Phobic Disorders

Phobias involve persistent, unrealistic, intense anxiety in response to specific external situations, such as looking down from heights or coming near a small dog. People who have a phobia avoid situations that trigger their anxiety, or they endure them with great distress.However, they recognize that their anxiety is excessive and therefore are aware that they have a problem.

Agoraphobia

Agoraphobia means “fear of market place”, formerly the term was used to denote phobias of open places alone but it is now used in a wider sense. It refers to a trapped state and morbid fear of places and situations from where, the patient believes, he cannot escape easily to a ‘safer” place, usually home.Typical situations that are difficult for people with agoraphobia include standing in line at a bank or supermarket, sitting in the middle of a long rowin a theatre or classroom, and riding on a bus, train or plane.

In severe cases the patient becomes totally home bound or totally dependent on another person when he has to leave home.

Prevalence

Agoraphobia is diagnosed in 3.8 percent of women and 1.8 percent of men during any 6-month period. The disorder most often begins in the early 20s; a first appearance after age 40 is unusual.

Symptoms

 Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situational, predisposed panic attack or panic-like symptoms.

 Fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and travelling in a bus, train, or automobile.

 The situations are avoided (e.g., travel is restricted) or else are endured with marked distressor with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.

Treatment

The best treatment for agoraphobia is exposure therapy, a type of behaviour therapy. With the help of a therapist, the person seeks out, confronts, and remains in contact with what s/he fears until her/his anxiety is slowly relieved by familiarity with the situation (a process called habituation). Exposure therapy helps more than 90 percent of the people who practice it faithfully.

Specific Phobias

Specific phobias are circumscribed fears of specific objects, situations, or activities. This syndrome has three components: 1. an anticipatory anxiety that is brought on by the possibility of confrontation with the phobic stimulus, 2. the central fear itself, and 3.

the avoidance behaviour by which the patient minimizes anxiety. In specific phobia, the fear is usually not of the object itself but of some dire outcome that the individuals believe may result from contact with that object. For example, individuals with snake phobia are afraid that they will be bitten. These fears are excessive, unreasonable, and enduring; although most individuals with specific phobias will readily acknowledge that they know there is really nothing to be afraid of, reassuring them of this does not diminish their fear. In DSM-IV, types of specific phobias have been adopted: natural environment (e.g., storms); animal (e.g., insects); blood-injury-injection; situational (e.g., cars, elevators, bridges); and other (e.g., choking, vomiting).

Prevalence

Specific phobias are the most common of the anxiety disorders.About 7 percent of  women and 4.3 percent of men have a specific phobia during any 6-month period.

Some specific phobias, such as the fear of large animals, the dark, or strangers, begin early in life. Many phobias stop as the person gets older.Other phobias, such as fear of insects, storms,water, heights, flying, or enclosed places, typically develop later in life.

At least 5 percent of people are to some degree phobic about blood, injections, or injury, and these people can actually faint,which does not happen with other phobias and anxiety disorders.

Symptoms

 The person experiences a strong, persistent fear that is excessive or unreasonable. It is set off (cued) by a specific objector situation that is either present or anticipated.

 The phobic stimulus almost always immediately provokes an anxiety response, which may be either a panic attack or symptoms of anxiety that do not meet criteria for a panic attack.

 The fear is unreasonable or out of proportion and the person realizes this.

 The person either avoids the phobic stimulus or endures it with severe anxiety or distress.

 Persons under the age of 18must have the symptoms for 6months or longer.

 Either there is marked distress about this fear or it markedly interferes with the person’s usual routines or social, job or personal functioning.

Social Phobia

In social phobias,morbid fear is experienced in situations where the patient is likely to be observed and criticized by others. Places like canteens or situations like meetings and parties are avoided by the patient. Unlike in agoraphobia, social phobias occur in small, intimate groups.All symptoms of anxiety mounting up to panic may be present.

Situations that commonly trigger anxiety among people with social phobia include public speaking; performing publicly, such as acting in a play or playing a musical instrument; eating in front of others; signing a document before witnesses; and using a public bathroom. People with social phobia are concerned that their performance or actions will seem in appropriate.Often they worry that their anxiety will be obvious—that they will sweat, blush, vomit, or tremble or that their voice will quiver; they will lose their train of thought; or they will not be able to find the words to express themselves.

Symptoms

 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 away (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.

 Exposure to the feared social situation almost invariably provokes anxiety,which may take the form of a situational bound or situationally predisposed Panic Attack.

Note: In children, the anxiety may be expressed by crying, tantrum, freezing, or shrinking from social situations with unfamiliar people.

 The person recognizes that the fear is excessive or unreasonable.Note: In children, this feature may be absent.

 The feared social or performance situations are avoided or else are endured with intense anxiety or distress.

 The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

 In individuals under age 18 years, the duration is at least 6months.

 The fear or avoidance is not due to the direct physiological effect of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder.

Aetiology

Psychoanalytic Perspectives

Historically, the aetiology of phobic disorders was typically explained from a psychoanalytic perspective.Although the defence mechanism of repression is typically used to protect the individual from experiencing the anxiety(and the underlying conflict), when repression is insufficient the ego must use additional defence mechanisms.

In the case of individuals with phobias, Freud proposed that displacement of the anxiety to a less relevant object or situation occurs (such as a dog or some other animal), so that the
feared object is used to symbolize the primary source of the conflict. Patients with phobias use avoidance further to escape the effects of the anxiety.

Learning and Conditioning Perspectives

Emotions are “contagious”. That is,we learn to respond to stimuli, in part, by observing other people’s responses and also by our own experiences in these situations. In other words,we come to fear dangerous situations easily.This is important from anethological perspective because our ancestors who could learn to fear threatening objects or situations easily were more likely to survive and pass these genes to their offspring.This inherited tendency to learn to experience fear in particular situations is the basis of conditioning models of phobia development.

Treatment

Exposure therapy, a type of behaviour therapy, works well for social phobia, but arranging for exposure to last long enough to permit habituation and comfort may not be easy. For example, a person who is afraid of speaking in front of her/his boss may not be able to arrange a series of speaking sessions in front of that boss. Substitute situations may help, such as joining an organization for those who have anxiety about speaking in front of an audience or reading a book to a group. Substitute sessions may or may not reduce anxiety during conversations with the boss.