Which mental status exam (MSE) findings suggest a specific phobia disorder?

Updated: Mar 27, 2019
  • Author: Nita V Bhatt, MD, MPH; Chief Editor: David Bienenfeld, MD  more...
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In a situation where the patient is acutely confronted with the object of his or her phobia, the patient’s mental status examination is significant for an anxious affect, with a restricted range. Neurovegetative signs (such as tremor or diaphoresis) might be present. The patient also reports feeling anxious (mood) and can clearly identify the reason for his/her anxiety (thought content). The thought content is significant for phobic ideation (unrealistic and out of proportion fears). Insight might be impaired, especially during exposure, but most times the patient has preserved insight and while reporting that they cannot control their feelings, they also acknowledge that the severity of their fears is not justified.

At any other time, a patient with phobic disorder has a mental status within normal limits, with the exception of thought content positive for phobic ideation. Of note, phobic ideas might remain undisclosed unless questions about phobias are specifically asked. Phobias do not present with suicidal or homicidal ideation, but comorbid conditions commonly associated with phobias, including depression and other anxiety disorders, do present with suicidal or homicidal ideation. If comorbid conditions exist, a specific assessment of the suicidal and homicidal risk should also be completed.

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