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Last reviewed: 16 Mar 2025
Last updated: 26 Oct 2022

Summary

Definition

History and exam

Key diagnostic factors

  • anticipatory anxiety
  • behavioral avoidance

Other diagnostic factors

  • onset during childhood
  • onset during early adulthood
  • nausea
  • dizziness
  • disgust
  • fainting
  • tachycardia
  • hyperventilation
  • exaggerated startle
  • sleep disruption

Risk factors

  • somatization disorder
  • anxiety disorders
  • mood disorders
  • first-degree relative with phobia
  • twin with phobia
  • aversive experiences
  • stress and negative life events
  • female sex
  • white ethnicity
  • parental anxiety and overprotectiveness
  • negative affectivity and behavioral inhibition
  • cognitive/attentional bias

Diagnostic tests

1st tests to order

  • self-report
  • behavioral observation and approach tests

Tests to consider

  • structured/semi-structured clinical interview

Treatment algorithm

Contributors

Authors

Amy Huberman, MD

Instructor of Psychiatry

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

AH declares that she has no competing interests.

Acknowledgements

Dr Amy Huberman would like to gratefully acknowledge Dr Eve Friedl, Dr E. Blake Zakarin, Dr Craig N. Sawchuk, and Dr Bunmi O. Olatunji, previous contributors to this topic.

Disclosures

EKF and EBZ declare that they have no competing interests. CNS is an author of a reference cited in this topic. BOO is an author of a reference cited in this topic.

Peer reviewers

Jeffrey M. Lohr, PhD

Professor

Clinical Training Program

Department of Psychology

University of Arkansas

Fayetteville

AR

Disclosures

JML declares that he has no competing interests.

David F. Tolin, PhD

Associate Professor

Institute of Living

Yale University

New Haven

CT

Disclosures

DFT declares that he has no competing interests.

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