Specific phobia

Specific phobia
Classification and external resources
Specialty	psychiatry
ICD-10	F40.2
ICD-9-CM	300.29

A specific phobia is any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations. As a result, the affected person tends to actively avoid direct contact with the objects or situations and, in severe cases, any mention or depiction of them. The fear can, in fact, be disabling to their daily lives.^[1]

The fear or anxiety may be triggered both by the presence and the anticipation of the specific object or situation. 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. 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.

Epidemiology

Specific phobias have a one-year prevalence of 8.7% in the USA with 21.9% of the cases being severe, 30.0% moderate and 48.1% mild.^[2][3] The usual age of onset is childhood to adolescence. Women are twice as likely to suffer from specific phobias as men.^[4]

Evolutionary theory argues that infants or children develop specific phobias to things that could possibly harm them, so their phobias alert them to the danger. The most common co-occurring disorder for children with a specific phobia is another anxiety disorder. Although comorbidity is frequent for children with specific phobias, it tends to be lower than for other anxiety disorders. Onset is typically between 7 and 9 years of age. Specific phobias can occur at any age but seem to peak between 10 and 13 years of age.

Categories

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

• Animal type – Fear of dogs, cats, rats and/or mice, pigs, cows, birds, spiders, or snakes.
• Natural environment type – Fear of heights (acrophobia), lightning and thunderstorms (astraphobia), or aging (gerascophobia).
• Situational type – Fear of failure (atychiphobia), of small confined spaces (claustrophobia), or the dark (nyctophobia).
• Blood/injection/injury type – this includes fear of medical procedures, including needles and injections (trypanophobia), fear of blood (hemophobia) and fear of getting injured.^[5]
• Other – Fear of contracting an illness; children's fears of loud sounds or costumed characters.^[6]

Diagnosis

Main features of diagnostic criteria for specific phobia in the DSM-IV-TR:

• 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).
• 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. In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
• The person recognizes that the fear is excessive or unreasonable. In children, this feature may be absent.
• The phobic situation(s) is avoided or else is endured with intense anxiety or distress.

Specific Phobia – DSM 5 Criteria^[7]

• Fear or anxiety about a specific object or situation (In children fear/anxiety can be expressed by crying, tantrums, freezing, or clinging)
• The phobic object or situation almost always provokes immediate fear or anxiety
• The phobic object or situation is actively 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

Treatments and medications

The following are two therapies normally used in treating specific phobia:

Cognitive behavioral therapy (CBT)- a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures.

One-session treatment (OST)- a variant of cognitive-behavioral therapy, combines graduated in vivo exposure, participant modeling, reinforcement, psychoeducation, cognitive challenges, and skills training in an intensive treatment model. Treatment is maximized to one three-hour session. The success of the treatment could be affected by the therapeutic relationship, motivation, and expectations towards the treatment and their possible relations with the outcome.

A type of CBT, exposure therapy, is usually utilized. The specific exposure treatments used for specific phobia include: systematic desensitization, imaginal exposure, in vivo, virtual reality, and interoceptive exposure.

While many kinds of therapies can be used, different subgroups respond better to certain treatments. Overall, in vivo therapy displays the greatest effectiveness despite its high dropout rates; there are some exceptions however. According to the Clinical Psychology Review, cognitive therapy looks like a successful solution to claustrophobia and virtual reality demonstrates equal effectiveness for fear of heights and flying. Blood-injury, in addition, responds well to applied tension. Medications have not been as encouraging with the exception of adjunctive D-clycoserine.^[8]

Medication - For situational phobias/ specific that produce intense, temporary anxiety (for example, a fear of flying), short-acting sedative-hypnotics (benzodiazepines)^[9]

See also

• List of phobias

References

1. "Phobias: Specific Phobias Types and Symptoms." WebMD. WebMD, n.d. http://www.webmd.com/anxiety-panic/specific-phobias
2. Kessler, PhD, Ronald; Chiu, AM, Wai Tat; Demler, Olga; Walters, Ellen (2005). "Prevalence, Severity and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication". Archives of General Psychiatry 62 (6): 617–709. doi:10.1001/archpsyc.62.6.617. PMC 2847357. PMID 15939839.
3. Narrow; et al. (2002). "Revised prevalence estimates of mental disorders in the United States". Archives of General Psychiatry 59 (2): 115–123. doi:10.1001/archpsyc.59.2.115. PMID 11825131.
4. Cameron, Alasdair (2004). Crash Course Psychiatry. Elsevier Ltd. ISBN 0-7234-3340-2.
5. ^ a b c d e "Oxford Textbook of Psychopathology" by Theodore Millon, Paul H. Blaney, Roger D. Davis (1999) ISBN 0-19-510307-6, p. 82
6. DSM-IV-TR 300.29, p. 445.
7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
8. Choy, MD, Yujuan; Fyer, Abby J.; Lipsitz, Josh D. (2007). "Treatment of specific phobia in adults". Clinical Psychology Review 27 (3): 266–286. doi:10.1016/j.cpr.2006.10.002. http://www.sciencedirect.com/science/article/pii/S0272735806001164
9. Goldberg, MD, Joseph (2014). "Anxiety & Panic Disorders Health Center". National Institute of Mental Health. http://www.webmd.com/anxiety-panic/specific-phobias?page=3

External links

• Encyclopedia of Mental Disorders – Specific phobias