Phobia

Phobia Dr. Jayesh Patidar

www.drjayeshpatidar.blogspot.com

Introduction It is persistent avoidance behavior

Secondary to irrational fear of a specific object, activity or situation.

Phobic reaction results in a disruption of the persons ability to function in life. Phobias are very common mental disorders & approximately 5 to 10% of the population is affected with phobia.

They must be recognized, otherwise they can lead to psychiatric complications

Phobias are often responsive to treatment with cognitive and behavioral psychotherapies, and to treatment with specific pharmacotherapy.

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Classification According to DSM IV

agoraphobia,

specific phobia and

social phobia

ICD-10 , includes phobic anxiety

disorders under the broad group of

neurotic.

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Epidemiology Life time prevalence of agoraphobia - 0.6 to

6%. half of the agoraphobic patients have panic

disorder.

Specific phobia is the most common mental

disorder among women and the second most

common in men

Six months prevalence being 5 to 10 % females

suffering twice as compared to males

Six months prevalence for social phobia is

about 2 to 3%

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Age of onset is usually in childhood and

adolescence

Onset is earliest in animal phobias, intermediate

in social phobias and latest in agoraphobia.

Patients with agoraphobia consistently have the

highest rate of co-morbidity, animal and

situational phobias the lowest, while social

phobias intermediate

Patients with social phobia have an increased

rate of suicidal ideation, financial dependency

and having sought medical treatment.

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Etiology Behavioral Factors

Stimulus response model

Operant Conditioning Theory

Psychoanalytic Theories

Genetic-Environmental Factors

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Behavioral Factors

Stimulus response model:- Anxiety is

aroused by a naturally frightening

stimulus

Operant Conditioning Theory:- The

conditioned stimulus gradually loses

its potency to arouse a response. The

symptom may last for years without

any apparent external reinforcement.

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Psychoanalytic Theories

According to it the major function of

anxiety is a signal to the ego, that a

forbidden unconscious drive is

pushing for conscious expression,

thus altering the ego to strengthen and

marshal its defenses against the

threatening instinctual force.

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Genetic-Environmental Factors

The subtypes of phobias can be place along

an etiologic continuum. At one end of

this continuum lies agoraphobia and at

the other end of this continuum lie the

simple phobias.

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Clinical Features Agoraphobia

Patients rigidly avoid situations. They prefer

to be accompanied by a friend or a

family member in such places as busy

streets, crowded stores, closed-in

spaces and closed-in vehicles. The

patients may insist that they be

accompanied every time they leave the

house. Severely affected patients may

simply refuse to leave the house. 30/04/2015 www.drjayeshpatidar.blogspot.com 11

Specific phobia

Specific phobias have been classified

according to the phobic stimulus. The

DSM-IV identifies subtypes of the most

common specific phobias.

Animal type

Natural Environment type

Blood-injection-injury type

Situational type

Other type

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Classification Fear

Acrophobia Height

Ailurophobia Cats

Algophobia Pain

Anthophobia Flowers

Anthropophobia People

Aquaphobia Water

Arachnophobia Spiders

Astraphobia Lightning

Belonophobia Needles

Brontophobia Thunder

Claustrophobia Closed spaces

Cynophobia Dogs

Dementophobia Insanity

Equinophobia Horses 30/04/2015 www.drjayeshpatidar.blogspot.com 13

Classification Fear

Herpetophobia Lizards, reptiles

Mikrophobia Germs

Murophobia Mice

Mysophobia Dirt, germs, contamination

Numerophobia Numbers

Nyctophobia Darkness

Ophidiophobia Snakes

Pyrophobia Fire

Sidrodromophobia Railways

Taphaphobia Being buried alive

Thanatophobia Death

Trichphobia Hair

Triskaidekaphobia 13 Persons at a table

Xenophobia Strangers

Zoophobia Animals

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Social Phobia

The presence of social phobia may be associated with a higher morbid risk for major depression. Rate of social phobia are highest among women and persons who are younger (age, 18 to 29 years), less educated, single, and of lower socioeconomic class.

Symptoms associated with social phobia usually involve blushing, muscle twitching, and anxiety about scrutiny.

According to DSM-IV, social phobia is characterized by a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing.

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Differential Diagnosis Common for social and specific phobia

Appropriate fear and normal shyness

Non-psychiatric medical conditions (Central

nervous system tumors, cerebro-vascular

disease)

Use of substances like hallucinogens.

Schizophrenia

Panic disorder

Agoraphobia

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Specific Phobia

Hypochondriasis

Obsessive compulsive disorder

Paranoid personality disorder

Social phobia

Major depressive disorder

Schizoid personality disorder

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Agoraphobia

All medical conditions causing anxiety or

depression

Major depressive disorder

Schizophrenia

Paranoid personality disorder

Avoidance personality disorder

Dependent personality disorder

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Course and Prognosis Agoraphobia without a history of panic

disorder is often incapacitating and chronic.

Depressive disorders and alcohol dependence often complicate the course of

agoraphobia.

As social phobia and specific phobia are relatively new diagnoses, little is known about

their course and prognosis.

The development of associated substance related disorders can also adversely affect the

course and the prognosis of the disorders.

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Treatment Psychotherapy:-

Insight-oriented psychotherapy enables the

patient to understand the origin of the

phobia, the phenomena of secondary gain

and the role of resistance, and enables the

patient to seek healthy way of dealing with

anxiety provoking stimuli.

Cognitive-behavior therapy and various

techniques of behavior therapy like

desensitization, flooding and social skill

training are used.

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All the three types of behavior therapies are useful in the treatment.

The key aspects of successful behavior therapy are:

The patients commitment to treatment,

Clearly identified problems and objectives, and

Available alternative strategies for copying with the patients feelings. In the special situation of blood/injection/injury phobia, some therapists recommend patients to tense their bodies during the exposure to help avoid possibility of fainting from vaso-vagal reaction to phobic stimulation.

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Pharmacotherapy For generalized type or social phobia,

Phenelzine,

Tranylcypromine,

Clonazepam,

Alprazolam,

Moclobemide and

Serotonin reuptake inhibitors (possibly)

Phenelzine is superior to atenolol and somewhat more than moclobemide.

Patients treated with phenelzine are none improved on measure of work and social disability.

The treatment of social phobia associated with performance situation frequently involves use of b-adrenergic antagonists atenolol and propranolol.

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