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 that are not consistently triggered by a specific situation, whereas this patient’s panic occurs reliably in response to flying. Choice B reason: This is correct. The patient exhibits situationally bound panic in response to flying, consistent with a specific phobia, situational type, causing avoidance and functional impairment. Choice C reason: Acute stress disorder occurs within 4 weeks of a traumatic event and is time-limited, which does not match the chronic pattern seen here. Choice D reason: Social anxiety disorder is characterized by fear of social scrutiny; the patient’s panic is specific to flying and not social situations.