Phobia Flashcards
Define phobia
Unwarranted, extreme and persistent fear of a specific object or situation that is out of proportion to the actual danger or threat
The fear and anxiety immediately upon encountering the feared object or situation and tend to lead to avoidance of the object or situation or extreme discomfort in the situation or in the presence of the object
ICD-10 criteria: restricted to highly specific situations such as proximity to particular animals, heights, thunder, flying, blood etc
What are the types of phobia
Animals: dogs, snakes, insects
Situational: lifts, flying, enclosed spaces (Claustrophobia)
Natural environment: storms, heights, water
Blood-injection-injury: injections, blood draws, medical procedures
Other: choking, vomiting, clowns
What are the risk factors for phobias
Somatisation disorder (10x)
Anxiety disorder
Mood disorder e.g. depression, mania
Family history of animal and blood-injection-injury phobias
Other: aversive experience, stress and negative life events, female, white, parental anxiety, neagtive affectivity , cognitive bias
What are the criteria for phobias
The phobia is unwarranted, extreme and persistent
Fear and anxiety occurs immediately upon encountering the feared object/situation
The individual recognises that the fear is excessive, unwarranted or out of proportion to the actual risk
Results in significant interference with the ADLs
What are the symptoms of phobias
Fear and anxiety immediately upon encountering the feared object/situation
Significant interference with ADLs
Anticipatory anxiety (catastrophic thoughts and fears of being unable to cope)
Behavioural avoidance
Physical symptoms: tachycardia and hyperventilation upon exposure (e.g. in phobia of blood and bodily injury), nausea, dizziness, fainting, exaggerated startle, sleep disruption
What is the ICD-10 definition of agoraphobia
Fear of open spaces and related aspectse.g. presence of crowds and difficulty of immediate easy escape back to a safe place, usually home ± panic disorder
what are the features of agoraphobia
Commonly in 20s or mid-thirties
May be gradual or precipitated by a sudden panic attack
Comorbid depression is common (be wary of drugs and alcohol to overcome)
Also higher incidence of sexual problems
What is the ICD-10 definition of social phobia
Fear of scrutiny by other people in comparatively small groups (as opposed to crowds), leading to avoidance of social situations
What are the features of social phobia
Most common anxiety disorder
Comparatively small = around 5-6 people (Usually 1-2 is fine)
May be specific (public speaking) or generalized (any social setting)
Physical symptoms: blushing, fear of vomiting
Symptoms include blushing (characteristic), palpitations, trembling, sweating
Can be precipitated by stressful or humiliating experiences, death of a parent, separation, chronic stress
Genetic vulnerability
May abuse alcohol or drugs (perpetuating problem)
What investigations should be done for panic disorder
Clinical diagnosis (self-report is sufficient)
Rating scales:
- Beck anxiety inventory
- HADS score (Hospital anxiety and Depression scale)
Behavioural observation and approach tasks - Behavioural approach tasks may be used to measure how willing patients are to have contact with feared stimuli.
What is the management for phobias
First line: Education and monitoring
- Explaining phobias
- Suggesting internet-assisted exposure interventions e.g. mobile apps
- Self-help manuals
Second line OR frequently interfering with activities: Cognitive behavioural therapy with exposure therapy
- Exposure therapy = systematic desensitisation (graded hierarchy approach). Repeated, frequent, controllable, and predictable exposures to the feared objects or situations
May be group therapy for children
Third line: hypnotherapy, flooding, modelling, pharmacotherapy (SSRIs, TCAs, beta blockers, benzodiazepines in emergent circumstances)
What is the prognosis for phobias
Animal phobias have the best outcome
Agoraphobias do worse
Up to 90% of patients reach clinically significant levels of improvement after treatment with exposure therapy
Early diagnosis and treatment are essential - shorter with better prognosis
