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Specific Phobia vs Panic Disorder in Children: A Unique Case Report and Review of Literature

Amanda Varughese and Sachidanand Peteru

Background: Specific phobia is defined as marked fear or anxiety about a specific object or situation. The phobic object or situation almost always provokes immediate fear and anxiety, is actively avoided, or endured with intense fear or anxiety that is out proportion to the actual danger posed by the specific object/situation and to the sociocultural context. These symptoms are persistent and last for at least six months. The prevalence of specific and social phobia in children and adolescents is 2.9 and 0.3%. Panic disorder is defined as recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and is accompanied by at least 4/13 symptoms. One of these panic attacks must be followed by at least one month of constant worry about additional panic attacks and their consequences. There is a significant maladaptive change in behavior related to the attacks. Such disturbances are not attributable to physiological effects of other substances, medical conditions, or other mental disorders. The prevalence of panic disorders is 5 – 15 percent in adolescents and 5 percent in children.

Case Presentation: We present a case of a 3-year old male with panic attacks for over one year which started after an incident of smoke detector alarm followed by three more episodes of panic attacks at the daycare center. The recent episode was 4 weeks ago. After the last incident, the patient stopped eating and refused food which worsened over the past 2 weeks. The patient was evaluated and diagnosed with panic disorder, specific phobia, eating disorder, and referred to outpatient Psychologist.

Objectives:

• Learn about anxiety disorders in children.

• Management options for anxiety in children.

• Etiopathogenesis of anxiety in children.

Conclusion: To the best of our knowledge, this is the first case reported in the literature of panic disorder below the age of 4. We conducted a literature review and found no cases published. This is an interesting case for psychiatrists, therapists and pediatricians to learn as there is a lack of evidence in treating children under the age of 4. No medication recommendations were available for this age group; however, off-label use of selective serotonin reuptake inhibitor (SSRI) medication was discussed with the patient’s mother who refused. We agreed with the primary care team’s recommendations and the case was referred to an out-patient psychotherapist.