Introduction
It is a relatively common psychiatric disorder across the population
Objects that become the target of phobia are those that cause distress and distaste in the general population
Relatively few individuals present for treatment because they view the fear as normal part of their personality or many stimuli can be avoided without much difficulty.
Epidemiology
Age at onset
⦁ Mean age at onset is 13-16 years
⦁ Persons with situational phobia have a later age (ex: claustrophobia 20 years) at onset than with other types
⦁ Animal and blood- injection phobia begin in childhood (7-9 years mean age at onset)
⦁ Many specific fears in youth are relatively transient but those that extend into adulthood are more severe and persistent.
Clinical features
⦁ The individual experiences a marked, persistent and excessive or unreasonable fear when in the presence of or when anticipating an encounter with a specific object or situation .
⦁ When not confronted with the stimulus, individual is generally symptom free.
⦁ The focus of the fear may be
⦁ Anticipated harm from some aspect of the object or situation
⦁ Concerns about losing control, panicking, somatic manifestations of anxiety and fear
⦁ Anxiety is invariably felt when immediately on confronting the stimulus and the level of anxiety increases with proximity of stimulus and the chances of escape from the stimulus is not possible
⦁ Individual should recognize that the fear is excessive and unreasonable
⦁ If the phobia does not significantly interfere with the individual’s functioning or cause marked distress the diagnosis is not made
⦁ Fears of magic or spirit should be diagnosed as phobia only if it is considered as excessive in the cultural context
⦁ In children anxiety may be expressed as crying, tantrums, freezing or clinging. Children do not recognize fear as excessive or unreasonable. Fear of animals or natural circumstances is a transient feature in childhood and should be diagnosed as phobia only if it is causing clinically significant impairment
⦁ All phobic individuals will show 2 broad sets of symptoms
⦁ First is the anxiety or sympathetic nervous system activation that occurs on anticipation of or confrontation of stimulus
⦁ Second is the desired or attempted avoidance that individual engage in.
⦁ But in some individuals with blood-injury type the response can be different. It is characterized by fainting, due to vasovagal response. It is characterized by initial brief acceleration of heart rate and elevation of blood pressure followed by a deceleration of heart rate and a drop in the blood pressure.
Subtypes
⦁ Animal type
⦁ Natural environment type – water, storm
⦁ Blood injection injury type – highly familial
⦁ Situational type – has a bimodal onset distribution, with one peak in childhood and another in the mid 20s. Appears similar to panic disorder with agoraphobia in sex ratio, age at onset, familial pattern.
⦁ Other type
Course
Usually starts in childhood or adolescence and occur at younger age for women than men
Phobias of traumatic origin can arise at any age
Specific phobias in adolescence increases the chances of either persistence of specific phobia or development of additional phobias in adulthood
Phobias that persist into adulthood remit infrequently (only 20% cases remit)
According to ICD 10,
All of the following should be fulfilled for a definite diagnosis
⦁ Psychological or autonomic symptoms must be primary manifestations of anxiety and not secondary to other symptoms such as delusion or obsessional thought
⦁ Anxiety must be restricted to the presence of particular phobic object or situation
⦁ Phobic situation is avoided whenever possible
⦁ Marked or persistent fear that is excessive or unreasonable, cued by the presence of or anticipation of a specific object or situation
⦁ Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack
⦁ Person recognizes that the fear is excessive r unreasonable
⦁ Phobic situations are avoided or else is endured with intense anxiety or distress
⦁ In individuals under age 18 years the duration is at least 6 months
⦁ The symptoms interferes with the person’s normal routine or relationships or there is marked distress about having a phobia
Disorders that mimic Phobia
⦁ Hypochondriacal disorder- fears of specific diseases unless they relate to specific situations.
⦁ Delusional disorder - If the conviction of the disease reaches delusional intensity.
⦁ PTSD – the intrusions and nightmares are not present in phobia and the fear is triggered by an external event
⦁ Panic disorder – Fear is specifically focused on having a panic attack. DSM recommends that info about the following will be helpful to differentiate
⦁ Situations that elicit the fear
⦁ Type and number of panic attack
⦁ Range of situations that the individual avoids
⦁ Level of anxiety between episodes of fear
Other disorders usually co exist
⦁ Other phobias – agoraphobia, social phobia
⦁ Affective disorder
⦁ Other anxiety disorders
Treatment-
Mainly with medication and behavior therapy
