Phobic Disorder Overview and Defining Features Extreme irrational

Phobic Disorder

Overview and Defining Features ◦ Extreme irrational fear of a specific object or situation ◦ Markedly interferes with one’s ability to function ◦ Persons will go to great lengths to avoid phobic objects, while recognizing that the fear and avoidance are unreasonable Facts and Statistics ◦ Females are again over-represented ◦ About 11% of the general population meet diagnostic criteria for specific phobia ◦ Phobias run a chronic course, with onset beginning between 15 and 20 years of age

Characteristic features of phobia A. Marked, persistent fear that is excessive or unreasonable, B. Exposure to the phobic stimulus almost always provokes an immediate anxiety response C. The person recognizes that the fear is excessive or unreasonable D. The phobic stimulus is avoided or endured with intense anxiety or distress E. There is significant distress or an impairment in functioning due to the phobia F. The phobia is not better accounted for by another mental disorder

Specific Phobias Selective, persistent and out of proportion Includes cognition that leads to behavioural response, threat +/- May be genetically, neurologically or experientially based Lifetime prevalence: ◦ 7% men, 16% women Types ◦ ◦ of specific phobias Animal Type Natural Environment Type Blood-Injection-Injury Type Situational Type

Specific phobias in other cultures Pa-feng and pa-leng Jin-kyofu-sho or taijin-kyofu-sho Ø Improper facial expression (rigid) Ø innapproriate eye contact Ø perspiring profusely Ø trembling hands, voice, feet Ø uncontrolled flatulance

Social Phobia A more pervasive, highly cognitive type of phobia Distinguishing feature is the fear of doing something in front of others May be situation or context (e. g. performance versus interaction anxiety) specific Fear of one’s own behaviour causing negative attention from others

AGORAPHOBIA WITHOUT PANIC DISORDER A. The presence of agoraphobia related to fear of developing panic like symptoms (e. g. , dizziness or diarrhea). B. Criteria have never been met for panic disorder. C. The disturbance is not due to the direct physiological effects of a substance (e. g. , a drug of abuse, a medication) or a general medical condition.

Parcopresis - fear of defecating in public places Paruresis - fear of urinating in public places

Rx. Psychological Phobias Treatments of Specific ◦ Cognitive-behavior therapies are highly effective ◦ Structured and consistent graduated exposure-based exercises Pharmacotherapy – benzodiazepines, SSRI, TCA, MAOI

Illustrative Case A medical student ranking in the top 10% of his class sought treatment before making a decision to drop out of medical school during the first clinical rotation in his third year. He had always experienced extreme anxiety whenever called on to speak in class and had successfully avoided such presentations through high school, college, and the first 2 years of medical school. He had taken pains to select a medical school in which he thought formal oral presentations were not required. At the beginning of his junior year, he was informed that he would have to make a “medical advances” presentation 4 months later. Although he quickly developed the topic and was confident of his material, he felt that he could not face the ordeal of making the presentation. Anticipatory anxiety had already begun to mount to a level that interfered with his sleep and performance on the wards. The student reported that his father had similar anxiety and had given up a career in law for work as an accountant because of his anxiety in moot court during law school. Treatment was begun with a combination of exposure therapy (with videotape feedback) and drug therapy (a β-blocker). Within 2 weeks (four exposure sessions), the student's anticipatory anxiety abated substantially, and he reported enjoyment of his newfound confidence and improved performance in public speaking. His presentation was

Case A 31 year old politician has a sudden onset of extreme anxiety, tremulousness and diaphoresis immediately before his 1 st scheduled appearance on national television and he is unable to go on the air. For the next week he is paralyzed by fear each time he faces the audience and he cancelled all his scheduled public appearances Which of the following is the most likely diagnosis? Ø Acute stress disorder Ø Adjustment disorder with anxious mood Ø Panic disorder Ø Social phobia Ø Specific phobia