Diagnostic Criteria for Phobias

When diagnosing a phobia, mental health professionals must use clinical skills and judgment alongside the written list of diagnostic criteria found in the Diagnostic and Statistical Manual (DSM-5, 5th Edition). Many of the symptoms of phobias are very similar to those of other mental disorders as well as physical illnesses. A phobia can be defined as an intense and irrational fear.

There are three types of phobias, as defined by the DSM-5: specific phobia, social phobia, and agoraphobia. Each type of phobia has its own unique diagnostic criteria.

Differential Diagnosis

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One of the most important steps in diagnosing a phobia is deciding whether the symptoms are better explained by another disorder. This process, which is undertaken by the health care provider, is known as differential diagnosis. Phobias can be traced to specific, concrete fears that adults often recognize as irrational.

The fact that the fear is concrete separates phobias from disorders such as generalized anxiety disorder, in which the anxiety is more broad-based. People who experience phobias are able to pinpoint an exact object or situation that they fear.

Being able to recognize the fear as irrational separates anxiety disorders from psychotic disorders such as schizophrenia. People with psychotic disorders genuinely believe that the fear is based on a real danger, though the nature of the danger appears illogical to others.

Common Criteria

Each type of phobia has its own unique set of diagnostic criteria. However, there are some overlaps. Diagnostic criteria that are similar to all phobias include:

  • Life-Limiting: A phobia is not diagnosed unless it significantly impacts the sufferer’s life in some way.
  • Avoidance: Some people with clinically diagnosable phobias are able to endure the feared situation. However, attempts to avoid the feared situation are an important criterion for diagnosing a phobia.
  • Anticipatory Anxiety: People with phobias tend to dwell on upcoming events that may feature the feared object or situation.

Diagnosing a Specific Phobia

A specific phobia involves intense fear of a specific object or situation. In order for a specific phobia to be diagnosed, one or more objects or situations must be identified as the cause of fear.

There are five different types of specific phobias: the natural/environmental type (such as hurricanes and lightning), the injury type (such as injections, or dental work), the animal type (such as dogs, snakes, or spiders), the situational type (such as enclosed spaces or driving), and the other type (such as choking or loud noises).

People with specific phobias often have other anxiety disorders as well, making it difficult to accurately pinpoint the diagnosis.

Diagnosing Social Phobia

Social phobia is a phobia of interacting with strangers in social situations. Social phobia is now known as social anxiety disorder (SAD) in the fifth edition of the DSM.

It is characterized by marked anxiety or fear about one or more social situations in which the individual might be scrutinized by other people. This can include talking to other people, eating or drinking in front of others, or performing in front of others.

People with this type of phobia feel intense anxiety when forced to endure social situations. These situations almost always trigger the fear response and the amount of anxiety the person experiences is out of proportion to the actual threat that the situation poses.

Social phobia may relate to only one type of situation, or it may be generalized to include all or most social settings.

In order to be diagnosed with social anxiety disorder, the symptoms must be present for six months or longer and must not be better explained by another disorder such as panic disorder.

Diagnosing Agoraphobia

Agoraphobia is characterized by a disproportionate fear of public places. People may have difficulty leaving the house or being in a public place where they cannot easily escape. Symptoms can include anxiety symptoms such as panic attacks when exposed to the source of the fear and avoidance of any situation or place that might trigger the fear response.

Symptoms that a person might experience when faced with a situation they fear include rapid heartbeat, shaking, shortness of breath, numbness, stomach upset, a sense of unreality, and a fear of losing control.

The avoidance behaviors and anticipatory anxiety that characterize agoraphobia make it difficult for people with the condition to function normally, leading to significant disruptions in normal routines and relationships as well as work and social activities.

In order to be diagnosed with agoraphobia, symptoms need to be present for a minimum of six months and should not be better explained by another underlying condition.

A Word From Verywell

If you suspect that you have a phobia, talk to your doctor or mental health professional. These conditions can lead to significant distress and disruptions in your normal life, but effective treatment options are available including behavioral therapy and medications.

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  1. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 16, DSM-IV to DSM-5 Social Phobia/Social Anxiety Disorder Comparison.

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