Individuals with specific phobia show similar patterns of impairment in psychosocial functioning and decreased quality of life as individuals with other anxiety disorders and alcohol and substance use disorders, including impairments in occupational and inter- personal functioning. In older adults, impairment may be seen in caregiving duties and volunteer activities. Also, fear of falling in older adults can lead to reduced mobility and reduced physical and social functioning, and may lead to receiving formal or informal home support. The distress and impairment caused by specific phobias tend to increase with the number of feared objects and situations. Thus, an individual who fears four ob- jects or situations is likely to have more impairment in his or her occupational and social roles and a lower quality of life than an individual who fears only one object or situation.
Individuals with blood-injection-injury specific phobia are often reluctant to obtain med- ical care even when a medical concern is present. Additionally, fear of vomiting and chok- ing may substantially reduce dietary intake.
Agoraphobia. Situational specific phobia may resemble agoraphobia in its clinical pre- sentation, given the overlap in feared situations (e.g., ﬂying, enclosed places, elevators). If an individual fears only one of the agoraphobia situations, then specific phobia, situa— tional, may be diagnosed. If two or more agoraphobic situations are feared, a diagnosis of agoraphobia is likely warranted. For example, an individual who fears airplanes and ele- vators (which overlap with the "public transportation” agoraphobic situation) but does not fear other agoraphobic situations would be diagnosed with specific phobia, situa- tional, whereas an individual who fears airplanes, elevators, and crowds (which overlap with two agoraphobic situations, ”using public transportation" and ”standing in line and or being in a crowd”) would be diagnosed with agoraphobia. Criterion B of agoraphobia (the situations are feared or avoided ”because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other inca- from specific phobia. If the situations are feared for other reasons, such as fear of being harmed directly by the object or situations (e.g., fear of the plane crashing, fear of the an- imal biting), a specific phobia diagnosis may be more appropriate.
Social anxiety disorder. It the situations are feared because of negative evaluation, so- cial anxiety disorder should be diagnosed instead of specific phobia.
Separation anxiety disorder. It the situations are feared because of separation from a primary caregiver or attachment figure, separation anxiety disorder should be diagnosed instead of specific phobia.
Panic disorder. Individuals with specific phobia may experience panic attacks when con- fronted with their feared situation or object. A diagnosis of specific phobia would be given if the panic attacks only occurred in response to the specific object or situation, whereas a di- agnosis of panic disorder would be given if the individual also experienced panic attacks that were unexpected (i.e., not in response to the specific phobia object or situation).
Obsessive-compulsive disorder. If an individual’s primary fear or anxiety is of an ob- ject or situation as a result of obsessions (e.g., fear of blood due to obsessive thoughts about contamination from blood-borne pathogens [i.e., HIV]; fear of driving due to obsessive im- ages of harming others), and if other diagnostic criteria for obsessive-compulsive disorder are met, then obsessive-compulsive disorder should be diagnosed.
Trauma- and stressor-related disorders. If the phobia develops following a traumatic event, posttraumatic stress disorder (PTSD) should be considered as a diagnosis. How- ever, traumatic events can precede the onset of PTSD and specific phobia. In this case, a di- agnosis of specific phobia would be assigned only if all of the criteria for PTSD are not met.