Situational phobias

PHOBIC DISORDERS profound fear of, and avoidance of, a dreaded object or situation. Agoraphobia. Fear of places or situations from which escape is difficult—can occur with or without a history of panic disorder Social phobia. Fear of social or performance situations Specific phobia. Fear of a specific object or situation... 

Often occurs in context of other anxiety disorders. The feared social or performance situation can be limited to a specific social interaction (e.g., public speaking) or generalized to most any social interaction. Differs from specific phobia, in which the fear and anxiety are limited to a particular object or situation (e.g., insects, heights, public transportation). 

Pharmacotherapy of SAD should lead to improvement in physiologic symptoms of anxiety and fear, functionality, and overall well-being.26 Many patients may not achieve full remission of symptoms but should have significant improvement. Monitor patients weekly during acute treatment (e.g., initiation and titration of pharmacotherapy). Once patients are stabilized, monitor monthly. Inquire about adverse effects and SAD symptoms at each visit. To aid in assessing improvement, ask patients to keep a diary to record fears, anxiety levels, and behaviors in social situations.26 You may administer the Leibowitz Social Anxiety Scale (LSAS) to rate SAD severity and change, and the Social Phobia Inventory can be used as a self-assessment tool for SAD patients. 

The American President Franklin Delano Roosevelt once said that there is nothing to fear but fear itself. It was a wise conclusion, especially from the standpoint of clinical psychology. Fear is indeed frightening. So much so that phobias - irrational fears of situations that are not dangerous - can be generated and maintained by the simple belief that one will experience intense fear. The panic and anxiety that are aroused in these disorders can be a simple, but intense, fear of fear.56... 

When is medication indicated in the treatment of psychiatric illness There is no short answer to this question. At one end of the continuum, patients with schizophrenia and other psychotic disorders, bipolar disorder, and severe major depressive disorder should always be considered candidates for pharmacotherapy, and neglecting to use medication, or at least discuss the use of medication with these patients, fails to adhere to the current standard of mental health care. Less severe depressive disorders, many anxiety disorders, and binge eating disorders can respond to psychotherapy and/or pharmacotherapy, and different therapies can target distinct symptom complexes in these situations. Finally, at the opposite end of the spectrum, adjustment disorders, specific phobias, or grief reactions should generally be treated with psychotherapy alone. 

Beta Blockers. Most often used to treat hypertension, beta blockers also alleviate many of the readily visible physical (i.e., autonomic) symptoms of anxiety. Namely, these medications decrease the sweating, palpitations, racing pulse, dry mouth, and tremulousness that can accompany anxiety. Although beta blockers do not remedy the emotional aspects of anxiety, they can circumvent the spiraling anxiety of patients with social phobia who during performance situations become self-conscious of their readily evident physical symptoms. 

The key feature of specific phobia is an intense and persistent fear of circumscribed situations or specific stimuli (e.g. exposure to animals, blood). Confrontation with the situation or stimulus provokes almost invariably an immediate anxiety response. Often, the situation or stimulus is therefore avoided or endured with considerable dread. Adolescents and adults with this disorder recognize that this anxiety reaction is excessive or unreasonable, but this may not be the case in children. For a diagnosis according to DSM-IV, the avoidance, fear or anxious anticipation of the phobic stimulus must interfere with the persons daily life or the person must be markedly distressed about having the phobia. Further, the phobic reactions are not better explained by another mental disorder, such as, for example, social phobia. 

Table 3 Lifetime prevalence of specific phobias according to the specific stimuli and situations in the NCS (adapted from Curtis et al. 1998)...

The terms social phobia or social anxiety disorder refer to a pattern of recurrent fear and apprehension in social situations or scenarios where an individual may be scrutinized. Before modifications in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), identification of social phobia in childhood was limited by having the condition closely aligned to both... 

These possibilities generate a series of questions amenable to study with modern neuroscience methods (Pine, 1999). For example, adults with social phobia exhibit hypersensitivity to social situations in which they may be scrutinized. This hypersensitivity may be... 

The word phobia comes from the Greek word for fear phobos, and refers to an inappropriately intense and irrational fear toward some object or situation. Most adults who experience phobias recognize that the fear is irrational. Most phobias fall into the category of specific (sometimes called simple ) phobias. The more complex social phobia (also called social anxiety disorder ) will be discussed later. 

A phobia is an inappropriately intense and irrational fear toward some object or situation. The fear is overwhelming, causing both emotionai and physical reactions. This testi-moniai was given by an empioyee at the State University of New York in Binghamton, New York, who had a specific situationai phobia. 

Phobia—An inappropriately intense and irrational fear toward some object or situation. 

The core features of social phobia center on the intense, irrational fear of scrutiny of others and the anticipation of humiliation (Table 25-2). Individuals with this disorder avoid or endure with marked distress the phobic situations. They realize that their fear is unreasonable or excessive. The disorder has been divided into subtypes. Individuals who have anxiety in well-circumscribed situations (e.g., public speaking) have been designated as having a performance subtype those who experience anxiety in a broader spectrum of interpersonal social situations are designated as having a generalized subtype of social phobia. As social phobia has become better character-... 

E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person s normal routine, occupational [academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. 

The Fear Questionnaire (FQ) is a 24-item self-rated scale used mainly for assessments in phobias. One component of the scale evaluates phobic behavior associated with a number of situations, whereas another component assesses symptoms of anxiety, depression and general distress caused by phobia (Marks and Mathews, 1979). The social phobia, strongly related to social anxiety, and most of the subscales are significantly related to neuroticism. The FQ has been utilized in several trials of social anxiety disorder. 

Specific phobia, characterized by fear of a specific object or situation other than fear of social embarrassment or humiliation... 

Formerly called simple phobia, specific phobia is a marked, excessive, or unreasonable and persistent fear of a specific object or situation (e g., snakes, heights, thunderstorms). Exposure to the phobic stimulus provokes immediate and intense anxiety that the individual recognizes as excessive or unreasonable. The degree of impairment frequently depends on whether the feared object or situation is commonly encountered or can be easily avoided. The diagnosis should only be made if avoidant behavior interferes with the person s normal routine, social activities, or relationships, or if there is marked distress about having the fear. Differential diagnosis may include the following ... 

Specific phobias used to be called simple phobias. They are excessive and unreasonable fears of specific objects or situations, such as flying in an airplane, heights, animals, seeing an injection, or seeing blood. In specific phobias, exposure to the feared situation or object causes an immediate anxiety response or even a full-blown... 

There is both a generalized and a more discrete type of social phobia. In the generalized type, the patient fears practically all social situations in which evaluation and scrutiny are possible. It is significantly more common than the discrete type, in which the individual fears a very specific social situation, usually of public speaking or public performance. Generalized social phobia is also more severe and disabling than discrete social phobia. 

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