How Phobia Is Diagnosed

People who have a specific phobia, also called a simple phobia, experience excessive and persistent fear and/or avoidance of specific objects or situations. Common types of specific phobias are those concerning heights or certain animals, such as spiders.

A phobia is a type of anxiety disorder. While it is common to feel anxious in some circumstances, those with phobias feel anxiety out of proportion to the actual danger caused by the situation or object.

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Specific phobias typically develop during late childhood or early adolescence. A diagnosis of the disorder will be made clinically by a mental health practitioner using the specific criteria described in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5).

An estimated 12.5% of U.S. adults experience specific phobia at some time in their lives. It is one of the most common types of anxiety disorders.

Professional Screenings

A primary care physician may do the initial screening. They will then refer you or your loved one to a licensed mental health professional who can provide an official diagnosis and potential treatment.

This diagnosis will be based on a thorough clinical interview using the criteria described in the DSM-5, which provides the diagnostic criteria from the American Psychiatric Association.

During the interview, you or your loved one will be asked about the symptoms you or they are experiencing. The mental health professional will also take a medical and family history. They may ask questions such as whether other family members have had phobias and about any experiences or trauma that might have triggered the phobia.

According to the DSM-5, a diagnosis of specific phobia requires the following:

  • Marked fear or anxiety about a specific object or situation
  • That the phobic object or situation almost always provokes immediate fear or anxiety
  • That the phobic object or situation is actively avoided or endured with intense fear or anxiety

The criteria require that the fear, anxiety, and avoidance:

  • Are out of proportion to the actual danger posed by the specific object or situation and to the socio-cultural context
  • Cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • Are persistent, typically lasting for six months or more

The DSM-5 also requires that the symptoms of another mental disorder do not better explain the disturbance.

Onset

Out of all anxiety disorders, specific phobias have been found to have one of the earliest ages of onset. According to a 2017 meta-analysis, the average age of onset for specific phobias is 11 years.

Specific phobias have high comorbidity, where there are one or more other mental health disorders, especially after the onset of the phobia.

A 2019 study that looked at mental health surveys carried out by the World Health Organization (WHO) in 16 countries worldwide found that childhood-onset specific phobias were related to adverse mental health outcomes throughout someone’s life.

The study also found that the development of social phobias during childhood increased the severity of other psychiatric disorders that a person would go on to experience.

It is normal for children and adolescents to experience some kind of specific fear at one point or another during their development. This means they do not always have specific phobias.

Determining Subtypes

According to the DSM-5, specific phobias can be categorized under the following general categories:

  • Animals: Such as spiders (arachnophobia), insects (entomophobia), and dogs (cynophobia)
  • Natural environments: Such as heights (acrophobia), storms (astraphobia), and water (hydrophobia)
  • Certain situations: Such as airplanes (aerophobia), elevators, and enclosed spaces
  • Blood-injection-injury: Such as needles (aichmophobia) and invasive medical procedures
  • Other types: Including the avoidance of situations that may lead to choking, vomiting, or contracting an illness, and in children, avoidance of loud sounds or of costumed characters (fear of clowns is called coulrophobia)

The mental health professional will determine which category the specific phobia belongs to during the diagnosis.

Differential Diagnosis

One of the most important steps in identifying a specific phobia is establishing whether its symptoms are better explained by another disorder. This is important as, while they may appear similar, they are treated in different ways.

During the diagnosis, the mental health professional will need to establish that the symptoms you are experiencing are not better explained by symptoms of other disorders, especially other anxiety disorders.

The most common disorders that may better explain the symptoms of specific phobias are the following:

Agoraphobia

Agoraphobia is characterized by a marked fear or anxiety about situations, including using public transportation, standing in line or being in a crowd, being outside the home, and being in open spaces or enclosed spaces such as shops or theaters.

The person fears or avoids these situations because of concerns that escape may be difficult if they panic or have other incapacitating symptoms.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a chronic mental health condition that involves uncontrollable and unwanted thoughts (obsessions) and/or behaviors (compulsions) that are often repetitive and aimed at reducing anxiety.

According to the DSM-5, if there are symptoms such as fear, anxiety, or avoidance of objects or situations related to obsessions, then the disorder may be better described by obsessive-compulsive disorder rather than specific phobias.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a mental health condition where you struggle to recover long after you experience or witness a deeply terrifying event.

According to the DSM-5, symptoms might be better explained by PTSD rather than specific phobias if the fear, anxiety, or avoidance is connected to reminders of traumatic events.

Separation Anxiety Disorder

Separation anxiety disorder is a condition in which a person feels extreme fear or distress when separated from an emotional attachment, such as a parent, a loved one, or a place they feel safe, like their home.

According to the DSM-5, fear, anxiety, or avoidance related to separation from home or attachment figures may be better explained by separation anxiety disorder than specific phobias.

Social Anxiety Disorder

Social anxiety disorder (SAD) involves a dread of social situations including performing or speaking in front of others for fear of being negatively judged. As such, fear, anxiety, and avoidance of social situations may be better explained by social anxiety disorder rather than specific phobias, according to the DSM-5.

Labs and Tests

There are no lab tests that can diagnose a specific phobia. The only way to diagnose a specific phobia is by consulting the criteria in the DSM-5.

Self/At-Home Testing

A diagnosis of phobia must be made by a mental health professional. However, recognizing the signs can help you seek help as soon as possible. This is important, as early treatment increases the chance of successful recovery.

Many people with specific phobias may realize that their fears are irrational. However, even thinking about facing the object or situation of their phobia can cause severe anxiety symptoms.

Signs that you may have a phobia include if you:

  • Have an irrational or excessive worry about encountering the feared object or situation
  • Take active steps to avoid the feared object or situation
  • Experience immediate intense anxiety upon encountering the feared object or situation
  • Endure unavoidable objects and situations with intense anxiety

If you have altered your life in some way due to the fear or anxiety you are experiencing, this may be a sign you have a specific phobia. The degree to which you have done so will depend on the kind of phobia you experience.

For example, some phobias concern certain animals, such as spiders (arachnophobia) or dogs (cynophobia). In these cases, you might be avoiding or removing yourself from situations where you come across these animals.

In other cases, where the specific phobia is associated with something that cannot so easily be avoided, the phobia may have caused you to severely change how you live your life. For example, a phobia of heights (acrophobia) might be preventing you from working in a specific building or driving a certain route.

Remember that self-assessment screens should not be the only strategy in making a diagnosis. If you are experiencing any of these symptoms, you should seek help from a mental health professional.

A Word From Verywell

While it can be very distressing if you or your loved one has specific phobias, remember that effective treatment is available and that seeking help as early as possible increases the chance of successful recovery.

If you have a loved one who experiences specific phobias, remember that it is a mental health disorder and they cannot control their symptoms. Support them to seek help and speak to a mental health professional about what they are experiencing.

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Article Sources
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