USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 24-year-old man comes to the clinic because of his fear of spiders. He states that he gets severe anxiety when he sees or thinks about spiders. As a result, he has not ventured into his garage for years. He feels foolish and that his fear is irrational, but he cannot overcome it. It has meant that he also has said no to camping trips and other social opportunities. He is otherwise in good health. He uses no medications or recreational drugs, Physical examination is unremarkable. Which of the following is the most likely diagnosis?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS
Everybody, whether they like to admit it or not, has fears and gets anxious about certain things, whether it be a spider crawling on the ground or speaking in front of large groups of people.
In most cases though, people cope with those fears and confront them.
A phobia is the most extreme type of fear.
Someone with a phobia will go to great lengths to avoid being exposed to the fear or perceived danger, even if there’s no actual risk or danger, and people often feel powerless against it.
Phobias are extreme, often unreasonable and irrational fears of something, which could literally be anything, like: pyrophobia, the fear of fire; alektorophobia, the fear of chickens; triskaidekaphobia, the fear of the number 13; phobophobia, the fear of developing phobias; or even pinaciphobia, the fear of lists.
Unreasonable or irrational fears get in the way of daily routines, work, and relationships, because patients with phobias often do whatever they can to avoid the anxiety and terrifying feelings associated with the phobia.
For example, most people don’t necessarily enjoy the company of spiders, but they also don’t let this fear affect their social or daily life; like, even though I know there are spiders in the woods, I wouldn’t avoid a camping trip on account of the spiders.
Even if they love camping, somebody with arachnophobia—a fear of spiders—might refuse to go because they know there’s a possibility of seeing a spider in close quarters.
In this case the fear’s clearly interfering with their social life and relationship with friends, meaning it’s a phobia.
The DSM-5 splits these specific phobias into five categories: fear of animals, like arachnophobia or alektorophobia; fear of the natural environment, like thalassophobia (fear of the ocean) or nyctophobia (fear of darkness); fear of blood and needles, like hemophobia (fear of blood); situational fears like aviophobia (fear of flying); and finally, “other” fears, like coulrophobia (fear of clowns).
These specific phobias are one of three main types of phobias.
Agoraphobia means fear of public places, but has to do with being fearful in a public space where it feels like it might be hard to escape quickly and return to a place perceived as “safe” like the person’s home.
Because of this, people with agoraphobia tend not to venture out very often.
Some commonly feared areas might be places like crowded shopping malls, or theaters, where it might be difficult to escape quickly.
Social phobias, on the other hand, are overwhelming and persistent fears of social situations and interactions.
People with social phobias are fearful of being embarrassed or judged by others.
Being embarrassed or feeling “awkward” in a social interaction from time to time is totally normal, but people with social phobias often feel anxiety for weeks leading up to events before they happen, and are afraid of doing common things in front of others.