Diagnosis of PHOBIC DISORDERS (social phobia F40, agoraphobia F41, specific phobias F40.2)

Presenting Complaints

Social Phobia: Fear and avoidance of social situations in case they are criticised or judged to be inferior or incompetent.

Agoraphobia: Fear and avoidance of situations in which help was unavailable (lonely places) or escape not possible (crowded places) in case of incapacitating anxiety or panic.

Specific Phobias: Fear and avoidance of heights, closed spaces, insects, snakes, animals, still water in case of harm.

• Patients may avoid or restrict activities because of fear
• Anticipatory anxiety is severe

Diagnostic Features

• Unreasonably strong fear of specific places or events.
• Avoidance of situation is a potent handicap.
• Social Phobia: speaking in front of others, being at a social gathering or meeting, eating with others, standing in a line, being the centre of attention for any reason.
• Agoraphobia: being alone, travelling away from home especially in a tunnel or bridge, travelling in planes and trains and buses, being in a crowded shopping centre or standing in line, being at a formal social gathering
• Specific phobias: as defined in presenting complaints

Differential Diagnosis

Differentiate between the three phobias by asking about the consequence: in social phobia the consequence is shame, in agoraphobia the feared consequence is collapse or death, in specific phobias the consequence is harm.

• If anxiety attacks occur in non feared situations, see Panic Disorder.
• If low or sad mood is prominent, see Depression .

Edited by Gavin Andrews MD, UNSW, Jan 03
© 2003 CRUfAD