. People with phobias, however, do not obsess about their fears and do not adopt compulsive behavior in order to relieve their anxiety.

Course
Onset of agoraphobia is usually within a year of the onset of repeated panic attacks. If the panic attacks are resolved the agoraphobia sometimes resolves too. However, in some cases the agoraphobia becomes chronic whether or not the person continues to experience panic attacks. Age of onset is typically in the 20s, although it can occur at any age.

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Onset of social phobia is usually in the teens. It may follow a pattern of social hesitation or shyness, or it may suddenly develop after a humiliating or disturbing experience in public.

The onset of specific phobia usually occurs in childhood and resolves by adulthood. Phobias caused by traumatic events, however, can occur at any age. Phobias with adult onset or that continue from childhood into adulthood tend to be chronic. Many specific phobias can be "lived with" because they don't impair the person's ability to function in their daily routine.

Diagnosis of Phobias

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