Fast Five Quiz: Common Phobias

Stephen Soreff, MD


October 20, 2020

In assessing for phobic disorder, the physician should consider a patient's appearance, behavior, ability to cooperate with the examination, level of activity, speech, mood and affect, thought processes and content, insight, and judgment.

During the mental status examination, a person who is abruptly confronted with a phobic object may demonstrate a significantly anxious affect with a restricted range or neurovegetative signs (eg, tremor, diaphoresis). The patient may also report feeling anxious (mood) and can clearly identify the reason for their anxiety (thought content). The thought content is significant for phobic ideation (unrealistic and out-of-proportion fears).

Insight may be impaired, especially during exposure, but in most cases, insight is preserved. Although patients still report they cannot control their feelings, they also acknowledge that the severity of their fears is not justified. Although they acknowledge the irrationality of their phobias, some patients are reluctant to tell a physician about them.

Anxiety is the most common feature in phobic disorders. All manifestations should be asked about and assessed, and include:

  • Sweating

  • Palpitations

  • Elevated blood pressure

  • Elevated heart rate

  • Dyspnea

  • Dizziness

  • Tremor

  • Diarrhea

  • Paresthesias

Most patients with blood-injection-injury phobia report a history of fainting in situations where they are presented with a trigger. Initial increases in heart rate and blood pressure are followed by decreases in both parameters, resulting in fainting. This physiologic response differs from the typical response seen in other phobias, in which exposure is followed by increased heart rate and blood pressure.

Read more about the assessment of phobic disorder.


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