Classifications of Phobic disorders

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phobic categories

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).

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