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Main features of diagnostic criteria for specific phobia in the DSM-IV-TR:
- Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
- Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack. In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
- The person recognizes that the fear is excessive or unreasonable. In children, this feature may be absent.
- The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
Specific Phobia – DSM 5 Criteria
- Fear or anxiety about a specific object or situation (In children fear/anxiety can be expressed by crying, tantrums, freezing, or clinging)
- The phobic object or situation almost always provokes immediate fear or anxiety
- The phobic object or situation is avoided or endured with intense fear or anxiety
- The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
- The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
- The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not better explained by symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms; objects or situations related to obsessions; reminders of traumatic events; separation from home or attachment figures; or social situations
According to the fourth revision of the "Diagnostic and Statistical Manual of Mental Disorders", phobias can be classified under the following general categories:
- Animal type – Fear of dogs, cats, rats and/or mice, pigs, cows, birds, spiders, or snakes.
- Natural environment type – Fear of water (aquaphobia), heights (acrophobia), lightning and thunderstorms (astraphobia), or aging (gerascophobia).
- Situational type – Fear of small confined spaces (claustrophobia), or the dark (nyctophobia).
- Blood/injection/injury type – this includes fear of medical procedures, including needles and injections (trypanophobia), fear of blood (hemophobia) and fear of getting injured.
- Other – children's fears of loud sounds or costumed characters.
The terms "distress" and "impairment" as defined by the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition" (DSM-IV-TR) should also take into account the context of the person's environment if attempting a diagnosis. The DSM-IV-TR states that if a feared stimulus, whether it be an object or a social situation, is absent entirely in an environment, a diagnosis cannot be made. An example of this situation would be an individual who has a fear of mice but lives in an area devoid of mice. Even though the concept of mice causes marked distress and impairment within the individual, because the individual does not usually encounter mice, no actual distress or impairment is ever experienced. Proximity to, and ability to escape from, the stimulus should also be considered. As the phobic person approaches a feared stimulus, anxiety levels increase, and the degree to which the person perceives they might escape from the stimulus affects the intensity of fear in instances such as riding an elevator (e.g. anxiety increases at the midway point between floors and decreases when the floor is reached and the doors open).
Phobias are a common form of anxiety disorders and distributions are heterogeneous by age and gender. An American study by the National Institute of Mental Health (NIMH) found that between 8.7 percent and 18.1 percent of Americans suffer from phobias, making it the most common mental illness among women in all age groups and the second most common illness among men older than 25. Between 4 percent and 10 percent of all children experience specific phobias during their lives, and social phobias occur in one percent to three percent of children and adolescents.
A Swedish study found that females have a higher incidence than males (26.5 percent for females and 12.4 percent for males). Among adults, 21.2 percent of women and 10.9 percent of men have a single specific phobia, while multiple phobias occur in 5.4 percent of females and 1.5 percent of males. Women are nearly four times as likely as men to have a fear of animals (12.1 percent in women and 3.3 percent in men) — a higher dimorphic than with all specific or generalized phobias or social phobias. Social phobias are more common in girls than in boys, while situational phobia occurs in 17.4 percent of women and 8.5 percent of men.
Of the simple phobias, aquaphobia is among the more common subtypes. In an article on anxiety disorders, Lindal and Stefansson suggest that aquaphobia may affect as many as 1.8% of the general Icelandic population, or roughly one in fifty people.
Aquaphobia or waterfright is a persistent and abnormal fear of water. Aquaphobia is a specific phobia that involves a level of fear that is beyond the patient's control or that may interfere with daily life. People suffer aquaphobia in many ways and may experience it even though they realize the water in an ocean, a river, or even a bathtub poses no imminent threat. They may avoid such activities as boating and swimming, or they may avoid swimming in the deep ocean despite having mastered basic swimming skills. This anxiety commonly extends to getting wet or splashed with water when it is unexpected, or being pushed or thrown into a body of water.