FFinalistSouthampton · 2027
Psychiatry
AKT · Psychiatry/Anxiety & stress

Phobias (including agoraphobia)

Overview

Marked, persistent, out-of-proportion fear of a specific object/situation (specific phobia), social scrutiny (social anxiety disorder) or situations where escape/help is difficult (agoraphobia), with avoidance. See the Health Psychology page for the full discrimination.

Recognise

  • Cued anxiety + avoidance
  • Blood-injection-injury phobia: unique vasovagal faint
  • Agoraphobia often coexists with panic disorder

Red flags

  • Severe avoidance causing housebound state or functional collapse

Differentials & how to tell them apart

Panic disorderattacks are unexpected, not cued by a specific situation
Social anxiety disorderfear of negative evaluation specifically
Agoraphobiafear of no escape/help, not of judgement

Investigations

Clinical. Identify the cue and the feared consequence (judgement vs entrapment vs the object).

Management

  1. 1CBT with graded exposure is first-line for all phobias.
  2. 2Social anxiety / agoraphobia: SSRI if CBT insufficient or declined.
SSRI — for social anxiety disorder / agoraphobia where therapy insufficient

Key points

Blood-injection-injury phobia: applied tension (not relaxation) counters the faint.

Monitor & prognosis

Avoidance and function.

Specific phobias respond very well to exposure.

Source: NICE CKS; DSM-5/ICD-11