The suffix ‘Phobia’ is derived from a Greek God named ‘Phobies’, who frightened his enemies. A phobia is a consistent or a disproportionate fear of a specific event or situation which otherwise poses little or no danger to the individual. Anxiety in phobic disorder is evoked only or predominantly by certain well-defined situations (for example, crowded places) or objects (for example, spiders) or natural phenomenon (for example thunder), which are not regarded as dangerous in nature and are external to the individual.
Symptoms of Phobic Anxiety Disorder:
- Presence of fear of an object, situation or activity.
• The fear is out of proportion to the dangerousness perceived.
• Patient recognizes the fear as irrational and unjustified.
- Fear faced by the patient is uncontrollable , which causes distress .
• This leads to persistent avoidance of the particular object, situation or activity.
• Gradually, the phobia and the phobic object becomes a preoccupation with the patient, resulting in marked distress and restriction of the freedom of mobility.
For clinical purposes, the three principle phobic syndromes recognized are Specific, Social and Agora phobia.
1. Specific Phobias
A person with a specific phobia is inappropriately anxious in the presence of one or more objects or situations for example standing at a height etc. Anticipatory anxiety, escape and avoidance of the feared object or situation is common. According to DSM-IV, there are five subtypes of specific phobias as given below:
• The animal type: it refers to the fear or animals or insects and usually begins during childhood.
• The natural environment type: it refers to the fear of height, water etc and usually begins during childhood.
• The blood-injury phobia: these individuals are fearful of the sight of blood or injury. It has a strong familial component with as many as two-third of individuals having blood phobia have first degree relatives who also have blood phobia.
• The situational phobia: it refers to the fear triggered by specific situations.
- Other types of phobias: refer to fear of writing, choking
2. Social Phobias
In it the individual experiences anxiety in social situations, where he or she feels that he or she is going to be observed and could be criticized. This involves a fear of negative evaluations by others or disapproval of others. Some patients feel anxious in specific situations such as public speaking (Specific Social Phobia), while others feel anxious in a wide range of social situations (Generalized social phobia). They tend to either completely avoid such situations or may not engage fully in them. Complaints of blushing and trembling are particularly frequent.
It was earlier thought to be a fear of open and closed spaces. It is now known that it is a fear of having a panic attack in situations from where escape may be difficult or embarrassing. Individuals suffering from agoraphobia are the ones who tend to get anxious when away from home, in crowds and in situations (such as buses, trains, plane, lift) that they cannot leave easily. Panic attacks, anxious cognitions about fainting and loss of control, anticipatory and the tendency to avoid such situations is frequent among agoraphobic patients. Depressive symptoms, depersonalization and obsessional thoughts may also be present. As the condition progresses, the patient tends to increasingly avoid more and more situations to a level where in severe cases they may be more or less confined to their homes. This is one of the reasons that this disorder is also known as Household Housewife Syndrome.Most patients are less anxious when accompanied by a trusted companion or in the presence of a child or a pet.
Causes of Phobic Disorders:
Several factors underlying phobic anxiety disorders are given below:
- The Psychoanalytical Perspective:
According to Freud , phobias are defence against anxiety that is produced by repressed childhood instinctual impulses. This anxiety is replaced from instinctual impulses to fear of an object or situation that has some symbolic connection to it. Thus, phobia is a way of avoiding to deal with a repressed childhood conflict.
2. The Behavioural Perspective:
According to this view, phobias are fears learnt through classical conditioning. When a neutral object or event is paired with some painful or fearful experience with that object then the individual develops the phobia of that object or event through classical conditioning. According to classical conditioning phobias once acquired, would generalize to other similar objects or situations. Phobia can also develop by observing others in an aversive conditioning situation. By virtue of positive consequence that follow phobic reactions may also be learned.
3. The Cognitive Perspective:
This perspective believes that individuals having phobias tend to markedly overestimate the probability that feared objects have been or will be followed by aversive events. They have a tendency to think negatively; have a bias towards remembering threatening cues and to focus automatically more on the threatening cues in the environment. It is likely that in their growing up years they must have encountered several unpredictable and uncontrollable events which may promote negative schemas, current anxiety and a vulnerability to anxiety in the presence of future stressors. In maintaining phobias cognitive variables may also play a significant role.
4. The biological perspective:
As per this view, the autonomic nervous system of these individuals becomes easily aroused. The speed and strength one conditioning of fear is affected by Genetic and temperamental or personality variables.
Before initiating any treatment, one should rule out other medically treatable conditions such as hyperthyroidism that may give rise to anxiety symptoms.
- Cognitive-behavioral therapy (CBT): It aims at modifying the negative self-statements and cognitive distortions these individuals engage in. In helping these individuals to overcome their avoidance behaviour flooding, Systematic disensitization , exposure and response prevention.
- Pharmacotherapy: Benzodiazepines, Beta-Blockers and Antidepressants like SSRIs, MAOIs and Tricyclics have been found to be quite effective in treating anxiety symptoms.
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