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Tests and diagnosis
By Mayo Clinic staffThere are no laboratory tests for phobias. Instead, the diagnosis is based on a thorough clinical interview and rigorous diagnostic guidelines. Your doctor will ask questions about your symptoms and take a medical, psychiatric and social history.
To be diagnosed with a phobia, you must meet certain criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.
Specific phobias
The diagnostic criteria for specific phobias include:
- A persistent and intense fear triggered by an object or situation, such as snakes, spiders or storms.
- An immediate anxiety response when you confront the source of your fear.
- Knowing that your fear is irrational or exaggerated but feeling powerless to control it. This doesn't apply to children, who often don't have the maturity to recognize that their fear is unreasonable.
- Avoiding what you fear at all costs, or enduring it with extreme distress.
- No other explainable reason for your symptoms, including medical conditions and other anxiety disorders.
- In children and teens, symptoms lasting at least six months.
Social phobia
The diagnostic criteria for social phobia include:
- A persistent and intense fear of humiliating or embarrassing yourself in one or more social situations — usually with unfamiliar people or when you're under close scrutiny.
- Exposure to the situations you fear creates intense anxiety, which may take the form of a panic attack.
- Knowing that your fear is unreasonable or exaggerated but feeling powerless to control it.
- Avoiding the social or performance situations that you fear or enduring them with extreme distress.
- The phobia and its complications severely affect your life, including your job, social activities and relationships.
- No other explainable reason for your symptoms, including health problems, medication or other psychological disorder.
In children, additional diagnostic criteria for social phobia include:
- Fear and social anxiety with other children, not just with adults.
- Anxiety expressed by crying, tantrums, freezing or shrinking from social situations with unfamiliar people.
- Often, an inability to realize that their fears are unreasonable.
- Phobia lasting at least six months.
Agoraphobia
The criteria for a diagnosis of agoraphobia include:
- An irrational fear of being alone in a place or situation where you would be unable to find help or to escape easily if you were to have a panic attack. People with agoraphobia might fear being in a large crowd, standing in line, or traveling on a bus, train or automobile. In the most severe cases, they may never leave the house.
- The avoidance of anxiety-provoking situations whenever possible. Having to face these situations causes extreme distress.
- No other explainable reason for your symptoms, such as a medical condition, medication or other psychological disorder.
- Let's talk facts about phobias. American Psychiatric Association. http://healthyminds.org/multimedia/phobias.pdf. Accessed Oct. 31, 2008.
- Kendler KS, et al. A longitudinal twin study of fears from middle childhood to early adulthood: Evidence for a developmentally dynamic genome. Archives of General Psychiatry. 2008;65(4):421-429.
- Ciechanowski P, et al. Overview of phobic disorders in adults. http://www.uptodate.com/home/index.html. Accessed Oct. 31, 2008.
- Social phobia (Social anxiety disorder). National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/social-phobia/index.shtml. Accessed Oct. 31, 2008.
- Anxiety disorders. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/anxiety-disorders/complete-publication.shtml. Accessed Oct. 31, 2008.
- Fava GA, et al. Long-term outcome of social phobia treated by exposure. Psychological Medicine. 2001;31:899-905.
- Agoraphobia. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Washington, D.C.: American Psychiatric Association, 1994. http://www.psychiatryonline.com. Accessed Oct. 31, 2008.
- Specific phobias. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Washington, D.C.: American Psychiatric Association, 1994. http://www.psychiatryonline.com. Accessed Oct. 31, 2008.
- Social phobia. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Washington, D.C.: American Psychiatric Association, 1994. http://www.psychiatryonline.com. Accessed Oct. 31, 2008.
- Mancini C. Social phobia in children and adolescents. Canadian Psychiatric Association. http://ww1.cpa-apc.org:8080/Publications/Archives/Bulletin/2001/May/Social.asp. Accessed Oct. 31, 2008.
- Bruce TJ, et al. Social anxiety disorder: A common unrecognized social disorder. American Family Physician. 1999;60(8):2311-2322.
