There is marked fear or anxiety regarding a specific object or situation, often the following:

• The specific object or situation almost always provokes immediate fear or anxiety
• Children may express the fear or anxiety by crying, tantrums, freezing, or by clinging
• The phobic object or situation is actively and persistently avoided for 6 months or more
• The fear or anxiety experienced is out of proportion to the actual danger posed by the specific object or situation
• Notable, clinical distress or impairment in social, occupational, or other important areas of functioning is evident
• The symptoms cannot be explained by another psychiatric disorder such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), separation anxiety disorder, or social anxiety disorder

Evaluation is usually limited to a detailed history and physical.

Behavior therapy is the most effective treatment for phobias is behavioral therapy. This includes systematic desensitization and flooding. In methodical desensitization, the patient is exposed to a list of stimuli ranking from the least to the most anxiety provoking. With this method, patients are taught various techniques to deal with anxiety such as relaxation, breathing control, and cognitive approaches. The cognitive behavioral approach includes reinforcing the realization that the phobic stimulus is safe. As the patient masters these techniques, they are taught to use them in the face of anxiety-provoking stimuli and induce relaxation. As the patients become desensitized to each stimulus on the scale, they keep moving up until the most anxiety-provoking stimuli no longer elicit any fear or anxiety.[8][9][10][11]

Patients with a blood injection injury phobia are advised to tense their bodies and remain seated during the exposure to avoid the possibility of fainting from a vasovagal reaction. Also, beta blockers and benzodiazepines can be used in patients when the phobia is associated with panic attacks. Flooding, also known as implosion, is another behavioral technique that can be used to treat specific phobias. This technique involves increasing exposure to the stimulus to induce habituation and decrease anxiety.

To be successful, behavioral therapy requires that patient be committed to the treatment, there are distinctly identified problems and objectives, and there are alternative strategies for dealing with the patient’s feelings.

Other forms of treatment that may also be considered are virtual therapy in which patient is exposed to or interact with the phobic object or situation on the computer screen. This field of treatment is relatively new and requires more research. Other treatment modalities include hypnosis, supportive therapy, and family therapy. The goal of all 3 forms of therapy is to help the patient recognize that the feared stimulus is not dangerous and to provide emotional support.

•  Medical conditions that can result in the development of a phobia include substance use particularly hallucinogens and sympathomimetics, central nervous system (CNS) tumors, and cerebrovascular diseases. However, in these conditions, phobic symptoms are unlikely in the absence of additional findings on physical, neurological, and mental status examinations.
• Schizophrenic patients may also present with phobic symptoms. However,  patients with phobia have intact insight to their irrational fears and lack psychotic symptoms associated with schizophrenia.
• It is also important to rule out panic disorder, agoraphobia, and avoidant personality disorder. It can be difficult to distinguish specific phobia from panic disorder, agoraphobia, and avoidant personality disorder. However, in specific phobia, these patients tend to experience anxiety or fear immediately upon exposure of the phobic stimulus. In addition, patients with specific phobia do not exhibit signs of fear or anxiety when they are not facing or anticipating the phobic stimulus.
• It is important to rule out other conditions such as hypochondriasis, obsessive-compulsive disorder, and paranoid personality disorder. There is a subtle difference between hypochondriasis and specific phobia. For example, patients with hypochondriasis fear having the disease and patients with specific phobia fear to contract the disease. Same holds true for the difference between obsessive-compulsive disorder and specific phobia. For example, patients with OCD may avoid knives because they have compulsive thoughts of harming their children; whereas, patients with a specific phobia may avoid knives because they fear cutting themselves. Patients with paranoid personality disorder have generalized fear, which is not found in patients with specific phobia.

With the appropriate behavioral techniques and medications, the prognosis is well.

Patients are advised to see a psychiatrist when symptoms are affecting their daily activities and quality of life.

The most common signs/symptoms that can be seen in specific phobia are:

• Feeling nauseous, dizzy, or fainting
• Difficulty breathing, chest tightness, or fast heartbeat
• The fear or anxiety out of proportion to the real danger posed by the specific object or situation

Common modalities of treatment include:

• Systematic desensitization
• Flooding
• Medications such as beta-blockers and benzodiazepines

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 relevant areas of functioning.

The management of phobias is usually with an interprofessional team that includes a mental health nurse, psychiastrist, psychotherapist and the primary care provider. In most cases, behavior therapy is first line treatment and does work. However, the period of desensitization can take weeks or even months.

To be successful, behavioral therapy requires that patient be committed to the treatment, there are distinctly identified problems and objectives, and there are alternative strategies for dealing with the patient’s feelings.

Other forms of treatment that may also be considered are virtual therapy in which patient is exposed to or interact with the phobic object or situation on the computer screen. This field of treatment is relatively new and requires more research. Other treatment modalities include hypnosis, supportive therapy, and family therapy. The goal of all 3 forms of therapy is to help the patient recognize that the feared stimulus is not dangerous and to provide emotional support.

Overall, the prognosis for most patients is fair because relapses are common. [12][13] (level V)