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Phobias

These questions and answers reach both


specific and social phobias. Main sources
are First and Tasman's book, 2003, and 10
th
Edition of Sadock and Sadock.
As of 4Sep08
Phobia - dx
Q. DSM-V-TR, list five criteria for specific
phobia in adults, what are they?
Phobia dx - 1
Ans.
1. Excessive and persistent fear, cued by
an object or situation.
2. Exposure to the object or situation
causes anxiety response.
3. Pt recognizes the fear is unreasonable.
4. see next slide
phobia dx - 2
4. The phobic situation is avoided or
endured with intense distress.
5. [usually DSM expectation that] causes
dysfunction or distress.
Phobias -- < 18 y/o
Q. How does the above criteria differ in
those under 18? There are three ways,
Phobias dx - < 18 y/o
Ans.
#2 above may be expressed by crying,
tantrums, freezing, or clinging
#3 above may not be present.
Additional criteria of duration of six
months.
Types
Q. Besides social phobia, what are DSM's
other four types of phobias?
Types
Ans.
-- animal type
-- Environment type [e.g., heights]
-- blood-injection type
-- situation type [e.g., elevators]
[of course, "Other]
Social phobia - name
Q. Another name for social phobia?
Social phobia - name
Ans. Social anxiety disorder.
eneralized
Q. When applied to social phobia, what
does the specifier "generalized mean?
eneralized
Ans. Phobia pertains to most social
situations, includes both public
performance and social interactions.
Sympathetic and parasympathetic
Q. Which involve sympathetic system
over-reacting and which involves
parasympathetic?
Sympathetic and parasympathetic
Ans. All involve sympathetic except blood-
injection type when the parasympathetic
over-reacts.
Vasovagel response
Q. Vasovagel response is associated
which phobia/phobias?
Vasovagel response
Ans. Blood-injection-injury type.
ender specific phobias
Q. ender breakdown?
ender specific phobias
Ans. 2/3 are female. Even higher
percentage female with animal phobias,
natural environment phobias, and
situational phobias.
ender social phobia
Q. Which gender is more prevalent in
social phobia?
ender social phobia
Ans. Women > men, but only slightly so.
Specific phobias onset - age
Q. Age of onset?
Specific Onset - age
Ans. Childhood.
Social phobia - onset
Q. What age is most common onset of
social phobia?
Social phobia - onset
Ans. Adolescents.
Specific & social phobias familial.
Q. Familial pattern?
Specific & social phobias - familial
Ans. ncreased risk if a member of the family
has a specific phobia.
Phobias prevalence
Q. What is prevalence of phobias?
Phobias - prevalence
Ans. Specific phobia in cross-section of
populations: 5%. Social phobia: 10%. But
depends on circumstances. Many with a
snake phobia may have no reason to be in
the neighborhood of snakes. Many with
social phobia as to public speaking may
have no reason to need to speak in public
events.
Treatment of social phobia
Q. Very generally, usual treatments of
social phobia is?
Treatment of social phobia
Ans. Meds and CBT.
Treatment of specific phobias
Q. Very generally, what is the treatment of
specific phobias?
Treatment of specific phobias
Ans. CBT. Meds can help with the
immediate situation. CBT has long-term
benefit.
Meds used in social phobia
Q. What classes of meds are used for
social phobia?
Meds used in social phobia - 1
Ans. Classes:
-- SSRs
-- Benzodiazepines
-- Venlafaxine
-- Buspirone
See next screen
Meds used in social phobias - 2
-- Beta-blockers [used, especially for
performance anxiety, e.g., propranolol, but
have not done well in controlled trials]
[MAOs , phenelzine, and gabapentin have
some support in the face of failure of first
choices.]
FDA approved for social phobia
Q. Which meds are FDA approved?
FDA approved for social phobia
Ans.
Paroxetine
Sertraline
Venlafaxine
Psychotherapy specific phobias
Q. What specific type of CBT is used for
most specific phobias?
Psychotherapy specific and
social phobias
Ans. n vivo exposure. Many therapies
involve a gradation of exposure until the
individual is comfortable with the extreme
without medications [or drinks], e.g., social
phobia in which the individual increases
social exposure gradually to where she
has a party at home and invites all her co-
workers.