Eating disorders. A diagnosis of specific phobia is not given if the avoidance behavior is exclusively limited to avoidance of food and food-related cues, in which case a diagnosis of anorexia nervosa or bulimia nervosa should be considered.
Schizophrenia spectmm and other psychotic disorders. When the fear and avoidance are due to delusional thinking (as in schizophrenia or other schizophrenia spectrum and other psychotic disorders), a diagnosis of specific phobia is not warranted.
Specific phobia is rarely seen in medical-clinical settings in the absence of other psycho- pathology and is more frequently seen in nonmedical mental health settings. Specific pho- bia is frequently associated with a range of other disorders, especially depression in older adults. Because of early onset, specific phobia is typically the temporally primary disorder.
Individuals with specific phobia are at increased risk for the development of other dis- orders, including other anxiety disorders, depressive and bipolar disorders, substance- related disorders, somatic symptom and related disorders, and personality disorders (par- ticularly dependent personality disorder).
Diagnostic Criteria 300.23 (F40.10)
A. Marked tear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., hav- ing a conversation, meeting unfamiliar people), being observed (e.g., eating or drink- ing), and performing in front of others (e.g., giving a speech).
Note: In children, the anxiety must occur in peer settings and not just during interac- tions with adults.
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
C. The social situations almost always provoke tear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a sub- stance (e.g., a drug of abuse, a medication) or another medical condition.
I. The fear. anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from bums or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Specify if:
Performance only: If the fear is restricted to speaking or performing in public.
Individuals with the performance only type of social anxiety disorder have performance fears that are typically most impairing in their professional lives (e.g., musicians, dancers, performers, athletes) or in roles that require regular public speaking. Performance fears may also manifest in work, school, or academic settings in which regular public presenta- tions are required. Individuals with performance only social anxiety disorder do not fear or avoid nonperformance social situations.
The essential feature of social anxiety disorder is a marked, or intense, fear or anxiety of so- cial situations in which the individual may be scrutinized by others. In children the fear or anxiety must occur in peer settings and not just during interactions with adults (Criterion