A 33-year-old man has intense fear of lifts. Whenever he enters a lift he develops palpitations, trembling, and a sense of choking that subsides within ten minutes of leaving it. He never has such episodes in any other situation, has no unexpected attacks, and does not worry about having attacks outside lift-related contexts. What is the most likely diagnosis?
- A Panic disorder with agoraphobia
- B Generalised anxiety disorder
- C Specific phobia, situational type ✓
- D Illness anxiety disorder
Correct answer: C. Specific phobia, situational type
Explanation
In specific phobia the panic-like response is reliably cued by the feared object or situation and does not occur unexpectedly, whereas panic disorder is defined by recurrent unexpected attacks plus persistent worry about further attacks or maladaptive change in behaviour lasting a month or more. Because his symptoms occur only in lifts with no anticipatory concern between exposures, situational-type specific phobia is the diagnosis.
Reference: Diagnostic and Statistical Manual of Mental Disorders, DSM-5, 5th ed.
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