DSM-5 Criteria
A. Fear or intense anxiety about a specific object or situation (e.g., flying, heights, animals, giving an injection, seeing blood).
Note: In children, fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or resisted with fear or intense anxiety.
D. The fear or anxiety is disproportionate 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 six or more months.
F. Fear, anxiety, or avoidance causes 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, such as fear, anxiety, and avoidance of situations associated with panic-like symptoms or other disabling symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder);
memory of traumatic events (as in post-traumatic stress disorder); leaving home or separation from attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).
Specify if:
Encoding 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-wound (e.g., needles, invasive medical procedures)
Coding Note: Select the specific ICD-10-CM code as follows: F40.230 fear of blood; F40.231 fear of injections and transfusions; F40.232 fear of other medical care; or F40.233 fear of injury.
300.29 (F40.248) Situational (e.g., airplane, elevator, closed spaces)
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, all applicable ICD-10-CM codes must be recorded (e.g., fear of spiders and traveling by plane, F40.218 specific phobia, animal, and F40.248 specific phobia , situational)
Simple phobias, also called specific, can involve objects or situations such as closed spaces, insects, heights, darkness, elevators, bridges, animals, flying, etc. A simple phobia differs from agoraphobia in that the anxiety is focused on a specific external object or situation and is present only when facing (imagined or real) that object or situation.
Simple phobias are common and normally do not cause major problems in daily life, as they tend to be avoided as much as possible. A phobia becomes a problem only when the feared object or situation cannot be easily avoided and is relevant to the individual’s personal or work life.
How can you acquire a phobia?
When developing an anxiety disorder, it is necessary to take into account both the internal factors of personality and character and the external factors related to traumatic events, education styles, family environment, etc., since both interact with each other giving gives rise to greater or lesser vulnerability in each person when suffering from such treatments.
We can talk about three common possibilities in acquiring the phobia:
- Classical conditioning. When the person experiences an unpleasant experience, for example, developing a phobia of flying when having an emergency landing, in which the plane becomes a conditioned stimulus for the anxiety response.
- Cognitive learning. Through the information received, which can come from different sources, especially those that the individual considers most relevant. For example, it may be the case that you have heard stories about the dangers of the sea, have seen movies about shipwrecks or have read a news story about people drowning and develop an intense fear of water that can lead to a phobia.
- Modeling. When a significant person (especially in parent-child relationships) has intense fear of some situation or object, the individual can develop a learning phobia. Just as it can happen if you are present during a traumatic or painful experience experienced by someone close to you.
Components of phobias
It is convenient to distinguish between two components of phobias: phobic anxiety and phobic avoidance.
When we talk about phobic anxiety We refer to the one that appears in the imagined or real presence of the feared situation, object or person, showing itself through a multitude of physiological symptoms such as tachycardia, difficulty breathing, sweating, cognitive symptoms such as perception of insecurity or loss of control, and engines like paralysis.
The avoidance It refers to the tendency to avoid contact with the phobic stimulus. As a result of anxiety, the individual tends to gather all possible information about situations related to the stimulus, trying to avoid those in which it is considered that there is danger or threat. When you flee from an anxiety-generating situation, this behavior is reinforced by producing immediate relief in the person. So the tendency to avoid is maintained over time and, in turn, the feeling of anxiety about the phobia increases.
Types of Phobia
The stimuli that can cause phobic reactions are practically unlimited and of all kinds, such as phobias of darkness, blood, wind, driving, etc. Following the DSM-IV classification we can distinguish five categories:
- Animal Type. It refers to different types of animals, which include everything from insects (cockroaches, spiders, etc.) to mammals (dogs, cats, etc.), including birds and, of course, reptiles, with snake phobia being one of the most common. This type of phobia usually appears in childhood.
- Environmental Type. Like the previous ones, it usually begins in childhood and refers to events related to nature and natural phenomena such as hurricanes, deep waters, wind, etc.
- Blood Type-Injections-Damage. The anxiety reaction occurs here when faced with stimuli related to blood, operations, wounds and even everything that is related to the hospital or surgical environment). This type usually occurs in members of the same family and fainting is a characteristic symptom.
- Situational type. They refer to those situations that share common conditions, such as closed places such as elevators, airplanes, public transportation, etc.
- Other types. Included in this group are situations that may lead to illness, choking, or vomiting. In addition, fears of restraint, of losing automatisms, of loud noises, etc. may also appear.
Treatment
The psychological therapies that have been most researched as beneficial for people with a phobia are: the “flood” technique or graduated exposure therapies, among which is Systematic Desensitization (SD). All of these techniques are part of the cognitive-behavioral therapy (CBT) approach.
Most people who have phobias understand that they are suffering from an irrational or disproportionate fear, although this recognition does not prevent them from continuing to express that intense emotional reaction to the phobic stimulus. Graded exposure and CBT work with the goal of desensitizing the person and changing the thought patterns that are contributing to the person’s fear.
CBT-based techniques are often effective, as long as the person with this problem is willing to undergo treatment that can last a few months (sometimes weeks).
Within the so-called third generation behavioral therapies, good results are also being achieved with Acceptance and Commitment Therapy (ACT) as a complement to CBT, with the aim of generalizing the results and preventing relapses.