specific phobia

Specific Phobia Symptoms and Related DSM-5 Diagnosis

Specific phobia 300. 29 (F 40. __)

Specific phobia is when an individual has a very high level of fear or anxiety in the presence of a specific circumstance or object. The target object or situation is referred to as the “phobic stimulus”. This fear or anxiety must be significantly disproportionate to the actual threat involved. Specific phobia was first identified as a mental health disorder in the DSM-III published by the American Psychiatric Association in 1987. Some studies have concluded that this phobic disorder carries a lifetime prevalence rate of 9.4% to 12.5%.

Specific Phobia: Main Features

The primary feature of a specific phobia is a very significant fear or anxiety of a specific object or situation which is very disproportionate to the actual threat. A specific phobia can result from experiencing or even witnessing a traumatic experience. Subsequently, the individual will then avoid any exposure or memory of the situation or object. The anxiety and fear will occur at every exposure and may even include panic attacks. The median age of onset is approximately 13 years old.

Significant physiological change occurs resulting in symptoms of accelerated heart rate and blood pressure, hyperarousal, and feeling faint. An individual’s quality of life and daily functioning can be significantly impaired. It is very important to have early intervention as the rate of recovery among children has been found to be about 60% after being treated with cognitive behavioral therapy.

It is important to consider ethnicity and culture when diagnosing specific phobia. In the context of some cultures, fear and anxiety from certain situations and objects may be very real, An example may be a fear of spiders in some geographic locations. African-Americans may have the highest prevalence of specific phobias followed by Caucasians in the United States. Latinos and Asians seem to possess lower rates of specific phobia among the main ethnic groups in the United States. The diagnosis should not be given if a fear is either relevant or proportional when considering the cultural context.

In addition to cultural considerations, it is also important to consider the developmental level involved. Childhood fears and anxieties may be more easily resolved or grown out of then the phobic responses of adults.
It is important to understand the degree of impairment and distress associated with a specific phobia. It is also very important to differentiate it from other phobic reactions. Agoraphobia is known to have many fears that seem to overlap with specific phobias. It would be necessary for the mental health clinician to diagnose agoraphobia when there is more than one object or circumstance that is feared. Social anxiety disorder (social phobia) may be diagnosed when social situations are the source of the fear and anxiety rather than specific phobia. Panic attacks may also occur in relation to feared objects. However, the diagnosis of panic disorder should always supersede the diagnosis of specific phobia if the panic attacks occur unexpectedly.

Specific Phobia Coding:

The ICD-9-CM coding system only included one diagnostic code for specific phobia (300.29). Under the newer ICD-10-CM system assignment is given in relation to the specific phobia involved. Under this newer system, psychologists and counselors should utilize all the codes involved. It has been noted that approximately 75% of individuals diagnosed with a specific phobia fear more than one object or situation. In cases where the individual also experiences panic attacks, the mental health clinician should also add with panic attacks to their specific diagnosis. A complete list of specifiers for specific phobia are listed on the Anxiety Disorders page. An overview of specific phobia information and treatment can also be found on this website.

Diagnostic criteria for specific phobia follow.

Specific Phobia diagnostic criteria:

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or cleaning.

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.

E. The fear, anxiety, or avoidance is persistent, typically lasting for six months or more.

F. The fear, anxiety, or avoidance cause 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 obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Specify if:
Code based on the phobic stimulus:

300. 29 (F40.218) Animal (e.g., spiders, insects, dogs).

300.29 (F40. 228) Natural environment (e.g., heights, storms, water).

300.29 (F40.23x) blood-injection-injury (E. G., Needles, invasive medical procedures).
Coding note:
ICD-10-CM code as follows:
F40.230 fear blood
F40.231 fear of injections and transfusions
F40.232 fear of other medical care
F40.233 fear of injury.

300. 29 (F40. 248) Situational (e.g., airplanes, elevators, enclosed places).

300. 29 (F40. 298) Other (e.g., situations that may lead to choking or vomiting; in children, e.g. loud sounds or costumed characters).
Coding note: When more than one phobic stimulus is present, code all ICD-10-CM codes that apply (e.g., for fear of snakes and flying, F40.218 specific phobia, animal, and F40.248 specific phobia, situational).

Diagnostic Information and Criterion adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist

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