Phobia specific

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... 

With a lifetime prevalence of 28.8%, anxiety disorders collectively represent the most prevalent Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR)2 class of disorders, with specific phobia (12.5%) and social anxiety disorder (12.1%) being the most common.3 Recent reports from the National Comorbidity Survey Revised (NCS-R) estimate the lifetime and 1-year prevalence of generalized anxiety disorder (GAD) for those 18 years of age and older to be 5.7% and 3.1%, respectively.3,4 Rates for panic disorder (PD) are slightly lower, with an estimated 12-month prevalence of 2.7% and lifetime prevalence of 4.7%. 

Anxiety disorders represent a diverse class of illnesses, with varied ages of onset. For example, according to the NCS-R epidemiologic study,3 PD and GAD had a median age of onset of 24 and 31 years, respectively, whereas specific phobia and social anxiety disorder (SAD) tend to develop much earlier (median age of onset 7 and 13 years, respectively). Although GAD and PD may not manifest fully until adulthood, as many as half of adult anxiety patients report subthreshold symptoms during childhood.6... 

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). 

Panic disorder Agoraphobia with panic disorder Agoraphobia without panic disorder Specific phobia Social phobia Generalised anxiety disorder Mild anxiety and depression disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD) Adjustment disorder Panic disorder without agoraphobia Panic disorder with agoraphobia Agoraphobia Specific phobia Social phobia (also called social anxiety disorder) Generalised anxiety disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD)... 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

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. 

Specific Phobia. This diagnosis is appropriate when exposure to a traumatic event leads to a phobic avoidance of some specific reminder of the trauma in the absence of other PTSD symptoms. For example, a survivor of a terrible automobile accident might avoid driving on freeways or traveling in cars altogether. If such avoidance occurs in the absence of other PTSD symptoms, then a specific phobia, rather than PTSD, could indeed be diagnosed. 

In this chapter, we consider categorical anxiety disorders as defined by the standardized diagnostic criteria of American Psychiatric Association s Diagnostic and Statistical Manual for Psychiatric Disorders [i.e., DSM-III (1980), DSM-III-R (1987), DSM-IV (1994)]. The subtypes of anxiety states included are panic disorder, agoraphobia, specific phobia, social phobia, generahzed anxiety/overanxious disorder, separation anxiety, and obsessive-compulsive disorder. 

Few studies have examined noradrenergic function in patients with phobic disorders. In patients with specific phobias, increases in subjective anxiety and increased heart rate, blood pressure, plasma NE, and epinephrine have been associated with exposure to the phobic stimulus (Nesse et al. 1985). This finding may be of interest from the standpoint of the model of conditioned fear, reviewed above, in which a potentiated release of NE occurs in response to a reexposure to the original stressful stimulus. Patients with social phobia have been found to have greater increases in plasma NE in comparison to healthy controls and patients with panic disorder (Stein et al. 1992). In contrast to panic disorder patients, the density of lymphocyte a-adrenoceptors is normal in social phobic patients (Stein et al. 1993). The growth hormone response to intravenous clonidine (a marker of central a2-receptor function) is blunted in social phobia patients (Tancer et al. 1990). 

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)...

Panic disorder Generalised anxiety disorder Social anxiety disorder Specific phobias... 

Benjamin J, Ben-Zion IZ, Karbofsky E, Dannon P (2000) Double-blind placebo-controlled pilot study of paroxetine for specific phobia. Psychopharmacology (Berl) 149 194-196 Berlant J, van Kammen DP (2002) Open-label topiramate as primary or adjunctive therapy in chronic civilian posttraumatic stress disorder a preliminary report. J Clin Psychiatry 63 15-20... 

SSRIs have been approved for the treatment of the majority of anxiety disorders, except agoraphobia and specific phobia. The mechanisms of action responsible for SSRIs anxiolytic activity remain to be fully delineated. Understanding of pre- and postsynaptic receptor regulation with chronic treatment and cross-system effects are critical in furthering our imderstanding of these drugs. Increasing specificity may improve clinical efficacy. 

Essau, C.A., Conradt, J., Essau, C.A., Conradt J and Petermann, (2000) Frequency, comorbidity, and psychosocial impairment of specific phobia in adolescents. / Clin Child Psychol 29 221-231. 

Fyer, A.J. (1998). Current approaches to etiology and pathophysiology of specific phobia. Biol Psychiatry 44 1295—1304. 

Muris, P., Schmidt, H., Muris, P., Schmidt, H., and MerCkelbach, H., (1999) The structure of specific phobia symptoms among children and adolescents. Behav Res Ther 37 863-868. 

Specific phobias come in many forms but can be categorized into these general categories ... 

Around 6.3 million adult Americans are affected by specific phobias, and as many as one in 10 people will experience a specific phobia at some point in their lifetime. Moreover, phobias affect twice as many women as men. Thus, phobias represent one of the most common anxiety disorders. 

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