Chapter 12PHOBIC AXINETY DISORDER

IntroductionPhobias are characterized by intense, persistent, irrational and recurrent fear of specific object, place or situation that results in a compelling desire to avoid the dreaded place, activity or situationEpidemiologyLifetime prevalence of specefic phobia is 4% in men and 13% in women.Classification1.Specific phobia2.Social phobia3.Agoraphobia

Definition of Specific PhobiaMarked and persistent fear that is excessive or unreasonable, cued by presence or anticipation of a specific object or situation.Subtypes1. Acrophobia (height)2. Ailurophobia (cat)3. Hydrophobia (water)4. Clustrophobia (closed area)5. Cynophobia (dog)6. Mysophobia (dirt & germs)7. Pyrophobia (fire)8. Xenophobia (stranger)9. Zoophobia (animal)

Lifetime prevalence 12-16%; M:F = ratio variable

Social phobia (social anxiety phobia)Definition: marked and persistent fear of social or performance situations in which one is exposed to unfamiliar people or to possible scrutiny by others; fearing he/she will act in a way that may be humiliating or embarassing (e.g. public speaking, initiating or maintaining conversion, dating, eating in public)Lifetime prevalence may be as high as 13-16%; M<FDiagnostic Criteria for phobic sorder1. Exposure to stimulus almost invariably provokes an

immediate anxiety response; may present as a panic attack

2. Person recognizes fear as excessive or unreasonable3. Situations are avoided or endured with anxiety/distress4. significant inerference with daily routine, occupational/

social functioning and/or marked distress 5. If person is < 18 yrs , duration is at least 6 months

Treatment1. Psychological Exposure therapy/desensitization, insight-oriented

psychotherapy behavioural therapy is more efficacious than

medication2. Biological β blockers or benzodiazepines in acute situations

(e.g. public speaking) SSRIs, MAOIs, clomipramine

Prognosischronic

The End