The one‑question differential
- Negative evaluation/scrutiny → social anxiety disorder (performance‑only subtype exists).
- A circumscribed object/situation (animals, heights, blood‑injection‑injury, flying) → specific phobia.
- Being unable to escape or get help if panicky/incapacitated (transport, crowds, queues, open spaces, outside home alone) → agoraphobia (not literally "fear of open spaces").
Clinically useful specifics
- Blood‑injection‑injury phobia is unique: a vasovagal biphasic response (tachycardia→bradycardia→syncope) → teach applied tension, not just relaxation.
- Agoraphobia frequently follows panic disorder as learned avoidance; screen for it whenever you diagnose panic.
- Social anxiety vs avoidant PD: dimensional overlap; avoidant PD is broader, more pervasive, earlier, and identity‑level.
Management
CBT with graded exposure is the core across all three (exposure directly reverses the avoidance that maintains the fear); SSRIs/SNRIs for social anxiety and agoraphobia; specific phobia is often exposure‑only.
Pitfalls
- Treating BII phobia with relaxation alone and precipitating syncope.
- Missing secondary agoraphobia in panic disorder.
Pearls
- 🎯 The object of fear is the whole differential.
- 🩺 Exposure is the active ingredient — avoidance is the disorder's fuel.
Next → Where psychiatry meets general medicine — somatic symptom and related disorders (Concept 26).