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%
Cont
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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.
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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
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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 badrenergic antagonists atenolol and propranolol.
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Phobia

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Phobia

Dr. Jayesh Patidar

Age of onset is usually in childhood and

Dirt, germs, contamination

Being buried alive

Appropriate fear and normal shyness

Major depressive disorder

All medical conditions causing anxiety or

Course and Prognosis

All the three types of behavior therapies are

For generalized type or social phobia,

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