Transcript Specific Phobia

Anxiety disorders:
(Simple phobia)
SPECIFIC PHOBIA
DEFINITION:
 A.
Marked and persistent fear that is excessive
or unreasonable, cued by the presence or
anticipation of a specific object or situation
(e.g., flying, heights, animals, receiving an
injection, seeing blood).
DEFINITION:
 B.
Exposure to the phobic stimulus almost
invariably provokes an immediate anxiety
response,
Note: In children, the anxiety may be expressed
by crying, tantrums, freezing, or clinging.
DEFINITION:
 C.
The person recognizes that the fear is
excessive or unreasonable.
Note: In children, this feature may be absent.
 D.
The phobic situation(s) is avoided
DEFINITION:
 E.
The avoidance, anxious anticipation, or
distress in the feared situation(s) interferes
significantly with the person's normal routine,
occupational (or academic) functioning, or
social activities or relationships, or there is
marked distress about having the phobia.
DEFINITION:
 F.
In individuals under age 18 years, the duration
is at least 6 months.
 G. The anxiety, panic attacks, or phobic avoidance
associated with the specific object or situation are
not better accounted for by another mental
disorder, such as OCD(e.g., fear of dirt in
someone with an obsession about contamination),
PTSD(e.g., avoidance of stimuli associated with a
severe stressor), SAD(e.g., avoidance of school),
social phobia (e.g., avoidance of social
situations because of fear of embarrassment),
panic disorder with agoraphobia, or agoraphobia
without history of panic disorder.
SPECIFY TYPE:
:
 1. Animal type
 2 . Natural environment type (e.g., heights,
.
storms, water)
 3 . Blood-injection-injury type
 4 . Situational type (e.g., airplanes, elevators,
.
enclosed places)
 5 . Other type (e.g., fear of choking, vomiting,
.
or contracting an illness; in children, fear
.
of loud sounds or costumed characters)
FINAL DIAGNOSE:
Normal - abnormal barrier ? : “clinically
significant” distress
 Impaired functioning ?
 Clinical judgment
 Organizing ideas: Empiricism/ E-B Medicine /
Translational Science/ .
Development

EPIDEMIOLOGY
Many people report subclinical fears of specific
objects
 12 month prevalence: 1/9 % in china to 8/7%
in US
 Life time prevalence: 1/5 to 10/8 percent
 Boys: 1 - 7.7 Girls: 2 – 17.8 percent
 Bimodal age of onset: childhood peak for
animal, natural, and blood -injury phobias
Early adulthood peak for others (situational)

Anxiety disorders:
(social anxiety disorder)
SOCIAL PHOBIA
EPIDEMIOLOGY

Life time prevalence of anxiety disorders in IRAN (CTP):
agoraphobia: 0.7%
social phobia: 0.8
GAD: 1.3% panic: 1.5% OCD: 1.8%
 All anxiety disorders : 8.4%
Life
time prevalence of social
phobia in IRAN: 0/8%


Mohammadi MR, Davidian H, Noorbala AA, Malekafzali H, Naghavi
HR: An epidemiological survey of psychiatric disorders in Iran.
Clinic Pract Epidemio Ment Health. 2005;26; 1:16.
Mohammadi MR, Ghanizadeh, A, Mohammadi M, Mesgarpour B:
Prevalene of social phobia and its comorbidity with psychiatric
disorders in Iran. Depress Anxiety. 2006;23(7) : 405.
EPIDEMIOLOGY
Social phobia : 0.2 – 15%
Highest prevalence in new zealand
 the lowest prevalence = Asian countries ( china
& Korea= 0/2)
 more common in Female than men
 Boys: 2 – 8% Girls: 2 – 14%
 Onset: late childhood and early adulthood

DEFINITION:

A-A marked and persistent fear of one or more
social or performance situations in which the
person is exposed to unfamiliar people or to
possible scrutiny by others. The individual fears
will be humiliating or embarrassing.
Note: In children, there must be evidence of the
capacity for age-appropriate social
relationships with familiar people and the
anxiety must occur in peer settings, not just in
interactions with adults.
DEFINITION:
B- Exposure to the feared social situation
almost provokes anxiety,
Note: In children, the anxiety may be expressed
by crying, tantrums, freezing, or shrinking from
social situations with unfamiliar people.
 C- The person recognizes that the fear is
excessive or unreasonable.
Note: In children, this feature may be absent.

DEFINITION:
D-The feared social or performance situations are
avoided or else are endured with intense anxiety
or distress.
 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.

DEFINITION:
F-In individuals under age 18 years, the duration is
at least 6 months.
 G-The fear or avoidance is not due to the direct
physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical
condition and is not better accounted for by
another mental disorder (e.g., panic disorder with
or without agoraphobia, separation anxiety
disorder, body dysmorphic disorder, a pervasive
developmental disorder, or schizoid personality
disorder).

DEFINITION:
H-If a general medical condition or another mental
disorder is present, the fear in Criterion A is
unrelated to it (e.g., the fear is not of stuttering,
trembling in Parkinson's disease, or exhibiting
abnormal eating behavior in anorexia nervosa or
bulimia nervosa).
 Specify if:
Generalized: if the fears include most social
situations (also consider the additional diagnosis
of avoidant personality disorder)

ETIOLOGY OF PHOBIAS
Behavioral factors:
classic stimulus response theory
operant conditioning theory
 Psychoanalytic factors: phobic neurosis/ signal
anxiety ( id, separation, castration, superego)
defense mechanisms: repression, displacement,
symbolization, avoidance
 Environmental stressors: humiliation, criticism

ETIOLOGY OF PHOBIAS
Genetic factors: Specific phobia tends to run in
families. The blood-injection-injury type has a
particularly high familial tendency.
First-degree relatives of social phobia are about
three times more likely to be affected with social
phobia. Monozygotic twins are more often
concordant than are dizygotic twins
 Neurochemical Factors: peformance phobia :
release more norepinephrine or epinephrine
generalized social phobia: dopaminergic activity

MANAGEMENT
First step: exclude medical illness ( asthma,
hypoglycemia, cardiac problems and seizure,
hyperthyroidism, pheochromocytoma, tumor,
drug use or withdrawal
 In general, appropriate management initially
involves pharmacotherapy & CBT
 Beta adrenergic antagonists : propranolol 2040 mg per dose & atenolol 25 – 50 mg per
dose for performance anxiety or 30 – 60
minutes before performance situation.

MANAGEMENT

antidepressants: SSRIs & venlafaxine for general
social anxiety : effective doses are the same for
depression but to start with lower initial doses
than in depression and titrate upward more
slowly. Therapeutic response 8 -12 weeks at an
optimized dose.
MANAGEMENT




Benzodiazepines: PRN basis in performance
anxiety ( alprazolam / lorazepam / clonazepam)
BNZ add to antidepressants for better effect in less
than optimal response to antidep.
Atypical antipsychotics: limited to augmentation of
antidepressants- resistant anxiety
Duration: 1 to 2 years then tapering: 10 to 25%
every 1 to 2 months.
CBT: exposure ( systematic Desensitization / vivo
exposure / imaginal exposure) is the treatment of
choice for specific phobia and social phobia.
‫گزارش مورد‬
‫‪ ‬پسر كالس اول دبستان‪ .‬چپ دست ‪ /‬پدر كمرو ‪/‬‬
‫روابط اجتمايي محدود‬
‫‪ ‬كالس دوم راست دستش مي كنند‬
‫‪ ‬در سالهاي بعدي‪:‬كمرو (خجالتي)‬
‫‪ ‬دبيرستان‪ :‬آشكار شدن فوبياي اجتمايي‬
‫‪ ‬ورود به دانشگاه با تداوم فوبياي اجتمايي‬
‫‪ ‬ورود به دوره دستياري ‪ :‬اقدام به درمان براي اولين‬
‫بار‪ :‬شناخت درماني ‪ +‬مواجهه سازي ‪ +‬ايندرال‬
‫با تشكر‬
‫خدا نگهدار‬