Monday, 28 November 2011

Phobia - A Brief Layout


A phobia, coming from the Greek word ‘Phobos’ meaning “Fear” is one of the many types of anxiety disorder, usually defined as a persistent fear of an object or situation in which the person will go far lengths in avoiding, even though the situation is disproportional to the actual danger posed.
Psychologists classify Phobias into 3 categories:

1 – Social Phobia: Associated with social related factors such as speaking in public, or simply the fear of ‘embarrassing’ themselves. This type of phobia is difficult to treat without the use of therapy. It further classifies into two groups
A-    Generalized Social Phobia: Also known as Social Anxiety Disorder
B-    Specific Social Phobia: Anxiety is only triggered by specific situations. For example, some people have a fear of urinating in public if there is no privacy.
2- Specific Phobias: Fear of a single specific panic trigger such as spiders, water, dogs, height. Normally, people are afraid of these but to a lesser degree than those who are phobic.
3- 3. Agoraphobia: a generalized fear of leaving home or a small familiar 'safe' area, and of possible panic attacks that might follow. It may also be caused by various specific phobias such as fear of open spaces, social embarrassment (social agoraphobia), fear of contamination (fear of germs, possibly complicated by obsessive-compulsive disorder or PTSD post traumatic stress disorder  related to a trauma that occurred out of doors.
Specific Phobia Diagnosis, according to the DSM-IV-TR:
1.      Marked and persistent fear that is eXcessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
2.      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. Note: In children, the anXiety may be expressed by crying, tantrums, freezing, or clinging.
3.      The person recognizes that the fear is eXcessive or unreasonable. Note: In children, this feature may be absent.
4.      The phobic situation(s) is avoided or else is endured with intense anXiety or distress.
5.      The avoidance, anXious anticipation or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
6.      In individuals under the age of 18, the duration is at least 6 months.
7.      The anXiety, panic attack, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder.

Social Phobia Diagnosis – DSM-IV-TR
The diagnostic criteria for 300.23 Social Phobia as outlined by the DSM-IV-TR:
1.      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 a way (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.
2.      EXposure to the feared social situation almost invariably provokes anXiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children the anXiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.
3.      The person recognized that the fear is eXcessive or unreasonable. Note: In children this feature may be absent.
4.      The feared social or performance situations are avoided or else are endured with intense anXiety or distress.
5.      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.
6.      In individuals under age 18, the duration is at least 6 months.
7.      The avoidance is not due to the direct physiological effects 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 (e.g. Panic Disorder With or Without Agoraphobia, Separation AnXiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, Schizoid Personality Disorder).
8.      If a general medical condition or another mental disorder is present, the fear in Criterion A (EXposure to the social or performance situation almost invariably provokes an immediate anXiety response) is unrelated to it, e.g., the fear is not of Stuttering, trembling in Parkinson's disease, or eXhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa.

Environmental –
Much in understanding causes of Phobia and fear responses can be attributed to the Pavlovian Model of Classical Conditioning.  For example, a child who has had a traumatic event such as falling from a high place or experiencing a faulty accident on a roller coaster would develop a phobia to ‘height’ as though being conditioned.

Circumstances of being afraid of heights or spiders may be linked to evolutionary factors wired in the brain. For eXample, early man who lived in the savannas had to be wary of spiders that were secretive, stealthy and eXtremely deadly. The same with heights, being conscious that falling would lead to damage and even death, over a prolonged period of time became wired in the brain that these are code red situations. This view does not necessarily hold that phobias are genetically inevitable. Instead, there may be a genetic predisposition to learn to fear certain things more easily than other things
As mentioned, phobias are caused by an event where the amgydala and hippocampus labels it as ‘red zone dangerous’ so if the situation ever happens again, the body will react as if the event was acting repeatedly afterward. Therefore treatment works similarly the same way – the most effect therapy is Cognitive Behavioral Therapy. The therapy is to replace this recorded fear with a more rational accepted scenario. This can be achieved through eXposure therapy where the sufferer is exposed to the phobia from a far scale little by little. The amygdala is the region of the brain associated with emotions such as fear in this case. The amygdala triggers secretion of hormones that affect fear and aggression – this is what puts the body in an active state known as the fight or flight response.

There are many techniques used in treating phobias, the most successful of these techniques include:
Cognitive Behavioral Therapy – A clinical trial showed this therapy cured 95% if all sufferers of phobias.
EMDR – Eye Movement Desensitization and Reprocessing – has been demonstrated to be successful in treating specific phobias but mainly in treating Post Traumatic Stress Disorder.
Antidepressant medications such SSRIs, MAOIs may be helpful in some cases of phobia. Benzodiazepines may be useful in acute treatment of severe symptoms but the risk benefit ratio is against their long-term use in phobic disorders
The Top Five Most Common Phobias:

Acrophobia – Fear of heights
As mentioned above, acrophobia is neurologically wired into us through evolution. It should not be confused with vertigo, which is a physical condition that causes dizziness or disorientation when one looks down from a great height.

Claustrophobia – Fear of Enclosed Spaces
The levels of claustrophobia differ from closing a room door to entering an elevator. Some people discover undiagnosed claustrophobia when undergoing an MRI.

Nyctophobia – Fear of the Dark
This fear is common and generally transient in children. If it persists for longer than six months and causes eXtreme anXiety, however, it may be diagnosed as a phobia. It is less common in adults.

Ophidiophobia - Fear of Snakes

People who are diagnosed with this phobia not only have a problem with seeing them or touching them, but will also have a problem talking about them.


Arachnophobia – Fear of Spiders

A very common animal phobia and most common insect phobia. People with this phobia will also react to spider webs or any other indication that a spider is near. The very thought of spiders to the sufferer makes them shiver. Severe cases go as far as having anXiety simply viewing a picture of a spider.


Top Five Most Bizarre Phobias


Ithyphallophobia – Fear of Erections

Though bizarre, this phobia is commonly growing amongst men. Most fear of erection therapies take months to years and sometimes even requires the patient to be eXposed to their fears. It can also lead to panic attacks.


 Ephebophobia – Fear of Youths

Categorized as a psychological social fear of youth.


Coulrophobia – Fear of Clowns

Quite common amongst children and even adults. This phobia can be traced to having a direct bad experience with a clown. Also, the red nose and overall face painting may appear bizarre and treacherous to some people who may perceive it as a threat. Batman’s nemesis Joker or Stephen King’s “IT” are good references.


Ergasiophobia – Fear of Work

A disorder in some people causing significantly psychological disability and dysfunction. These individuals may actually be suffering from other health problems such as clinical depression and/or ADHD.

Gymnophobia – Fear of Nudity

This phobia is a fear of being seen naked or seeing others naked. It is a social phobia usually associated with people who view their bodies as ‘inferior’ particularly due to comparison with idealized images portrayed in the media.



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