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A PECULIAR CASE OF PHOBIA-

ANTHOPHOBIA

ABSTRACT

All fears, anxieties and particular phobias are all categorized as internalized behavioral problems.
Flowers usually induce gratifying effects on our mind and body, and are perceived as a pleasant
stimulus, but in some rare cases, flowers are perceived to be pernicious. Irrational fear towards
flowers is known as Anthophobia.

INTRODUCTION

Having specific fears and anxiety usually considered as accustomed as well as impressive during
the course of child development as it might indicate burgeoning of complex thought processes.
But when these fears keep gnawing the person even during adulthood, it might be an indication
of development of a phobia. Further childhood phobias might be caused due to petrifying
experiences.

CASE STUDY

An eleven year old boy (let’s call him Malcolm), was a scholar at school, studying in the seventh
grade. He had an amiable nature towards others. Born at full-term, he was delivered normally
with no developmental delays. There was no psychiatric illness history reported in the family as
well. By five years of age, he was noticed walking during sleep with impassive facial
expressions. When he met the psychiatrist for the first time, he made less eye contact. His mother
reported that he used to scream, sweat, become flustered, totally go berserk at just a mere sight of
a flower. The first time she showed such a behavior was on his third birthday, when he was
gifted with flowers.
Later, by eight years of age, the fear kept lingering in him when he saw flowers on social
occasions. The parents or the parents could not report any early life incidents that could have
triggered the fear.
A dual diagnosis of a specific phobia and somnambulism was made according to ICD-10.

DIAGNOSIS
● Magnetic Resonance Imaging of the brain indicated arachnoid cyst measuring
15x20x45cm with well-defined margins in the midbrain, posterior fossa in retrocerebellar
location and communicating with the fourth ventricle.
● No seizure activity or or slowing were observed in eletcroenchephalography.
● A preliminary psychological test revealed his IQ to be 112.
● Children's Apperception Test (CAT) revealed intricacies and interpersonal relationships
with parental figures and a need for achievement and deploring of situations causing
anxiety.

BACKGROUND ANALYSIS

A dynamic introspection revealed that the child was ambivalently attached to his mother whereas
exhibited less attachment towards his father as he was negligent towards his emotional needs.
There were interpersonal and familial conflicts as well.
During probing sessions, the mother revealed that she had told her son long ago about her fears
related to flowers because of her being bit by a bee while trying to touch the flower. The fears
were reinforced when he saw a person on television being perplexed at the sight of a flower. The
patient reported that he gets baffled at the sight of nectar and pollen from flowers as they attract
bees as their bite is pain inflicting. He was also afraid of petals, leaves and big flowers, precisely
tuberoses and marigold. The child has no personal experience of getting bitten by a bee but it
seems like he has unconsciously take up his mother’s fears and the television character.

TREATMENT

The treatment was initiated with escitalopram and subsequently increased to 10 mg along with
clonazepam 0.25 mg. Psychological management was initiated with free association relaxation
training exercise. Relaxation was followed by systematic sensitization.
The therapist started in-vitro exposure with imagery and then in-vivo exposure to artificial and
real flowers, simultaneously cognitive restructuring was also started. Initial few sessions were
interactive using creative therapies like drawing and writings following which his interactions
with the therapist improved.
By the sixth session, the patient was more comfortable with touching artificial flowers, initially
small ones and subsequently bigger ones. Eventually, the propinquity towards the real flowers
was reinstated and by the ninth session he was able to properly hold a flower in his hand
comfortably. A total of 12 sessions were conducted. When he was able to cope with his
anxieties, he was taken to the garden where he previously exhibited a fearful reaction towards
hibiscus and sunflower but was able to react with relatively reduced anxiety, with no terrifying
response.
During Cognitive Behavior Therapy (CBT) sessions, he was explained about the mechanism of
learning fear and how it was being maintained. Therapy was focused on giving him alternative
explanations to challenge his fears, avoidance behaviors and attempts were made to substitute it
with more adaptive beliefs and responses. He was given homework(s) like reading about flowers,
noting facts, watering flowers, making small bouquets at home, etc.

TREATMENT OUTCOMES

By the end of the eighth month of the therapies, the child displayed remarkable improvements in
his overall symptoms,that is when other aspects of his personality were brought into therapy for
which social skill training were regularly conducted. Currently, the patient and his family have
reported improvement in anxieties and also in his sleep behavior. He was gradually tapered down
to 5 mg dose of escitalopram and CBT maintenance sessions were continued.

REFERENCES

1. The ICD-10 (1993). Classification of mental and behavioural disorders: Diagnostic


criteria for research. Geneva: World Health Organization
2. Peter M, Herald M, Cor M, Karlijn VDB (2002). Cognitive development and worry in
normal children. Cogn Ther Res 26:775-787.
3. Strauss CC, Last CG (1993). Social and simple phobias in children. J Anxiety Disord
7:141-152.
4. http://www.nams-india.in/anams/2017/NAMS53_3_article175-178.pdf

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