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The two most widely used classifications today are ICD-10 and DSM-IV-TR (Tables 1.1–1.4). ICD-10 lists, under the heading ‘‘Neurotic, stress-related and somatoform disorders’’, F40 Phobic anxiety disorders, the diagnoses F40.0 Agoraphobia, 40.1 Social phobias and 40.2 Specific (isolated) phobias, which closely resemble those that DSM-IV-TR lists under the heading ‘‘Anxiety disorders’’ (300.21, 300.22, 300.23 and 300.29). ICD-10 and DSM-IV-TR are similar in excluding from their list of phobia diagnoses other syndromes with phobia-like features of anxious avoidance, such as dysmorphophobia (non-delusional) and hypochondriasis, OCD and touch/sound aversions. ICD-10 lists, under F40 Phobic anxiety disorders, two diagnoses (F40.8 Other phobic anxiety disorders and F40.9 Phobic anxiety disorder unspecified) that have no counterpart in DSM-IV-TR. ICD-10 lists a diagnosis F41.0 Panic disorder (episodic paroxysmal anxiety) under F41 Anxiety disorders rather than F40 Phobic anxiety disorders (and excludes from it F40.0 Panic disorder with agoraphobia). DSM-IV-TR lists its counterpart 300.01 Panic disorder without agoraphobia under ‘‘Anxiety disorders’’.
THE MAIN PHOBIC SYNDROMES
The rest of this chapter outlines each syndrome of anxious avoidance that has a phobia diagnosis in ICD-10 (F40) and DSM-IV-TR (300.2). Thereafter it notes more briefly other syndromes of anxious avoidance. Almost all the syndromes are detailed in Marks [19,41]. They are described in the order in which they appear in the left-hand column of Table 1.1.
TABLE 1.1 Phobias coded under anxiety disorders in ICD-10 [11] and DSM-IV-TR
| F40–48 NEUROTIC, STRESSRELATED AND SOMATOFORM DISORDERS | ANXIETY DISORDERS |
| Phobic anxiety disorders | No ‘Phobic anxiety disorders’ or ‘Phobias’ ‘Agoraphobia’ is not codable as a diagnosis; instead: |
| F40.0 Agoraphobia | 300.21 Panic disorder with agoraphobia 300.22 Agoraphobia without history of panic disorder |
| F40.1 Social phobias | 300.23 Social phobia (social anxiety disorder) |
| F40.2 Specific (isolated) phobias 300.29 Specific (formerly simple) phobia Subtypes: animal type, nature forces, blood–injection–injury, enclosed spaces, [sphincteric], other |
300.29 Specific (formerly simple) phobia Subtypes: animal, natural environment (e.g. storms, heights, water), blood– injection–injury, situational (e.g. public transport, tunnels, bridges, elevators, flying, driving, enclosed places) |
| F40.8 Other phobic anxiety disorders | |
| F40.9 Phobic anxiety disorder, unspecified Phobia NOS, Phobic state NOS |
TABLE 1.2 Phobia-like syndromes not called phobias in ICD-10 [11]
or DSM-IV-TR [8]
| F42 Obsessive–compulsive disorder | 300.3 Obsessive–compulsive disorder |
| F43 Reaction to severe stress, and adjustment disorders | |
| F43.1 Post-traumatic stress disorder 309.81 Post-traumatic stress disorder F45 Somatoform disorders |
300.7 Body dysmorphic disorder |
| F45.2 Hypochondriacal disorder ?nosophobia | 300.7 Hypochondriasis |
Touch and sound aversions (not in ICD–10 or DSM–IV-TR)
TABLE 1.3 Non-phobia-like syndromes often associated with phobias
| F41 Other anxiety disorders | ANXIETY DISORDERS |
| F41.0 Panic disorder (episodic paroxysmal anxiety) | 300.01 Panic disorder without agoraphobia |
| F41.1 Generalized anxiety disorder | 300.02 Generalized anxiety disorder |
| F41.2 Mixed anxiety and depressive disorder F41.3 Other mixed anxiety disorders | |
| F48 Other neurotic disorders | |
| F48.0 Neurasthenia F48.1 Depersonalization–derealization syndrome |
|
| F32 Depressive episode | |
| F33 Recurrent depressive disorder F34 Persistent mood (affective) disorder F34.1 Dysthymia F38 Other mood (affective) disorders |
TABLE 1.4 Non-phobia-like syndromes with some aspects vaguely like those of phobias
- F50.0 Anorexia nervosa
- F64 Gender identity disorders
- F64.0 Transsexualism
they can avoid the cue easily in everyday life (e.g. snakes in the UK), than if they cannot avoid the evoking cue without incurring handicap (e.g. leaving home in most societies other than women in purdah).