Evidence based assessment/Simple phobia (disorder portfolio)

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Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Please refer to the full text of the Wikiversity medical disclaimer.

What is a "portfolio"?[edit]

  • For background information on what assessment portfolios are, click the link in the heading above.

Preparation phase[edit]

Diagnostic criteria for phobic anxiety disorders[edit]

Click here for ICD-10 and DSM-5 Diagnostic Information

ICD-10 Diagnostic Criteria

A group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous. As a result these situations are characteristically avoided or endured with dread. The patient's concern may be focused on individual symptoms like palpitations or feeling faint and is often associated with secondary fears of dying, losing control, or going mad. Contemplating entry to the phobic situation usually generates anticipatory anxiety. Phobic anxiety and depression often coexist. Whether two diagnoses, phobic anxiety and depressive episode, are needed, or only one, is determined by the time course of the two conditions and by therapeutic considerations at the time of consultation.

A. Agoraphobia

  • A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes. Panic disorder is a frequent feature of both present and past episodes. Depressive and obsessional symptoms and social phobias are also commonly present as subsidiary features. Avoidance of the phobic situation is often prominent, and some agoraphobics experience little anxiety because they are able to avoid their phobic situations.

B. Social phobias

  • Fear of scrutiny by other people leading to avoidance of social situations. More pervasive social phobias are usually associated with low self-esteem and fear of criticism. They may present as a complaint of blushing, hand tremor, nausea, or urgency of micturition, the patient sometimes being convinced that one of these secondary manifestations of their anxiety is the primary problem. Symptoms may progress to panic attacks.

C. Specific (Simple) phobias

  • Phobias restricted to highly specific situations such as proximity to particular animals, heights, thunder, darkness, flying, closed spaces, urinating or defecating in public toilets, eating certain foods, dentistry, or the sight of blood or injury. Though the triggering situation is discrete, contact with it can evoke panic as in agoraphobia or social phobia. (Ex. Acrophobia, Animal phobias, Claustrophobia)

Changes in DSM-5

  • The diagnostic criteria for simple phobia changed slightly from DSM-IV to DSM-5. Summaries are available here and here.

Base rates of simple phobia in different populations and clinical settings[edit]

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of simple phobia that they are likely to see in their clinical practice.

  • To see prevalence rates across multiple disorders, click here.
Setting Reference Base Rate Demography Diagnostic Method Best Recommended For
Mexican-American Prevalence and Service Survey (MAPSS) – adults 18+, all specific phobias Vega et al., 1998[1] 7.4% California CIDI/DSM-III-R
NCS replication, adults 18+, 12-month prevalence Kessler et al., 2005[2] 8.7% All of US CIDI/DSM-IV
National Comorbidity Survey (NCS); non-institutionalized adults between 18-54, all specific phobias Kessler et al., 2005[3] 11.3% All of US CIDI/DSM-III-R
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), adults 18+, all specific phobias Stinson et al., 2007[4] 9.4% All of US AUDADIS-IV/DSM-IV
Adults 18+, all specific phobias Robins et al., 1984[5] 7.8% New Haven, CT Clinical interview/DSM-III
Adults 18+, all specific phobias Robins et al., 1984[5] 23.3% Baltimore, MD Clinical interview/DSM-III
Adults 18+, all specific phobias Robins et al., 1984[5] 11.1% St. Louis, MI Clinical interview/DSM-III
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), adults 18+, all Specific Phobias Grant et al., 2004[6] 7.14% All of US AUDADIS-IV/DSM-IV
Different age groups, all specific phobias Fifth Edition of the Diagnostic and Statistical Manual of Psychiatric Disorders, 2013 Community Prevalence: 7-9%

Children: 5%

13- to 17- year olds: 16%

Older Adults: 3-5%

Note: Females are more frequently affected than males at a rate of 2:1

All of US DSM-V
Outpatient clinic (DAU) [7] 6% (specific)[7]
Outpatient clinic (SDI) [8] 15% (specific)[8]
General Population [9] 19% specific[9]

Prediction phase[edit]

Psychometric properties of screening instruments for simple phobia[edit]

The following section contains a list of screening and diagnostic instruments for simple phobia. The section includes administration information, psychometric data, and PDFs or links to the screenings.

  • Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
  • For a list of more broadly reaching screening instruments, click here.
Screening measures for simple phobia
Measure Format (Reporter) Age Range Administration/

Completion Time

Inter-rater reliability Test-retest reliability Construct validity Content validity Highly recommended Free and Accessible Measure
Fear Survey Schedule for Children-Revised (FSSC-R) Questionnaire (self-report) 7-16 years 19-20 minutes NA G G E
Fear of Spiders Questionnaire (FSQ) Questionnaire (self-report) 13 years-adult 5 minutes NA A G A
Snake Anxiety Questionnaire (SNAQ) Questionnaire (self-report) 13 years-adult 30 minutes-3 hours G G A G
Dental Anxiety Inventory (DAI) Questionnaire (self-report) 5 years-adult 8 minutes NA A G A
Disgust Scale Questionnaire (self-report) 16 years-adult 8 minutes NA U G E
Spider Phobia Beliefs Questionnaire
Acrophobia Questionnaire
Blood Injection Symptom Scale (BISS)
Claustrophobia Scale (CS)
Specific Phobia of Vomiting Inventory (SPOVI)
Revised Children’s Anxiety and Depression Scale (RCADS) Questionnaire (Child) 6-18 12 minutes G[10] G[11] G[10]

PDFs for RCADS

Subscales

Translations

User Guide

Likelihood ratios and AUCs of screening measures for simple phobia[edit]

  • For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
Screening Measure (Primary Reference) AUC and Sample Size LR+ (Score) LR- (Score) Citation Clinical generalizability
Specific Phobia of Vomiting Inventory (SPOVI) 0.944 (N = 185) 24.3 (10+) 0.03 (<10) (Veale et al., 2012)[12] High: able to distinguish between phobics and controls
The Claustrophobia Scale (CS) - Anxiety Subscale (Rachman and Taylor, 1993) --- (N = 285) 49.0 (24+) 0.0002 (<24) (Ost, 2007)[13] High: able to distinguish between phobics and controls
The Claustrophobia Scale (CS) - Avoidance Subscale (Rachman and Taylor, 1993) --- (N = 285) 19.2 (9+) 0.0004 (<9) (Ost, 2007)[13] High: able to distinguish between phobics and controls

Search terms: [specific phobia] AND [sensitivity OR specificity] in Google Scholar and PsycINFO

Interpreting specififc phobia screening measure scores[edit]

  • For information on interpreting screening measure scores, click here.

Prescription phase[edit]

Gold standard diagnostic interviews[edit]

For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Recommended diagnostic instruments for simple phobia[edit]

Diagnostic instruments for simple phobia
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Anxiety Disorders Interview Schedule for Children (ADIS-C)[14] Child 6 years-adult 90 minutes E[14] E[14] G to E[14] N/A
Anxiety Disorders Interview Schedule for Children (ADIS-P)[14] Parent 6 years-adult 90 minutes E[14] E[14] E[14] N/A
  • Not free
Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV)

*not free

Interview (clinician) 6 years-adult 90 minutes A[15] NA[15] A[15] A[15] [15]
Light green check.svg
  • Not free
Structured Clinical Interview for DSM-IV-TR for Axis I Disorders (SCID-I/P)

*not free

6-17 years 1-2 hours A[15] NA[15] A[15] A[15]
Structured Clinical Interview for DSM-IV-TR for Axis II Disorders (SCID-II)

*not free

6-17 years 1-2 hours E[15] NA[15] U[15] U[15]
Structured Clinical Interview for DSM-IV (SCID-IV)

*not free

6-17 years 1-2 hours A[15] A[15] E[15] E[15]
Diagnostic Interview Schedule for Children and Adolescents (DICA) Interview (clinician) 6-17 years 1-2 hours A G G G

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Severity interviews for simple phobia[edit]

Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Process phase[edit]

The following section contains a list of process and outcome measures for simple phobia. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

Process measures[edit]

Two types of behavioral approach tests (BAT) can be used to observe patients in typically avoided situations.

  1. A progressive BAT gradually exposes the patient to a fear-inducing situation in a step-by-step manner, and responses to each step are recorded.
  2. A selective BAT allows the clinician to select one or more challenges from the patient’s hierarchy, and the patient is to complete each challenge to induce a phobic response and rate the inducing fear.

Outcome and severity measures[edit]

This table includes clinically significant benchmarks for simple phobia specific outcome measures

  • Information on how to interpret this table can be found here.
  • Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
  • For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Clinically significant change benchmarks (based on published norms)
Measure Subscale Cut-off scores Critical Change

(unstandardized scores)

A B C 95% 90% SEdifference
Dental Cognitions Questionnaire (1995 Norms)[16] 9.1 16.4 41.2 4.2 3.6 2.2
The Claustrophobia Questionnaire (2001 Norms) - Total[17] 18.6 67.7 41.2 11. 9.4 5.7
The Claustrophobia Questionnaire (2001 Norms) - Suffocation[17] 7.0 24.9 16.2 5.0 4.3 2.6
The Claustrophobia Questionnaire (2001 Norms) - Restriction[17] 8.4 45.5 24.3 6.9 5.8 3.5
Spider Phobia Questionnaire (1996 Norms)[18] 15.1 20.7 17.3 3.0 2.5 1.5
Anxiety Disorder Interview Schedule (ADIS) 5.9 4.4 5.2 0.2 0.2 0.1
Fear Survey Schedule for Children-Revised (FSSC-R) 77.8 159 118.4 6.3 5.3 3.2

Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean. Search terms: [specific phobia] AND [adults] AND [clinical significance OR outcomes] in Google Scholar and PsycINFO

Treatment[edit]

Two treatments of specific phobia treatment include in-vivo exposure and virtual reality therapy. The former is most effective in specific phobias by hierarchically exposing the client to the fear-inducing stimulus and measuring anxiety response. The latter therapy is most effective in driving and height fears by using computer-generated, interactive virtual environments that the clinician manipulates.

External Resources[edit]

  1. ICD-10 diagnostic criteria
  2. Find-a-Therapist (a curated list of find-a-therapist websites where you can find a provider)
  3. NIMH entry about anxiety disorders
  4. Effective Child Therapy(guide about anxiety symptoms, treatment, and more)
  5. OMIM (Online Mendelian Inheritance in Man) for simple phobia
    1. 608251
  6. eMedicine entry about phobic disorders
  7. Society of Clinical Child and Adolescent Psychology
  8. EffectiveChildTherapy.Org information on fear, worry, and anxiety
  9. For information on conducting Exposure Therapy for anxiety disordered youth, see www.BravePracticeForKids.com

References[edit]

Click here for references
  1. Vega, WA; Kolody, B; Aguilar-Gaxiola, S; Alderete, E; Catalano, R; Caraveo-Anduaga, J (September 1998). "Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California.". Archives of general psychiatry 55 (9): 771-8. PMID 9736002. 
  2. Kessler, RC; Berglund, P; Demler, O; Jin, R; Merikangas, KR; Walters, EE (June 2005). "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.". Archives of general psychiatry 62 (6): 593-602. PMID 15939837. 
  3. Kessler, RC; Chiu, WT; Demler, O; Merikangas, KR; Walters, EE (June 2005). "Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.". Archives of general psychiatry 62 (6): 617-27. PMID 15939839. 
  4. Stinson, FS; Dawson, DA; Patricia Chou, S; Smith, S; Goldstein, RB; June Ruan, W; Grant, BF (July 2007). "The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions.". Psychological medicine 37 (7): 1047-59. PMID 17335637. 
  5. 5.0 5.1 5.2 Robins, LN; Helzer, JE; Weissman, MM; Orvaschel, H; Gruenberg, E; Burke JD, Jr; Regier, DA (October 1984). "Lifetime prevalence of specific psychiatric disorders in three sites.". Archives of general psychiatry 41 (10): 949-58. PMID 6332590. 
  6. Grant, BF; Stinson, FS; Dawson, DA; Chou, SP; Dufour, MC; Compton, W; Pickering, RP; Kaplan, K (August 2004). "Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.". Archives of general psychiatry 61 (8): 807-16. PMID 15289279. 
  7. 7.0 7.1 Rettew, David C.; Lynch, Alicia Doyle; Achenbach, Thomas M.; Dumenci, Levent; Ivanova, Masha Y. (2009-09). "Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews" (in en). International Journal of Methods in Psychiatric Research 18 (3): 169–184. doi:10.1002/mpr.289. ISSN 1049-8931. http://dx.doi.org/10.1002/mpr.289. 
  8. 8.0 8.1 Rettew, David C.; Lynch, Alicia Doyle; Achenbach, Thomas M.; Dumenci, Levent; Ivanova, Masha Y. (2009-09). "Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews" (in en). International Journal of Methods in Psychiatric Research 18 (3): 169–184. doi:10.1002/mpr.289. ISSN 1049-8931. http://dx.doi.org/10.1002/mpr.289. 
  9. 9.0 9.1 Kessler, R. C., Avenevoli, S., Costello, E. J., Georgiades, K., Green, J. G., Gruber, M. J., . . . Merikangas, K. R. (2012). Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry, 69(4), 372-380. doi:10.1001/archgenpsychiatry.2011.160
  10. 10.0 10.1 Chorpita, Bruce F.; Moffitt, Catherine E.; Gray, Jennifer (2005-03). "Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample". Behaviour Research and Therapy 43 (3): 309–322. doi:10.1016/j.brat.2004.02.004. ISSN 0005-7967. http://dx.doi.org/10.1016/j.brat.2004.02.004. 
  11. Chorpita, Bruce F; Yim, Letitia; Moffitt, Catherine; Umemoto, Lori A; Francis, Sarah E (2000-08). "Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale". Behaviour Research and Therapy 38 (8): 835–855. doi:10.1016/s0005-7967(99)00130-8. ISSN 0005-7967. http://dx.doi.org/10.1016/s0005-7967(99)00130-8. 
  12. Veale, David; Ellison, Nell; Boschen, Mark J.; Costa, Ana; Whelan, Chantelle; Muccio, Francesca; Henry, Kareina (18 December 2012). "Development of an Inventory to Measure Specific Phobia of Vomiting (Emetophobia)". Cognitive Therapy and Research 37 (3): 595–604. doi:10.1007/s10608-012-9495-y. 
  13. 13.0 13.1 Ost, LG (May 2007). "The claustrophobia scale: a psychometric evaluation.". Behaviour research and therapy 45 (5): 1053-64. PMID 17303070. 
  14. 14.0 14.1 14.2 14.3 14.4 14.5 14.6 14.7 "Test-Retest Reliability of Anxiety Symptoms and Diagnoses With the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions" (in en). Journal of the American Academy of Child & Adolescent Psychiatry 40 (8): 937–944. 2001-08-01. doi:10.1097/00004583-200108000-00016. ISSN 0890-8567. https://www.sciencedirect.com/science/article/pii/S0890856709603427. 
  15. 15.00 15.01 15.02 15.03 15.04 15.05 15.06 15.07 15.08 15.09 15.10 15.11 15.12 15.13 15.14 15.15 15.16 Cite error: Invalid <ref> tag; no text was provided for refs named :0
  16. de Jongh, A; Muris, P; Schoenmakers, N; ter Horst, G (June 1995). "Negative cognitions of dental phobics: reliability and validity of the dental cognitions questionnaire.". Behaviour research and therapy 33 (5): 507-15. PMID 7598671. 
  17. 17.0 17.1 17.2 Radomsky, AS; Rachman, S; Thordarson, DS; McIsaac, HK; Teachman, BA (2001). "The Claustrophobia Questionnaire.". Journal of anxiety disorders 15 (4): 287-97. PMID 11474815. 
  18. Mulkens, SA; de Jong, PJ; Merckelbach, H (August 1996). "Disgust and spider phobia.". Journal of abnormal psychology 105 (3): 464-8. PMID 8772018.