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Phobia

Neurosis Phobic

Phobia is a persistent, unreasonable, excessive fear of a specific object or situation.


Presentation

A panic attack is the most common and disabling symptom of a phobia. With a panic attack, the individual presents with a pounding or racing heart, shortened breath, rapid speech or cessation of speech, dry mouth, nausea or upset stomach, elevated blood pressure, shaking or trembling, chest pain or tightness, choking sensation, dizziness or lightheadedness, excessive sweating, heightened expectation of disaster, etc. [6]. 
However, it is not compulsory for these presentations of panic attacks to be visible for accurate diagnosis. The intensity of the anxiety can also vary among people with phobias.

Medication Noncompliance
  • A changing criterion design was used to examine graduated exposure treatment for blood-injury-injection phobia in an adult male with autism and intellectual disability and a history of medical noncompliance.[ncbi.nlm.nih.gov]
Noncompliance
  • A changing criterion design was used to examine graduated exposure treatment for blood-injury-injection phobia in an adult male with autism and intellectual disability and a history of medical noncompliance.[ncbi.nlm.nih.gov]
Hypoventilation
  • One of the interventions was a novel Hypoventilation Respiratory Training (HRT) aimed at reducing the exaggerated ventilation response (hyperventilation) seen in BII phobia.[ncbi.nlm.nih.gov]
Nausea
  • ., faintness and nausea) in comparison to youth with dog phobia. The present study advances knowledge relating to this poorly understood condition in youth. Copyright 2016. Published by Elsevier Ltd.[ncbi.nlm.nih.gov]
  • The secondary outcome measures are real-time evaluation of HR and VR (Virtual Reality) experience (presence, realism, nausea) during and following the VRET intervention respectively.[ncbi.nlm.nih.gov]
  • Physical symptoms, including rapid heartbeat, lightheadedness, nausea, shortness of breath, and trembling occur.[pchtreatment.com]
  • With a panic attack, the individual presents with a pounding or racing heart, shortened breath, rapid speech or cessation of speech, dry mouth, nausea or upset stomach, elevated blood pressure, shaking or trembling, chest pain or tightness, choking sensation[symptoma.com]
  • SSRIs may initially cause nausea, sleeping problems, and headaches. If the SSRI does not work, the doctor may prescribe a monoamine oxidase inhibitor (MAOI) for social phobia. Individuals on an MAOI may have to avoid certain types of food.[medicalnewstoday.com]
Tachycardia
  • The fight-or-flight response is characterized by an increased heart rate ( tachycardia ), anxiety, increased perspiration, tremour, and increased blood glucose concentrations (due to glycogenolysis, or breakdown of liver glycogen ).[britannica.com]
Ulcer
  • A series of logistic regression analyses was performed with outcome measures of: presence of decayed teeth; presence of missing teeth; pulp exposure ulceration fistula abscess (PUFA) score; periodontal health indices (plaque, bleeding and loss of attachments[ncbi.nlm.nih.gov]
  • Stimulation of the lateral septum attenuates immobilization-induced stress ulcers. Physiol Behav 1996; 59 : 883–886. 86. Yadin E, Thomas E, Grishkat HL, Strickland CE. The role of the lateral septum in anxiolysis.[doi.org]
Fear
  • Among the more common examples are acrophobia, fear of high places; claustrophobia, fear of closed places; nyctophobia, fear of the dark; ochlophobia, fear of crowds; xenophobia, fear of strangers; and zoophobia, fear of animals.[britannica.com]
  • Eighty-one percent reported to have a certain amount of fear of TCS.[ncbi.nlm.nih.gov]
  • They were more likely than those with no or little fear to have poorer asthma control (mean ACT scores 21.3 4.0 vs 23.1 3.3, P   0.02), discuss their fears with their doctors (P CONCLUSIONS: CS fear and CM usage are prevalent.[ncbi.nlm.nih.gov]
  • There is evidence for dissociable neural correlates of phasic fear and sustained anxiety.[ncbi.nlm.nih.gov]
  • Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia.[ncbi.nlm.nih.gov]
Incontinence
  • Results: The first case is a girl with incontinence and no behavioral comorbidities, for whom treatment was more complicated than expected because of her TP.[ncbi.nlm.nih.gov]
Agitation
  • Initially, this was because of difficult venous access but more recently because of severe distress and agitation when approached with a cannula.[ncbi.nlm.nih.gov]
  • "I get easily agitated." "I can be stirred up easily." . * Anxiety: " I worry about almost everything ." "I'm always fearful or on edge about bad things that might happen." "I always expect the worst to happen." "I am a very anxious person."[mentalhealth.com]
Behavior Problem
  • Conclusion: TRS in preschool children is a common condition, associated with high rates of constipation and behavioral problems.[ncbi.nlm.nih.gov]

Workup

When it comes to diagnosis, there are no diagnostic laboratory tests for phobias. Diagnosis is most of the time dependent on the patient’s account of their experiences. [7]

To rule out anxiety secondary medical conditions however, some laboratory tests can be carried out. Some of this includes drug screening for substance-induced anxiety, fasting glucose to rule out hypoglycaemia, thyroid function tests to rule out hypo/hyperthyroidism and 24-hour urine for 5-hydroxyindoleacetic acid (5-HIAA) for pheochromocytoma.

Sinus Arrhythmia
  • KEYWORDS: blood-injection-injury phobia; cardiac activity; disgust; parasympathetic activity; respiration; respiratory sinus arrhythmia; sympathetic activity[ncbi.nlm.nih.gov]

Treatment

Treatment for phobias generally involves therapeutic techniques, medications and a combination of both. [8]

Cognitive behavioural therapy is the most commonly used therapeutic treatment for phobias. It involves an exposure to the source of the fear in a controlled environment. The treatment has deconditioning abilities and can reduce anxiety. The therapy focuses on identifying and changing negative thoughts, dysfunctional beliefs, as well as negative reactions to fear. Some of the newer techniques expose the patient safely to the source of the phobia.

Antidepressant and anti-anxiety medications can also help calm the mind and physical reactions to fear [9]. Most of the time, the best results are seen with a combination of medications and professional therapy.

Prognosis

Following proper resolution of symptoms, most phobia patients will respond to treatment [5]. The most positive outlook is seen in patients with a specific phobic disorder while those that have social anxiety disorders or agarophobia display residual symptoms. Such individuals also face the risk of a reoccurrence following successful treatment. However, patients who have social anxiety disorders with extensive deficits in social skills generally find it hard to respond positively to treatment.

Etiology

There is no singular etiologic factor for development of a phobia. However, there are several factors that may contribute to its development [2]:

Specific incidents or traumas

An individual that had a harrowing flying experience at a young age may end up developing a phobia about flying.

Responses picked up in early life

It is possible to develop the same specific phobia as a parent or an older sibling. Factors in the family environment such as worried or anxious parents can have an effect on the way you cope with anxiety much later in life.

Genetics

It has been proven that some individuals are born with the tendency to be more anxious than others.

Responses to panic or fear

When an individual has a strong reaction or panic attack following a particular situation or subject and people around react in an embarrassment inducing manner, he or she can develop intense anxiety about ever being in such a situation again.

Stress

Long term stress can lead to feelings of anxiety and depression making it harder for the individual to cope in certain situations. This will leave them feeling more fearful or anxious about being in such a situation ever again. Over a long period of time, this can lead to the development of a phobia.

Epidemiology

Phobias are a relatively common form of anxiety disorders [3]. Its distribution is heterogeneous by age and gender. In the United States between 8.7% and 18.1% of people suffer from phobias. It is also the most common mental condition among women across all age groups and the second most common illness among men that are older than 25. Around 10% of all children experience specific phobias during their lives and social phobias also occur in 1-3% of children and adolescents.

Studies have also shown that women have a higher incidence of phobias than males. Figures show 26.5% for females and 12.4% for males. Multiple phobias can be found in 4% of females and 1.5% of males. Women are 4 times more likely to have a fear of animals compared. This is the highest disparity in incidence amongst all other forms of social phobias. Other phobias such as situational and social phobias are also more common in girls than in boys.

Sex distribution
Age distribution

Pathophysiology

The underlying mechanism in the development of phobia is an interaction between the amygdala, anterior cingulate cortex and insula hyperactivity [4]. This theory was put forward following research which showed significant reductions in site-specific neural activity in these areas following evidence-based exposure treatments. Neuroimaging studies have also shown an increase in amygdala activation following exposure to cues relevant to the phobia as well as heightened activity in the insula and the dorsal anterior cingulate cortex regions.

Prevention

The most common way to prevent phobic disorders is to tackle it at the bud by ensuring the individual receives psychotherapy or medication following any form of overwhelming exposure [10].

Summary

A phobia is a debilitating and overwhelming fear of a place, object, situation, feeling or animal [1]. The phobias are much more pronounced than fears. It develops when the patient has a heightened and totally unrealistic sense of danger about a situation or object.

Severe cases of phobias may lead to an individual reorganising their life to avoid the things that are responsible for the heightened fear. This will lead to a disruption of day-to-day life and also lead to considerable anguish.

A phobia is a type of anxiety disorder. This means that the individual may not show any symptoms until they come in contact with the source of the phobia. However, it is possible for an individual to feel anxious or panicky by just thinking about the source of a phobia, a condition referred to as anticipatory anxiety.

Patient Information

A phobia refers to an overwhelming and unreasonable fear of a subject, object, situation which poses small real danger but provokes the feeling of avoidance or anxiety in an individual. Unlike the small anxiety people feel with taking tests of addressing a crowd, a phobia lasts far longer and causes some form of intense physical and psychological reactions which often affect the patient negatively at work or at play.

There are various types of phobias. Some people are scared of large spaces while others cannot cope with some social situations. Others on the other hand have a specific phobia like the fear of dogs, heights or air travel.

Most phobias don’t require treatment but if it gets to the point of affecting your daily life negatively, therapies and treatments can be deployed to help overcome the fears permanently.

References

Article

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association Press; 2000.
  2. Mathew SJ, Coplan JD, Gorman JM. Neurobiological mechanisms of social anxiety disorder. Am J Psychiatry. Oct 2001;158(10):1558-67.
  3. Kendler KS, Karkowski LM, Prescott CA. Fears and phobias: reliability and heritability. Psychol Med. May 1999;29(3):539-53.
  4. Fyer AJ, Mannuzza S, Chapman TF, Liebowitz MR, Klein DF. A direct interview family study of social phobia. Arch Gen Psychiatry. Apr 1993;50(4):286-93.
  5. Van Houtem CM, Laine ML, Boomsma DI, Ligthart L, van Wijk AJ, De Jongh A. A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears. J Anxiety Disord. May 2013;27(4):379-88.
  6. LeBeau RT, Glenn D, Liao B, et al. Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V. Depress Anxiety. Feb 2010;27(2):148-67.
  7. Bourne, Edmund J. (2011). The Anxiety & Phobia Workbook 5th ed. New Harbinger Publications. pp. 50–51.
  8. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington D.C.: American Psychiatric Association. 1994. p. 406. ISBN 0-89042-062-9.
  9. Bolles, R. C. (1970). "Species-specific Defense Reactions and Avoidance Learning". Psychological Review 77: 32–38
  10. Kendall, P. C., Aschenbrand, S. G., & Hudson, J. L. (2003). Child-focused treatment of anxiety. In A. E. Kazdin, J. R. Weisz (Eds.) , Evidence-based psychotherapies for children and adolescents (pp. 81-100). New York, NY US: Guilford Press

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Last updated: 2019-07-11 22:54