Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V

Abstract

The present review was conducted in order to evaluate the current diagnostic criteria for specific phobia (SP) in light of the empirical evidence gathered since DSM-IV and to propose changes to DSM-V where change is clearly and reliably indicated by the evidence. In response to questions put forth by the DSM-V Anxiety, OC Spectrum, Posttraumatic, and Dissociative Disorder Work Group, four primary areas were determined for this review: the accuracy and utility of the current SP type classification system, the validity of test anxiety as a type of SP, the boundary between agoraphobia and SP, and the reliability and utility of the diagnostic criteria for SP. Developmental issues are addressed within each area. Literature reviews examining academic findings published between 1994 and 2009 were carried out and the results are included herein. The review presents a number of options and preliminary recommendations to be considered for DSM-V. All of these recommendations should be considered tentative as they await the field trials and expert consensus necessary prior to their inclusion in the DSM-V. The present review also reveals a great need for future research in the area of SP and directions for such research is provided.

Fear of Heights and Visual Height Intolerance in Children 8–10 Years Old

“…A higher female susceptibility has also been reported for the specific phobia fear of heights [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The prepubertal children in the current study showed no gender predominance in susceptibility.…”

“…The life-time prevalence of the specific phobia fear of heights (acrophobia) ranged between 3.1 and 6.4% [2][3][4]. If the survey on fear of heights includes the less severe form of visual height intolerance as described in the Introduction, the prevalence rate in adults is much higher, i.e.…”

“…Its life-time prevalence ranges from 3.1 to 6.4% [2][3][4]. There is a continuum of severity ranging from acrophobia to a less distressing visual height intolerance (vHI), to which the categorical distinction of a specific phobia does not apply, but which may also cause medically relevant restrictions [4][5][6].…”

A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears

“…With life-time prevalence rates of over 10% (Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005a;LeBeau, Glenn, Liao, Wittchen, Beesdo-Baum, Ollendick, & Craske, 2010), specific phobias are the most prevalent group of mental disorders. A specific phobia is a common, long lasting, often chronic anxiety disorder (Depla et al, 2008;Goisman, Allsworth, Rogers, Warshaw, Goldenberg, Vasile, Rodriguez-Villa, Mallya, & Keller, 1998), associated with serious impairment (Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996;Alonso et al, 2004;Oosterink, de Jongh & Hoogstraten, 2009) that represents a serious public health problem with a substantial economic burden (Alonso et al, 2004;Greenberg, Sisitsky, Kessler, Finkelstein, Berndt, Davidson, Ballenger, & Fyer, 1999;Robins, Helzer, Weismann, Orvaschel, Gruenberg, Burke, & Regier, 1984).…”

The Structure of Common Fears: Comparing Three Different Models

“…Such information may particularly be important since some phobic conditions differ in their response to a confrontation with a phobic stimulus. For example, blood-injury-injection phobia appears to be uniquely associated with fainting in phobic situations, and has been found to be especially responsive to an intervention that is tailored to its physiological profile (i.e., applied tension; LeBeau, Glenn, Liao, Wittchen, Beesdo-Baum, Ollendick & Craske, 2010). Although fears are by definition lower in clinical severity than phobias, highly fearful individuals meet at least some criteria for specific phobia and therefore they may still be in need of straightforward and effective, exposure-based, interventions to alleviate the severity of their distress and avoidance patterns.…”