Phobic anxiety disorder

For an ICD-10 diagnosis, children must manifest a persistent or recurrent fear (phobia) that is developmentally phase appropriate but abnormal in degree, associated with significant social impairment and that is present for at least 4 weeks.

The core clinical characteristics are the thought that exposure to the feared stimulus will result in harm to self—'flight', together with avoidance of the object, is a frequent behavioural feature. Common feared stimuli are dogs, lightning, school, and peer groups. Simple phobic anxiety is not to be diagnosed if fears closely follow traumatic events such as road traffic accidents. These are discussed in detail in the section on post-traumatic stress disorder (see below). Obsessional disorders should be considered if the thoughts are repetitive and intrusive and involve fears of dirt and contamination (see Chapter.4.,8). More pervasive anxious symptoms indicate a generalized anxiety disorder. Unlike adults, children are less likely to recognize their fears as being excessive or unreasonable.

Prevalence rates in children and adolescents are estimated at around 2 per cent. (5) The rate of comorbidity with other anxious syndromes appears to be high in both community and clinical populations.^!1

The natural history of simple phobias in childhood and adolescence is unclear. Retrospective studies of adults with panic agoraphobia show that there is a childhood history of simple phobias, suggesting that some childhood phobias may persist over time—perhaps evolving to a different adult-type phenotype. However, the proportion does not appear to be large, perhaps no more than 10 to 15 per cent. ^l3)

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