< Evidence-based assessment

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What is a "portfolio"?

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

Preparation phase

Diagnostic criteria for phobic anxiety disorders

Click here for ICD-11 and DSM-5 Diagnostic Information

ICD-11 Diagnostic Criteria

Specific phobia is characterized by a marked and excessive fear or anxiety that consistently occurs when exposed to one or more specific objects or situations (e.g., proximity to certain animals, flying, heights, closed spaces, sight of blood or injury) and that is out of proportion to actual danger. The phobic objects or situations are avoided or else endured with intense fear or anxiety. Symptoms persist for at least several months and are sufficiently severe to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

Inclusions

  • Simple phobia
  • Acrophobia
  • Claustrophobia

Exclusions

  • Body dysmorphic disorder
  • Hypochondriasis

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

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.
SettingReferenceBase RateDemographyDiagnostic Method Best Recommended For
Mexican-American Prevalence and Service Survey (MAPSS) – adults 18+, all specific phobiasVega et al., 1998[1]7.4%CaliforniaCIDI/DSM-III-R
NCS replication, adults 18+, 12-month prevalenceKessler et al., 2005[2]8.7%All of USCIDI/DSM-IV
National Comorbidity Survey (NCS); non-institutionalized adults between 18-54, all specific phobiasKessler et al., 2005[3]11.3%All of USCIDI/DSM-III-R
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), adults 18+, all specific phobiasStinson et al., 2007[4]9.4%All of USAUDADIS-IV/DSM-IV
Adults 18+, all specific phobiasRobins et al., 1984[5]7.8%New Haven, CTClinical interview/DSM-III
Adults 18+, all specific phobiasRobins et al., 1984[5]23.3%Baltimore, MDClinical interview/DSM-III
Adults 18+, all specific phobiasRobins et al., 1984[5]11.1%St. Louis, MIClinical interview/DSM-III
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), adults 18+, all Specific PhobiasGrant et al., 2004[6]7.14%All of USAUDADIS-IV/DSM-IV
Different age groups, all specific phobiasFifth Edition of the Diagnostic and Statistical Manual of Psychiatric Disorders, 2013Community 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 USDSM-V
Outpatient clinic (DAU) Rettew et al., 2009[7] 6% (specific)[7]
Outpatient clinic (SDI) Rettew et al., 2009[8] 15% (specific)[8]
General Population Kessler et al., 2012[9] 19% specific[9]

Prediction phase

Psychometric properties of screening instruments for simple phobia

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 Yes (article PDF link)
Fear of Spiders Questionnaire (FSQ) Questionnaire (self-report) 13 years-adult 5 minutes NA A G A Yes (article PDF link)
Snake Anxiety Questionnaire (SNAQ) Questionnaire (self-report) 13 years-adult 30 minutes-3 hours G G A G Article PDF link
Dental Anxiety Inventory (DAI) Questionnaire (self-report) 5 years-adult 8 minutes NA A G A Yes (Questionnaire PDF)
Disgust Scale Questionnaire (self-report) 16 years-adult 8 minutes NA U G E Yes (Questionnaire homepage and PDF)
Spider Phobia Beliefs Questionnaire[10] Questionnaire (self-report) 17 years-adult
Acrophobia Questionnaire Questionnaire (self-report) 14 years-adult
Blood Injection Symptom Scale (BISS)[11] Questionnaire (self-report)
Claustrophobia Scale (CS)
Specific Phobia of Vomiting Inventory (SPOVI) Yes (Questionnaire PDF)
Revised Children’s Anxiety and Depression Scale (RCADS) Questionnaire (Child) 6-18 12 minutes G[12] G[13] G[12]

PDFs for RCADS

Subscales

Translations

User Guide

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

    Likelihood ratios and AUCs of screening measures for simple phobia

    • For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
    Screening Measure (Primary Reference)AUC and Sample SizeLR+ (Score)LR- (Score)CitationClinical generalizability
    Specific Phobia of Vomiting Inventory (SPOVI)0.944 (N = 185)24.3 (10+)0.03 (<10)(Veale et al., 2012)[14]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)[15]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)[15]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

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

    Prescription phase

    Gold standard diagnostic interviews

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

    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)[16] Child 6 years-adult 90 minutes E[16] E[16] G to E[16] N/A
    Anxiety Disorders Interview Schedule for Children (ADIS-P)[16] Parent 6 years-adult 90 minutes E[16] E[16] E[16] N/A
    • Not free
    Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV)

    *not free

    		 Interview (clinician) 6 years-adult 90 minutes A[17] NA[17] A[17] A[17] [17]
    • 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[17] NA[17] A[17] A[17]
    Structured Clinical Interview for DSM-IV-TR for Axis II Disorders (SCID-II)

    *not free

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

    *not free

    		 6-17 years 1-2 hours A[17] A[17] E[17] E[17]
    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

    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

    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

    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

    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 SubscaleCut-off scoresCritical Change

    (unstandardized scores)

    A B C 95% 90% SEdifference
    Dental Cognitions Questionnaire (1995 Norms)[18] 9.116.441.24.23.62.2
    The Claustrophobia Questionnaire (2001 Norms) - Total[19] 18.667.741.211.9.45.7
    The Claustrophobia Questionnaire (2001 Norms) - Suffocation[19] 7.024.916.25.04.32.6
    The Claustrophobia Questionnaire (2001 Norms) - Restriction[19] 8.445.524.36.95.83.5
    Spider Phobia Questionnaire (1996 Norms)[20] 15.120.717.33.02.51.5
    Anxiety Disorder Interview Schedule (ADIS) 5.94.45.20.20.20.1
    Fear Survey Schedule for Children-Revised (FSSC-R) 77.8159118.46.35.33.2

    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

    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

    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

    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. 1 2 3 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. 1 2 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". 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. 1 2 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". 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. 1 2 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. ↑ "(PDF) Negative beliefs of spider phobics: a psychometric evaluation of the Spider Phobia Beliefs Questionnaire". ResearchGate. Retrieved 2020-01-30.
    11. ↑ Page, Andrew C.; Bennett, Kellie S.; Carter, Owen; Smith, Julia; Woodmore, Kirrily. "The Blood-Injection Symptom Scale (BISS): Assessing a structure of phobic symptoms elicited by blood and injections". Behaviour Research and Therapy 35 (5): 457–464. ISSN 0005-7967. https://www.academia.edu/13291456/The_Blood-Injection_Symptom_Scale_BISS_Assessing_a_structure_of_phobic_symptoms_elicited_by_blood_and_injections.
    12. 1 2 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.
    13. ↑ 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.
    14. ↑ 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.
    15. 1 2 Ost, LG (May 2007). "The claustrophobia scale: a psychometric evaluation.". Behaviour research and therapy 45 (5): 1053-64. PMID 17303070.
    16. 1 2 3 4 5 6 7 8 "Test-Retest Reliability of Anxiety Symptoms and Diagnoses With the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions". 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.
    17. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
    18. ↑ 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.
    19. 1 2 3 Radomsky, AS; Rachman, S; Thordarson, DS; McIsaac, HK; Teachman, BA (2001). "The Claustrophobia Questionnaire.". Journal of anxiety disorders 15 (4): 287-97. PMID 11474815.
    20. ↑ Mulkens, SA; de Jong, PJ; Merckelbach, H (August 1996). "Disgust and spider phobia.". Journal of abnormal psychology 105 (3): 464-8. PMID 8772018.
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