Specific phobia

Meet the patient

A 34-year-old executive has routed every deal through video calls for a decade to dodge flying — and the promotion now demands a Sydney to London nonstop. Or a 28-year-old who faints at every blood draw, just told she needs fortnightly anticoagulant monitoring. Or the eight-year-old who screams at the dentist, now sitting in your clinic with a swollen face from an abscessed molar.[2][4][17]

Three patients, one syndrome, one question that pays at every exam: "What is first-line, and why is it not an SSRI?" Specific phobia is the cleanest "exposure first, drugs limited" teaching example in the anxiety chapter — and the one juniors most often medicate by reflex.[4][11]

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1. [1]LeBeau RT, Glenn D, Liao B, Wittchen HU, et al. Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V Depress Anxiety, 2010.PMID 20099272
2. [2]Wardenaar KJ, Lim CCW, Al-Hamzawi AO, Alonso J, et al. The cross-national epidemiology of specific phobia in the World Mental Health Surveys Psychol Med, 2017.PMID 28222820
3. [3]Craske MG, Stein MB Anxiety Lancet, 2016.PMID 27349358
4. [4]Choy Y, Fyer AJ, Lipsitz JD Treatment of specific phobia in adults Clin Psychol Rev, 2007.PMID 17112646
5. [5]Wolitzky-Taylor KB, Horowitz JD, Powers MB, Telch MJ Psychological approaches in the treatment of specific phobias: a meta-analysis Clin Psychol Rev, 2008.PMID 18410984
6. [6]Ost LG One-session treatment for specific phobias Behav Res Ther, 1989.PMID 2914000
7. [7]Zlomke K, Davis TE 3rd One-session treatment of specific phobias: a detailed description and review of treatment efficacy Behav Ther, 2008.PMID 18721635
8. [8]Ollendick TH, Ost LG, Reuterskiöld L, Costa N, et al. One-session treatment of specific phobias in youth: a randomized clinical trial in the United States and Sweden J Consult Clin Psychol, 2009.PMID 19485591
9. [9]Ost LG, Fellenius J, Sterner U Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia Behav Res Ther, 1991.PMID 1684704
10. [10]Ost LG, Sterner U, Fellenius J Applied tension, applied relaxation, and the combination in the treatment of blood phobia Behav Res Ther, 1989.PMID 2564772
11. [11]Katzman MA, Bleau P, Blier P, Chokka P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders BMC Psychiatry, 2014.PMID 25081580
12. [12]Bandelow B, Allgulander C, Baldwin DS, Costa DLDC, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part I: Anxiety disorders World J Biol Psychiatry, 2023.PMID 35900161
13. [13]van Dis EAM, van Veen SC, Hagenaars MA, Batelaan NM, et al. Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis JAMA Psychiatry, 2020.PMID 31758858
14. [14]Thng CEW, Lim-Ashworth NSJ, Poh BZQ, Lim CG Recent developments in the intervention of specific phobia among adults: a rapid review F1000Res, 2020.PMID 32226611
15. [15]Choy Y, Fyer AJ, Goodwin RD Specific phobia and comorbid depression: a closer look at the National Comorbidity Survey data Compr Psychiatry, 2007.PMID 17292703
16. [16]Depla MF, ten Have ML, van Balkom AJ, de Graaf R Specific fears and phobias in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) Soc Psychiatry Psychiatr Epidemiol, 2008.PMID 18060338
17. [17]Oosterink FM, de Jongh A, Hoogstraten J Prevalence of dental fear and phobia relative to other fear and phobia subtypes Eur J Oral Sci, 2009.PMID 19320722
18. [18]Davis TE 3rd, Ollendick TH, Öst LG One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review Annu Rev Clin Psychol, 2019.PMID 30550722