A 47-year-old man only travels by train despite the necessity of frequently traveling long distances for his job. This causes significant difficulty, since the train trips are much longer than the plane rides and he misses important meetings. He has tried flying on several occasions, only to have a panic attack each time, even when the flight was smooth with no turbulence. Which of the following is the correct diagnosis?

Choice A reason: Panic disorder involves recurrent, unexpected panic attacks and persistent concern about having additional attacks. In this case, the patient’s panic attacks are triggered specifically by flying, not occurring unexpectedly in multiple situations. Therefore, the attacks are situationally bound rather than generalized or spontaneous. Choice B reason: Specific phobia, situational type, is characterized by intense fear or anxiety triggered by a specific object or situation, such as flying, that leads to avoidance behavior. The patient’s avoidance of air travel and repeated panic attacks during flights are consistent with this diagnosis. Choice C reason: Acute stress disorder occurs after exposure to a traumatic event and involves intrusive memories, dissociation, or hyperarousal. The patient’s symptoms are not related to a recent trauma and are specifically associated with air travel, making this diagnosis less appropriate. Choice D reason: Social anxiety disorder involves fear or anxiety about social situations in which the person may be judged or scrutinized. The patient’s anxiety is related to flying, not social evaluation, so this diagnosis does not fit the clinical picture.