Phobic Anxiety Disorders Flashcards
Define:
- Phobia
- Agoraphobia
- Social phobia
- Specific (isolated) phobia
Phobia: is an intense, irrational fear of an object, situation, place or person that is recognized as excessive (out of proportion to the threat) or unreasonable.
Agoraphobia: agoraphobia literally means a ‘fear of the marketplace’. It is a fear of public spaces or fear of entering a public space from which immediate escape would be difficult in the event of a panic attack.
Social phobia (social anxiety disorder): a fear of social situations which may lead to humiliation, criticism or embarrassment.
Specific (isolated) phobia: fear restricted to a specific object or situation (excluding agoraphobia and social phobia).
Briefly describe the aetiology of agoraphobia
Maintained by avoidance which prevents deconditioning and sets up a vicious cycle of anxiety.
Briefly describe the aetiology of social phobia
Uncertain aetiology. Usually begins in late adolescence, an age at which people are concerned about the impression they make on others.
Briefly describe the aetiology of specific phobia
Conditioning event in early life, i.e. frightening experience. Possibly a role for learned behaviour e.g. from parents.
Give examples of some common specific phobias
- Animals
- Spiders (arachno-)
- Insects (entomo-)
- Dogs (cyno-)
- Nature and forces
- Thunder (astra-)
- Water (aqua-)
- Blood, infection and injury
- Sight of blood (haemo-)
- Physical injury or illness (traumato-)
- Needles or injection (needle-)
- Situational
- Closed spaces (claustro-)
- Heights (acro-)
- Darkness (nycto-)
What is the 1 year prevalence of agoraphobia, social phobia and specific phobia?
Agoraphobia: 0.4%.
Social phobia: 1.2%.
Specific phobia: 3.5%.
What is the age of onset of agoraphobia, social phobia and specific phobia?
Agoraphobia: early adulthood (25-30 years of age).
Social phobia: usually adolescence.
Specific phobia: usually childhood but can develop later in life.
What is the male to female ratio of agoraphobia, social phobia and specific phobia?
Agoraphobia: 2:1.
Social phobia: 1:1.
Specific phobia: 1:1.
What are the risk factors for phobias?
- Aversive experiences (prior experiences with specific objects or situations)
- Stress and negative life events
- Other anxiety disorders
- Mood disorders
- Substance misuse disorders
- Family history
What are the biological and psychological symptoms of phobias?
Biological: tachycardia is the usual autonomic response, however in phobias of blood, injection and injury, a vasovagal response (bradycardia) is produced, commonly leading to fainting (syncope).
Psychological: include unpleasant anticipatory anxiety, inability to relax, urge to avoid the feared situation and, at extremes, a fear of dying .
Briefly describe the ICD-10 Classification of agoraphobia
Marked and consistently manifest fear in, or avoidance of, at least two of the following:
- Crowds
- Public spaces
- Travelling alone
- Travelling away from home
Symptoms of anxiety in the feared situation with at least two symptoms present together (and at least one symptom of autonomic arousal).
Significant emotional distress due to the avoidance, or anxiety symptoms. Recognised as excessive or unreasonable.
Symptoms restricted to (or predominate in) feared situation .
Briefly describe the ICD-10 Classification of social phobia
Marked fear (or marked avoidance) of being the focus of attention, or fear of acting in a way that will be embarrassing or humiliating.
At least two symptoms of anxiety in the feared situation plus one of the following:
- Blushing
- Fear of vomiting
- Urgency or fear of micturition/defecation
Significant emotional distress due to the avoidance of anxiety symptoms.
Recognised as excessive or unreasonable.
Symptoms restricted to (or predominate in) feared situation.
Briefly describe the ICD-10 Criteria for specific phobias
Marked fear (or avoidance) of a specific object or situation that is not agoraphobia or social phobia.
Symptoms of anxiety in the feared situation.
Significant emotional distress due to the avoidance or anxiety symptoms. Recognised as excessive or unreasonable.
Symptoms restricted to the feared situation.
What are the features that differentiate phobic anxiety disorders from GAD?
Even if a patient is calm when you speak to them, you should screen for phobias as they are restricting conditions due to avoidance of the feared stimulus. Three features separate phobic anxiety from GAD.
- Anxiety occurs in specific situations:
- Agoraphobia- public transport, supermarkets (especially waiting in queues), cinemas and empty streets.
- Social phobia- social gatherings, parties, public speaking, meetings, classrooms and eating in public.
- There is anticipatory anxiety when there is a prospect of encountering the feared situation.
- There is attempted avoidance of circumstances that precipitate anxiety.
Briefly describe the MSE for phobic anxiety disorders
Appearance and behaviour: restless and wanting to escape. Pale, sweaty and hyperventilating. May lose consciousness (blood or injection phobia).
Speech: may be trembling or they may become speechless.
Mood: anxious.
Thought: unpleasant feelings towards threat. Fear of situation. Desire to escape. Fear of dying.
Insight: poor when feared stimulus is present. Good when separated from stimulus.
Note: MSE will be largely normall unless exposed to the stimulus for phobia.
Compare and contrast GAD, panic disorders and phobic anxiety
- Age of onset
- When does it occur?
- Associated behaviour
- Cognition
- Associations
