SPECIFIC PHOBIA

Presented by:

Shaista Butt

Definition

Specific phobia, or simple phobia, is an intense, unreasonable, and persistent fear caused by the presence or anticipation of a specific object or situation.

It provokes an immediate anxiety response that can sometimes take the form of a panic attack.

This intense fear often leads to avoidance, and causes severe distress when the situation can’t be avoided (Bernstein, 1997).

Subtype of specific phobiaPhobias are classified into different subtypes. – Situational type: concerns a specific situation, such as the fear

of flying, bridges, elevators, driving, etc. – Blood-injection-injury type: also includes any invasive

medical procedure. This kind of phobia is often associated with fear of seeing blood or wounds, having injection and other medical procedures.

Subtype (Cont..)

– Animal type: fear of insects, dogs, snakes, rodents, spiders, etc.

– Other type: phobias can be caused by a wide variety of objects or situations that don’t fit the categories listed above. These include a fear of choking, loud noises, contracting an illness, vomiting, etc.

Animal phobia is most common in childhood, while blood-injury phobias are most common in adolescents. (Silverman, & Moreno, 2005).

‾ Natural environment type: fear of storms, heights, the dark, water, etc.

Age of Onset

The usual age of onset is childhood to adolescence. Symptoms usually peak between 10 and 13 years of age.

The onset of phobias differed between groups: hardly any phobias of animals had started after age 5, while most phobias of the other varieties started after age 10 (Jackson, 2002).

Signs and Symptoms Children with phobia show different symptoms when

confront phobic objects or situations. The anxiety response occurs immediately when the child is confronted with the feared object.

The child may respond by – crying, – cringe, – clinging to parents, – avoidance, aggression, – running away, – shaking, or immobilization. (Muris, Merckelbach, & Ollendick,

2002).

Signs and Symptoms (Cont..) Anxiety can sometimes cause symptoms of panic, such as – rapid heart rate, – dizziness, light-headedness, and– the fear of dying, losing control, – sweating, – trembling, or – a choking sensation.

Phobias disrupt a child’s daily routines, work efficiency, and/or social relationships (Muris, Merckelbach, & Ollendick, 2002)..

DSM V Criteria Marked and out of proportion fear within an

environmental or situational context to the presence or anticipation of a specific object or situation.

Exposure to the phobic stimulus provokes an immediate distress or anxiety response, which may take the form of a panic attack.

The avoidance, anxious anticipation or distress in the feared situation(s) interferes significantly with the child’s normal routine, academic functioning, or social relationships.

The symptoms must have duration of at least 6 months (APA, 2013).

Co morbidity

Specific phobia is co-morbid with a number of disorders including:– major depression,– Somatoform disorder, and – attention-deficit hyperactivity disorder (Peterman, 2000),.

Prevalence and Epidemiology According to the various studies, specific phobias affect

7% to 11% of the population at some point in their life,

Generally more common among women, with percentages varying depending on the type of phobia.

It is interesting to note that the objects of phobias vary from culture to culture (Becker, et al. 2007).

Etiology and Pathogenesis The etiology of specific phobia is partly unknown.

Studies demonstrate that both biological and environmental factors play a role.

Genetics:

Relatives of children with phobias have greater likelihood of having phobias.

Moreover, type of feared stimuli may run in families For instance, if one family member has situational phobia its more likely that other members will have situational phobia (Ollendick, Hagopian, & King. 1997).

Learning and conditioning:

Development of phobias can be explained by conditioning. – Phobia can be developed by classical conditioning, when a

natural fear response to natural feared object is paired with a neutral object. For example, a child who has been attacked (natural object) by a dog will have a fearful response (natural fear response) to the presence of any dog (neutral stimulus) nearby.

– In operant conditioning, phobia may be developed due to contingencies (i.e. rewarding child for phobia behavior) e.g. a child who fears dog may be rewarded by parental attention

(Jackson, 2002).

Traumatic experiences:

Someone who has, for example, witnessed or experienced a traumatic event (e.g. being bitten by an animal or trapped in an enclosed space) may feel extremely fearful of situations or objects associated with the event afterwards.

By avoiding these, even when they are in a non-threatening situation, they may develop a specific phobia (Essau, Conradt, & Petermann, 2000).

Psychodynamic causes: Psychodynamic theorists explain that phobias emerge

because individuals have impulses that are unacceptable, and they repress these impulses.

When repression does not work, individuals with phobias displace their anxiety connected to the unresolved conflict upon a situation or object that is less relevant. The feared situation or object symbolizes the source of the conflict. – For example, a specific phobia may be connected to an

individual's conflict about aggressive thoughts and feelings. A phobia protects individuals from realizing their emotional issues (Jackson, 2002).

Treatment A variety of treatment options exists, including

cognitive-behavioral therapy (CBT), exposure therapy, anxiety management, relaxation techniques, and medications. One or a combination of these may be recommended (Ollendick, Hagopian, & King. 1997).

• Psychotherapy:

The psychotherapy in form of “exposure” and “systematic desensitization” are effective treatments for specific phobia, in which the feared situation is faced directly or through imagery.

Exposure therapy: The most effective way to overcome phobia is gradual

and repeated exposure to the feared object in a safe and controlled way until it no longer triggers the fear response. This can be done via – “imaginal exposure” i.e. imagining confronting the feared

situation in one’s mind, or via – “in vivo exposure”-confronting the feared situation in real

life.

Through repeated experiences facing fear, child begins to realize that the worst isn’t going to happen and feels more confident and the phobia begins to lose its power. The child works moving up the fear ladder (Foe & Kozak, 1986).

For example:

1. look at picture of dog,

2. watch video with dogs in it,

3. look at a dog through window,

4. stand across the street from a dog on a leash,

5. stand beside a dog on a leash,

6. pet a small dog that someone is holding the street from a dog on a leash,

7. stand 5 feet away from a dog,

8. stand beside a dog on a leash,

9. pet a small dog that someone is holding, and

10. pet a large dog on a leash.

Desensitization:

Desensitization pairs gradual exposure to phobic stimuli with relaxation methods.

– Systematic desensitization exposes the child to imagined stimuli, while

– in in-vivo desensitization exposes child to actual stimuli.

Desensitization begins with the hierarchy of anxiety provoking stimuli (Davis & Ollendick, 2005).

For example:

If child is afraid of dogs, hierarchy might include:

1. looking at picture of dog,

2. looking at a dog through window,

3. standing across the street from a dog on a leash,

4. stand beside a dog on a leash and so on.

The child is taught relaxation techniques for dealing with fear (Davis & Ollendick, 2005).

Modeling:

In modeling, the child observes others (the “models”) in the presence of the phobic stimulus who is responding with relaxation rather than fear.

In this way, the patient is encouraged to imitate the model(s) and thereby relieve their phobia.

Combining live modeling with personal imitation is sometimes called participant modeling (Bernstein, 1997).

Medication

There is little research on the use of medication and specific phobias.

However, some people with situational-type phobias (i.e. flying) do note some benefit in taking anti-anxiety medications (i.e. Ativan) or serotonin reuptake inhibiters (i.e. Paxil) before confronting the feared situation.

Thus, they should be used with caution and sparingly, because they can cause tolerance and addiction problems. (Davis & Ollendick, 2005).

 

ReferencesAmerican Psychiatric Association (2000). Diagnostic and

Statistical Manual of Mental Disorders (4th ed, text revision). Washington, DC: American Psychiatric Association.

Becker, E., Rinck, M., & Turke, V., et al. (2007). Epidemiology of specific phobia subtypes: findings from the Dresden Mental Health Study. Europe Psychiatry, 22, 69-74.

Bernstein, D. (1997). Psychology (4th ed.). New York: Houghton Mifflin.