Submitted to:
Centers for Disease Control and Prevention
(ICD-11 Coordination & Maintenance)
For consideration by:
World Health Organization
(ICD-11 Mortality and Morbidity Statistics)
1. Proposed Diagnostic Name
Aviophobia (Fear of Flying)
2. Proposed ICD-11 Placement
-
Parent category: HA60 – Specific phobia
-
Proposed subcode: HA60.A – Aviophobia (Fear of Flying)
3. Proposed Diagnostic Definition
Aviophobia is a specific phobia characterized by marked and persistent fear or anxiety triggered by air travel, including anticipation of flying, boarding aircraft, or being airborne. Exposure reliably provokes immediate fear or panic responses, leading to avoidance or endurance with intense distress. The fear is disproportionate to actual risk, persists for at least six months, and causes clinically significant distress or functional impairment.
Definition consistent with ICD-11 HA60 framework and DSM-5-TR specific phobia criteria.
References:
-
World Health Organization. ICD-11 Clinical Descriptions and Diagnostic Guidelines: Specific Phobia (HA60). WHO, 2019.
-
American Psychiatric Association. DSM-5-TR. APA Publishing, 2022.
4. Rationale for a Distinct Code (with Evidence)
A. High Prevalence and Public Health Significance
Fear of flying is among the most prevalent situational phobias in industrialized societies.
-
Population studies estimate 10–25% of adults report significant fear of flying.
-
2–5% meet criteria for a clinically impairing phobia.
References:
-
McIntosh, I. B., et al. “Fear of Flying: Clinical Characteristics and Treatment Outcomes.” Journal of Anxiety Disorders 23, no. 5 (2009): 627–632.
-
Oakes, M., & Bor, R. “The Psychology of Fear of Flying.” Aviation Psychology and Applied Human Factors 1, no. 2 (2011): 98–109.
-
Van Gerwen, L. J., et al. “Fear of Flying Treatment Programs.” Aviation, Space, and Environmental Medicine 68, no. 6 (1997): 510–516.
B. Distinct Clinical and Psychopathological Profile
Aviophobia differs from other specific phobias in mechanism, phenomenology, and risk behaviors:
-
Combines loss of control, catastrophic risk misinterpretation, and enclosed-space exposure
-
Strong association with panic attacks rather than simple fear
-
High rates of anticipatory anxiety lasting days to weeks
References:
-
Bor, R. “Psychological Factors in Fear of Flying.” Aviation, Space, and Environmental Medicine 78, no. 7 (2007): B20–B25.
-
Wilhelm, F. H., & Roth, W. T. “The Somatic Symptom Paradox in Panic Disorder.” Journal of Anxiety Disorders 15, no. 3 (2001): 253–268.
C. Medication Misuse and Patient Safety Concerns
Aviophobia is uniquely associated with situational benzodiazepine prescribing, alcohol self-medication, and unsafe sedation practices during flights.
-
Benzodiazepines are frequently prescribed off-label for flight anxiety despite lack of evidence for long-term benefit
-
Combined benzodiazepine–alcohol use during flights increases risk of respiratory depression and disinhibition
References:
-
Oakes, M., & Bor, R. “Benzodiazepines and Fear of Flying.” British Journal of General Practice 60, no. 572 (2010): 366–367.
-
Cloos, J.-M., & Ferreira, V. “Current Use of Benzodiazepines in Anxiety Disorders.” Current Opinion in Psychiatry 22, no. 1 (2009): 90–95.
-
Federal Aviation Administration. Medical Facts for Pilots. FAA, current edition.
D. Occupational, Disability, and Transportation Relevance
Fear of flying has direct occupational and economic consequences, disproportionately affecting:
-
Executives, clinicians, military personnel, pilots (non-operational), and emergency responders
-
Patients requiring air travel for specialized medical care
-
Individuals seeking disability accommodations or workplace modifications
Lack of a specific ICD code complicates documentation, accommodation, and outcomes tracking.
References:
-
Bor, R., et al. Clinical Psychology in Aviation. Wiley-Blackwell, 2002.
-
European Union Aviation Safety Agency (EASA). Mental Health in Aviation. EASA, 2019.
E. Research and Epidemiologic Limitations Under Current Coding
Without a discrete ICD-11 code:
-
Epidemiologic surveillance is impossible
-
Treatment outcomes (CBT, exposure therapy, VR-based treatment) cannot be reliably compared
-
Health-services utilization cannot be accurately tracked
Virtual-reality exposure therapy, now widely studied for aviophobia, cannot be reliably coded.
References:
-
Rothbaum, B. O., et al. “Virtual Reality Exposure Therapy for Fear of Flying.” American Journal of Psychiatry 157, no. 7 (2000): 1120–1122.
-
Carl, E., et al. “Virtual Reality Exposure Therapy for Anxiety Disorders.” Journal of Anxiety Disorders 61 (2019): 27–36.
5. Proposed Diagnostic Criteria (Summary)
A diagnosis of Aviophobia may be assigned when:
-
Flying or anticipation of flying reliably provokes intense fear or anxiety
-
Exposure results in panic symptoms or marked distress
-
Avoidance or endurance with distress is present
-
Symptoms persist ≥ 6 months
-
Clinically significant impairment in occupational, social, or medical functioning
-
Not better explained by PTSD or another mental disorder
References:
-
WHO ICD-11 HA60 guidelines
-
APA DSM-5-TR, Specific Phobia criteria
6. Coding Notes
-
May be coded with panic attacks
-
May be coded with anticipatory anxiety
-
May be coded with comorbid substance use related to situational coping
7. Benefits of Adoption
-
Improved diagnostic precision
-
Safer prescribing practices
-
Better occupational and disability documentation
-
Enhanced aviation-related mental health research
-
Reduced stigma through formal recognition
Supporting Frameworks:
-
WHO ICD-11 dimensional model
-
CDC public-health surveillance objectives
8. Conclusion
Aviophobia is a common, impairing, and clinically distinct condition with significant public health, safety, and economic implications. The absence of a specific ICD-11 code undermines patient care, research, and policy development. Creation of a discrete subcode under HA60 would materially improve diagnostic clarity while remaining fully consistent with ICD-11’s structure and intent.
No comments:
Post a Comment