Pediatric Specific Phobia Clinical Presentation

  • Author: William R Yates, MD, MS; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Mar 29, 2011
 

History

Behaviorally, phobias manifest as the need to escape or avoid the feared object or situation. The fear may be expressed somatically by tremor, feeling faint or actually fainting, nausea, diaphoresis, rapid heart rate, increased blood pressure, and feelings of panic. Children may present with crying, tantrums, clinging, or immobilization.

Parents of children with anxiety disorders typically have a higher than average incidence of anxiety disorders in their histories. Similarly, children whose parents have a specific phobia display a higher rate of specific phobia than do control subjects.

Children with anxiety disorders are more likely to display distorted and maladaptive thoughts, but whether these negative thoughts are causes or consequences of their fears is unclear.

Specific phobia may be associated with problems with peers, family, and school, difficulties that may negatively affect self-esteem. Unlike adults, children may not acknowledge that their fear is excessive or unreasonable. (See Workup.)

Self-medication by adults with alcohol and drugs, which has been reported with some anxiety disorders, is not commonly reported in patients with specific phobia.[4]

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Physical Examination

Physical examination may be helpful in documenting evidence of autonomic hyperactivity common in specific phobia. Signs of autonomic hyperactivity may include increased blood pressure, increased heart rate, diaphoresis with sweating palms, or mydriasis. However, autonomic hyperactivity may be sporadic and not present during the physical examination. Physical symptoms such as headaches or stomachaches are commonly seen in children with anxiety disorders, including specific phobias.

Physicians may elect to use a targeted physical examination to aid in ruling out a physical cause for prominent specific physical complaints in individual cases.

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Contributor Information and Disclosures
Author

William R Yates, MD, MS  Research Psychiatrist, Laureate Institute for Brain Research; Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa

William R Yates, MD, MS is a member of the following medical societies: American Academy of Family Physicians and American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Kerim M Munir, MD, MPH, DSc  Director of Psychiatry, Division of General Pediatrics, Developmental Medicine Center, Children's Hospital Boston

Kerim M Munir, MD, MPH, DSc is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Chet Johnson, MD  Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. Biel MG, Klein RG, Mannuzza S, et al. Does major depressive disorder in parents predict specific fears and phobias in offspring?. Depress Anxiety. 2008;25(5):379-82. [Medline].

  2. Cooke LJ, Haworth CM, Wardle J. Genetic and environmental influences on children's food neophobia. Am J Clin Nutr. Aug 2007;86(2):428-33. [Medline].

  3. NIMH. Anxiety disorders. National institutes of Mental Health. Available at http://www.nimh.nih.gov/health/publications/anxiety-disorders/complete-index.shtml. Accessed Last accessed January 13, 2006.

  4. Robinson J, Sareen J, Cox BJ, Bolton J. Self-medication of anxiety disorders with alcohol and drugs: Results from a nationally representative sample. J Anxiety Disord. Mar 22 2008;[Medline].

  5. American Psychiatric Association. Anxiety disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 1994:393-444.

  6. Zlomke K, Davis TE 3rd. One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behav Ther. Sep 2008;39(3):207-23. [Medline].

  7. Liber JM, Van Widenfelt BM, Utens EM, et al. No differences between group versus individual treatment of childhood anxiety disorders in a randomised clinical trial. J Child Psychol Psychiatry. Aug 2008;49(8):886-93. [Medline].

  8. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline].

 
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