Phobias

Sharizal bin Saklin Roll no: 63

Introduction

The word Phobia originates from phobos

A Greek word means fear or morbid fear

Definition: an irrational fear of a specific object, situation or activity.

Often leading to persistent avoidance of the feared object, situation or activity

Characteristic of phobia

Presence of the fear of an object, situation or activity. The fear is out of proportion to the dangerousness perceived. Patient recognizes the fear as irrational and unjustified. (Insight is present) Patient unable to control the fear and is very distressed by it. Persistent avoidance of the particular object, situation or activity. Gradually, the phobia and the phobic object become a preoccupation with the patient, resulting in marked distress and restriction of freedom of mobility. (Phobic avoidance)

Epidemiology

Phobias are generally common in women. Onset: usually late second decade or early third decade. Worldwide prevalance:

Agoraphobia 1.6% Social Phobia 4.5% Specific Phobia 3.0%

An American study by the National Institute of Mental Health (NIMH-2005) found that

between 8.7% and 18.1% of Americans suffer from phobias. based on age and gender, the study found that phobias were

the most common mental illness among women in all age groups the second most common illness among men older than 25.

Etiology of phobias

There are three theories can explain the etiology of phobias:

Psychodynamic theory Behavioral theories Biological theories

Psychodynamic Theory

Anxiety usually dealt with primary defence mechanism-repression. When repression fails to function, other secondary mechanisms will come into action. In phobias, the secondary mechanism is displacement. Displacement will transfer anxiety from a really dangerous or frightening object to a neutral object. Usually the neutral object chosen unconsciously is the one can be easily avoided.

Behavioral Theories

It explains phobia as a conditioned reflex. Initially, anxiety provoked by naturally frightening or dangerous object occurs with presence of second neutral object. When this happen often enough, the neutral object become conditioned stimulus for causing anxiety. This was experimented by John Watson on 11 years old boy in 1920 by pairing white object with loud noise.

Biological Theories

Genetic evidence: 15-20% of 1st degree relatives exhibit anxiety disorder. All phobias especially agoraphobia are close linked with anxiety disorder. It has been suggested that the theory also applied in phobia. There is genetic factor in specific phobias of blood-injury type. There is also some evidence of familial factor in social phobia.

Clinical types of phobias

According to ICD-10, phobias are classiffied into:

F40 Phobic anxiety disorders

F40.0 Agoraphobia

40.00 Without panic disorder 40.01 With panic disorder

F40.1 Social phobias F40.2 Specific (isolated) phobias F40.8 Other phobic anxiety disorders F40.9 Phobic anxiety disorder, unspecified

Agoraphobia

This is an example of irrational fear of a situation. The commonest type of phobia. The term of agoraphobia originally refer to the fear of being in the open space, but now its refer to the wider related aspects including the presence of crowds and difficulty to escape to a safe place (usually home). Prevalence are more in women and the onset is usually in early adult life. It includes:

Fear of entering shop Fear of public places Fear of travelling alone in trains, buses or planes. Fear of being away from home

These conditions ultimately will lead to completely housebound. It can be further divided into:

Without panic disorder only a few panic symptoms may occur With panic disorder full blown panic attack

Diagnostic guidelines for Agoraphobia

According to ICD-10, all of the following criteria should be fulfilled for a definite diagnosis:

the psychological or autonomic symptoms must be primarily manifestations of anxiety and not secondary to other symptoms, such as delusions or obsessional thoughts. the anxiety must be restricted to (or occur mainly in) atleast two of the following situations:

crowds public places travelling away from home travelling alone

avoidance of the phobic situation must be, or have been, a prominent feature.

Social phobias

This is an example of irrational fear of activities. It is characterized by an irrational fear of scrutiny by other people in comparatively small groups (as opposed to crowds). This usually will lead to the avoidance of social interactions or situations. This condition often starts in adolescent and equally common in men and women. The fear can be:

discrete restricted to fear to eating in public, to public speaking, or to encounters with the opposite sex. diffuse - involving almost all social situations outside the family circle.

It is usually associated with low self-esteem and fear of criticism. The patient may present with complain of blushing, hand tremors, nausea or urgency of micturition. Symptoms may progress to panic attack and leads to complete social isolation.

Diagnostic guideline for Social Phobia

According to ICD-10, all of the following criteria should be fulfilled for a definite diagnosis:

the psychological, behavioural, or autonomic symptoms must be primarily manifestations of anxiety and not secondary to other symptoms such as delusions or obsessional thoughts. the anxiety must be restricted to or predominate in particular social situations the phobic situation is avoided whenever possible.

Specific phobias

These phobias are restricted to highly specified objects, situations or activities. It can be fear of particular animals, height (altophobia), thunder (astraphobia), darkness (scotophobia), flying (aviophobia), closed space (claustrophobia), dentistry (dental phobia), sight of blood (hemophobia), or exposure to a specific disease. Specific phobias usually arise in childhood or early adult life and can persist for decades. The severity of handicap by this phobia usually depends on how easy it is to avoid the feared object.

Diagnostic guidelines for Specific phobias

According to ICD-10, all of the following should be fulfilled for a definite diagnosis:

the psychological or autonomic symptoms must be primary manifestations of anxiety, and not secondary to other symptoms such as delusion or obsessional thought. the anxiety must be restricted to the presence of the particular phobic object or situation. the phobic situation is avoided whenever possible.

Management of Phobias

Most patients tends to rely on avoidance to manage their fears. The patients that seek for treatment are those who are forced to face the phobic situation and those with more than one phobia with panic symptoms. The treatment approach is usually multi-modal which may includes:

Psychotherapy Behavioral therapy Drug treatment Hypnotherapy

Psychotherapy

Psychodynamically oriented psychotherapy

not usually helpful. It is only indicated when there are character or personality difficulties. helpful together with behavior and drug therapy.
can be used to break the anxiety pattern in phobic disorder.

Supportive psychotherapy

Cognitive behavioral therapy

Behavior Therapy
With proper plan, this modalities are usually successful. Techniques in this mode of treatment are:

Flooding Systematic desensitization Exposure and response prevention Relaxation techniques

Drug treatment

Drugs used in treatment of phobias are:

Benzodiazepines

useful in reducing the anticipatory anxiety (alprazolam, clonazepam, diazepam) In long term use, the danger of tolerance and dependence should be monitored. SSRIs currently drug of choice (paroxetine, flouxetine and sertraline) Other antidepressant (imipramine and phenelzine) are also helpful

Antidepressant

Hypnotherapy

Hypnotherapy is usually coupled with Neurolinguistic programming can also be used to help remove the associations that trigger a phobic reaction Lack of research and scientific testing compromises its status as an effective treatment.

Case study

Mrs. A., a 32 year mother of two kids hates to stand in line at a crowded bus station because she's afraid that everyone is watching her. She knows that it's not really true, but she can't shake the feeling. While she is shopping, she is conscious of the fact that people might be staring at her from the big mirrors on the inside front of the ceiling. Now, she has to talk to the person who's checking out her groceries. She tries to smile, but her voice comes out weakly. She's sure she's making a fool of herself. Her selfconsciousness and anxiety rise to the roof...

Thank you~

Do you know what is the phobia of long word?

It is Hippopotomonstrosesquipedaliophobia- Fear of long words.