Specific phobia

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Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object or situation.[1][2] Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

Although fears are common and normal, a phobia is an extreme type of fear where great lengths are taken to avoid being exposed to the particular danger. Phobias are considered the most common psychiatric disorder, affecting about 10% of the population in the US,[3] according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), (among children, 5%; among teens, 16%). About 75% of patients have more than one specific phobia.

It can be described as when patients are anxious about a particular situation. It causes a great load of difficulty in life. Patients have a lot of distress or interference when functioning in their daily life. Unreasonable or irrational fears get in the way of daily routines, work, and relationships due to the effort that a patient makes to avoid the terrifying feelings associated with the fear.[4]

Females are twice as likely to be diagnosed than males with a specific phobia (although this can depend on the stimulus).

Children and adolescents who are diagnosed with a specific phobia are at an increased risk for additional psychopathology later in life.[5]

Signs and symptoms[edit]

The fear or anxiety may be triggered both by the presence and the anticipation of the specific object or situation. In most adults, the person may logically know the fear is unreasonable but still find it difficult to control the anxiety. Thus, this condition may significantly impair the person's functioning and even physical health.[medical citation needed]

The cause of specific phobias can vary based on the phobia itself, but can include genetics, environmental influences, conditioning, and other indirect pathways. Causes can be both experiential and non-experiential; for example, there appears to be a stronger genetic component to blood-injection-injury phobias compared to animal phobias, which are more likely to stem from an experience.[6]

A person who encounters that of which they are phobic will often show signs of fear or express discomfort. In some cases, it can result in a panic attack.[medical citation needed] The fear or anxiety associated with specific phobia can manifest in physical symptoms such as an increased heart rate, shortness of breath, muscle tension, sweating, or a desire to escape the situation.[7]

Diagnosis[edit]

Specific Phobia – DSM 5 Criteria[8]

The object or situation that a patient is afraid of must not actually pose the danger that the patient fears about. The individual has to have the fear for more than 6 months in order to be diagnosed with Specific Phobia. It must interfere with school, work, or their personal life.

- For example, patients who are afraid of heights or flying will not be willing to fly to see a loved one, or potentially miss a job opportunity in another location.

- Patients who are afraid of bugs or spiders would refuse to attend a camping trip with a family or friend in order to avoid any bugs that are found in nature.

The patient may change the way that they live to actively avoid coming in contact with the object or situation. It is common for the patient to know that their fear is illogical or irrational, but they are just unable to control their feelings towards it. The symptoms cannot be the result of other medication, illegal substances, or other medical conditions.

Children that have specific phobia experience different feelings than seen in adults.[medical citation needed] In children fear/anxiety can be expressed by crying, tantrums, freezing, or clinging. For this reason, there are specific types of therapy for children, adolescents, and adults who that specific phobia.

  • The phobic object or situation almost always provokes immediate fear or anxiety
  • The phobic object or situation is avoided or endured with intense fear or anxiety
  • The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
  • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
  • The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • The disturbance is not better explained by symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms; objects or situations related to obsessions; reminders of traumatic events; separation from home or attachment figures; or social situations

Types[edit]

According to the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders, phobias can be classified under the following general categories:

Treatment[edit]

Specific phobia treatments are based on gradually exposing the person to the feared stimuli.[9]

Cognitive behavioral therapy (CBT), a short term, skills-focused therapy that aims to help people diffuse unhelpful emotional responses by helping people consider them differently or change their behavior, is effective in treating specific phobias.[medical citation needed]

Exposure therapy is a particularly effective form of CBT for many specific phobias, however, treatment acceptance and high drop-out rates have been noted as concerns.[medical citation needed] Other interventions have been successful for particular types of specific phobia, such as virtual reality exposure therapy (VRET) for spider, dental, and height phobias, applied muscle tension (AMT) for needle phobia, and psychoeducation with relaxation exercises for fear of childbirth.[medical citation needed]

Exposure can be in vivo or imaginal (less effective) and can involve:

  • Systematic desensitization -- Based on a patient's fear hierarchy, this method uses relaxing strategies to help calm the patient as they are exposed to the fear
  • Flooding -- Patients are at great risk for dropping out of treatment as this method repeatedly exposes the patient to the fear.
  • Modeling -- This method includes the clinician approaching the feared stimuli while the patient observes and tries to repeat the approach themselves.

Pharmacotherapeutics[edit]

As of late 2020, there is limited evidence for the use of pharmacotherapy in the treatment of specific phobia. The selective serotonin re-uptake inhibitors (SSRIs), paroxetine and escitalopram, have shown preliminary efficacy in small randomized controlled clinical trials.[10] However, these trials were too small to show any definitive benefits of anxiolytic medication alone in treating phobia.[11] Benzodiazepines are occasionally used for acute symptom relief, but have not been shown to be effective for long term treatment.[11] There are some findings suggesting that adjuvant use of the NMDA receptor partial agonist, d-cycloserine, with virtual reality exposure therapy may improve specific phobia symptoms more than virtual reality exposure therapy alone. As of 2020, studies on the use of adjunct d-cycloserine are inconclusive.[11]

Epidemiology[edit]

Specific phobia affects up to 12% of people at some point in their life.[12] Specific phobias have a lifetime prevalence rate of 7.4% and a one-year prevalence of 5.5% according to data collected from 22 different countries.[13] In the USA, the lifetime prevalence rate is 12.5% and a one-year prevalence rate of 9.1%.[13] The usual age of onset is childhood to adolescence. Women are twice as likely to experience specific phobias compared with men.[14]

See also[edit]

References[edit]

  1. ^ Eaton WW, Bienvenu OJ, Miloyan B (August 2018). "Specific phobias". The Lancet. Psychiatry. 5 (8): 678–686. doi:10.1016/S2215-0366(18)30169-X. PMC 7233312. PMID 30060873.
  2. ^ "Specific Phobia". National Institute of Mental Health (NIMH). U.S. Department of Health and Human Services. Retrieved 2021-06-14.
  3. ^ Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association (APA). 22 May 2013. ISBN 978-0-89042-557-2. Retrieved 2021-06-14.
  4. ^ Smith M, Robinson L, Segal R, Segal J (September 2020). "Phobias and Irrational Fears". HelpGuide.org. Retrieved 2021-06-14.
  5. ^ Eaton WW, Bienvenu OJ, Miloyan B (August 2018). "Specific phobias". The Lancet. Psychiatry. 5 (8): 678–686. doi:10.1016/S2215-0366(18)30169-X. PMC 7233312. PMID 30060873.
  6. ^ "Specific Phobia". Anxiety Canada. Retrieved 2021-06-14.
  7. ^ "Phobias Symptoms & Causes | Boston Children's Hospital". www.childrenshospital.org. Retrieved 2021-06-14.
  8. ^ Glass RM (April 2009). "Nomenclature". AMA Manual of Style: A Guide for Authors and Editors (10th ed.). doi:10.1093/jama/9780195176339.022.529. ISBN 978-0-19-517633-9.
  9. ^ Kaczkurkin AN, Foa EB (September 2015). "Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence". Dialogues in Clinical Neuroscience. 17 (3): 337–46. doi:10.31887/DCNS.2015.17.3/akaczkurkin. PMC 4610618. PMID 26487814.
  10. ^ Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M, et al. (2014). "Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders". BMC Psychiatry. 14 Suppl 1 (Suppl 1): S1. doi:10.1186/1471-244X-14-S1-S1. PMC 4120194. PMID 25081580.
  11. ^ a b c Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, et al. (May 2014). "Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology". Journal of Psychopharmacology. 28 (5): 403–39. doi:10.1177/0269881114525674. PMID 24713617. S2CID 28893331.
  12. ^ Craske MG, Stein MB (December 2016). "Anxiety". Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358. S2CID 208789585.
  13. ^ a b Wardenaar KJ, Lim CC, Al-Hamzawi AO, Alonso J, Andrade LH, Benjet C, et al. (July 2017). "The cross-national epidemiology of specific phobia in the World Mental Health Surveys". Psychological Medicine. 47 (10): 1744–1760. doi:10.1017/S0033291717000174. PMC 5674525. PMID 28222820.
  14. ^ Cameron A (2004). Crash Course Psychiatry. Elsevier Ltd. ISBN 978-0-7234-3340-8.

External links[edit]

Classification
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