History and exam
Key diagnostic factors
common
anticipatory anxiety
Anticipation of contact with phobic stimuli may be associated with catastrophic thoughts and fears of being unable to cope.
behavioral avoidance
Greater degrees of avoidance are typically associated with increased levels of functional impairment. Patients may endure situations with marked distress.
Other diagnostic factors
common
onset during childhood
onset during early adulthood
Situational phobias often arise in adolescence or early adulthood.
nausea
Nausea may be provoked upon exposure to certain phobic cues, especially those involving blood-injury.
dizziness
Dizziness may be experienced upon anticipated or actual exposure to phobic stimuli.
disgust
Disgust of objects or situations, either alone or in combination with fears, may be involved in the onset and maintenance of various animal and blood-injection-injury phobias.[15]
fainting
Up to 80% of people with blood-injection-injury phobias may have fainting episodes.[24]
tachycardia
Heart rate may be increased upon exposure or anticipated exposure to phobic cues. However, physiologic response varies. While individuals with situational, natural environment, and animal-specific phobias are likely to show sympathetic nervous system arousal, those with blood-injection-injury phobias often demonstrate a vasovagal fainting response marked by an initial brief acceleration in heart rate and blood pressure, followed by deceleration in heart rate and drop in blood pressure.[45]
hyperventilation
Hyperventilation may occur upon exposure or anticipated exposure to phobic cues.
exaggerated startle
There may be exaggerated startles upon exposure or anticipated exposure to phobic cues.
uncommon
sleep disruption
Sleep disruption may develop due to high levels of anticipatory anxiety and worry: for example, anticipation of air travel.
Risk factors
strong
somatization disorder
The onset of a phobia is >10 times more likely in an individual with a diagnosis of somatization disorder than in a person with no other psychiatric disorder.[28]
anxiety disorders
mood disorders
first-degree relative with phobia
First-degree relatives of individuals with specific phobias are roughly 3.9 times more likely to develop a specific phobia than first-degree relatives of nonaffected individuals.[30]
twin with phobia
Monozygotic twin pairs are more likely to share a diagnosis of a specific phobia than dizygotic twin pairs, suggesting that genetics can contribute to symptom-onset vulnerability. Based on twin studies, blood-injection injury and animal phobias have been found to be the most heritable of the phobias, with heritability indices of roughly 33% and 32%, respectively.[31]
weak
aversive experiences
Onset of phobias can be precipitated by prior experiences with specific objects or situations. Direct and vicarious traumatic learning experiences are common.[14] At the same time, a majority of individuals with phobias of evolutionary-based threats (such as heights or spiders) do not recall negative or aversive experiences at the onset of their phobias.[16]
stress and negative life events
Onset of phobias can be precipitated by negative or stressful life events such as relationship difficulties, relocations, and economic difficulties.[32]
female sex
Phobias are approximately 2 to 3 times more common among women than men.
white ethnicity
Phobias are more common among white people than among Hispanic and Asian people.
parental anxiety and overprotectiveness
Parental anxiety and overprotective behaviors can play a role in the development and maintenance of anxiety disorders, and specific phobias in particular.[33]
negative affectivity and behavioral inhibition
cognitive/attentional bias
Increasing literature supports that attentional biases toward threat are associated with the development and maintenance of specific phobias.[36]
Use of this content is subject to our disclaimer