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Phobia Dr. Jayesh Patidar www.drjayeshpatidar.blogspot.com
Phobia
Dr. Jayesh Patidar
www.drjayeshpatidar.blogspot.com
Introduction It is persistent avoidance behavior Secondary to irrational fear of a specific object, activity
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
person’s 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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psychotherapies, and to treatment with specific pharmacotherapy. 30/04/2015 www.drjayeshpatidar.blogspot.com 3
Classification According to DSM – IV  agoraphobia,  specific phobia and  social phobia
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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phobic anxiety disorders under the broad group of neurotic. 30/04/2015 www.drjayeshpatidar.blogspot.com 4
Epidemiology Life time prevalence of agoraphobia - 0.6 to 6%. half of the agoraphobic patients
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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males Six months prevalence for social phobia is about 2 to 3% Cont… 30/04/2015 www.drjayeshpatidar.blogspot.com 5
Age of onset is usually in childhood and adolescence Onset is earliest in animal phobias,
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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ideation, financial dependency and having sought medical treatment. 30/04/2015 www.drjayeshpatidar.blogspot.com 6
Etiology
Etiology
Etiology Behavioral Factors Stimulus response model Operant Conditioning Theory Psychoanalytic Theories  
Etiology Behavioral Factors Stimulus response model Operant Conditioning Theory Psychoanalytic Theories  

Behavioral Factors Stimulus response model Operant Conditioning Theory Psychoanalytic Theories

model Operant Conditioning Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015
  Genetic-Environmental Factors
Genetic-Environmental Factors
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
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Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
Theory Psychoanalytic Theories   Genetic-Environmental Factors 30/04/2015 www.drjayeshpatidar.blogspot.com 7
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Behavioral Factors  Stimulus response model:- Anxiety is aroused by a naturally frightening stimulus 
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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symptom may last for years without any apparent external reinforcement. 30/04/2015 www.drjayeshpatidar.blogspot.com 8
Psychoanalytic Theories According to it the major function of anxiety is a signal to the
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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and marshal its defenses against the threatening instinctual force. 30/04/2015 www.drjayeshpatidar.blogspot.com 9
Genetic-Environmental Factors The subtypes of phobias can be place along an etiologic continuum. At one
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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and at the other end of this continuum lie the simple phobias. 30/04/2015 www.drjayeshpatidar.blogspot.com 10
Clinical Features Agoraphobia Patients rigidly avoid situations. They prefer to be accompanied by a friend
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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house. Severely affected patients may simply refuse to leave the house. 30/04/2015 www.drjayeshpatidar.blogspot.com 11
Specific phobia Specific phobias have been classified according to the phobic stimulus. The DSM-IV identifies
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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 Blood-injection-injury type  Situational type  Other type 30/04/2015 www.drjayeshpatidar.blogspot.com 12
Classification Fear Acrophobia Height Ailurophobia Cats Algophobia Pain Anthophobia Flowers Anthropophobia
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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spaces Cynophobia Dogs Dementophobia Insanity Equinophobia Horses 30/04/2015 www.drjayeshpatidar.blogspot.com 13

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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13 Persons at a table Xenophobia Strangers Zoophobia Animals 30/04/2015 www.drjayeshpatidar.blogspot.com 14
Social Phobia The presence of social phobia may be associated with a higher morbid risk
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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he or she will act in a way that will be humiliating or embarrassing. 30/04/2015 www.drjayeshpatidar.blogspot.com
Differential Diagnosis Common for social and specific phobia  Appropriate fear and normal shyness 
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
Specific Phobia
 Hypochondriasis
 Obsessive compulsive disorder
 Paranoid personality disorder
Social phobia
Major depressive disorder
Schizoid personality disorder
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 Major depressive disorder  Schizoid personality disorder 30/04/2015 www.drjayeshpatidar.blogspot.com 17
Agoraphobia  All medical conditions causing anxiety or depression  Major depressive disorder  Schizophrenia
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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 Avoidance personality disorder  Dependent personality disorder 30/04/2015 www.drjayeshpatidar.blogspot.com 18
Course and Prognosis – Agoraphobia without a history of panic disorder is often incapacitating and
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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also adversely affect the course and the prognosis of the disorders. 30/04/2015 www.drjayeshpatidar.blogspot.com 19
Treatment Psychotherapy:- Insight-oriented psychotherapy enables the patient to understand the origin of the phobia,
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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like desensitization, flooding and social skill training are used. 30/04/2015 www.drjayeshpatidar.blogspot.com 20
All the three types of behavior therapies are useful in the treatment. The key aspects
All the three types of behavior therapies are
useful in the treatment.
The key aspects of successful behavior
therapy are:
 The patient’s commitment to treatment,
 Clearly identified problems and objectives, and
 Available alternative strategies for copying with
the patient’s 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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of fainting from vaso-vagal reaction to phobic stimulation. 30/04/2015 www.drjayeshpatidar.blogspot.com 21
Pharmacotherapy    For generalized type or social phobia, Phenelzine, Tranylcypromine, Clonazepam, Alprazolam,
Pharmacotherapy    For generalized type or social phobia, Phenelzine, Tranylcypromine, Clonazepam, Alprazolam,
Pharmacotherapy 
Pharmacotherapy
 

For generalized type or social phobia, Phenelzine, Tranylcypromine,

type or social phobia, Phenelzine, Tranylcypromine, Clonazepam, Alprazolam, Moclobemide and Serotonin
Clonazepam, Alprazolam, Moclobemide and Serotonin reuptake inhibitors (possibly) Phenelzine is superior to atenolol
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 b-
adrenergic antagonists atenolol and propranolol.
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