Phobic Anxiety Disorders

What is a phobia ?

Persistent irrational fear of an object, activity or situation and a wish to avoid it.

Phobic anxiety disorder

Core symptoms of Anxiety (Generalized Anxiety Disorder)

Tremor

Palpitation

Sweating

Blurring of vision etc…..

Occurs only in particular circumstances

Situations

eg. Crowded places

Objects

eg. Spiders

Natural Phenomena

eg. Thunder

Avoidance of circumstances that provoke anxiety

Anticipatory Anxiety

Types of phobic anxiety disorders

Specific ( Simple ) Phobias

Agoraphobia

Social Phobia

Specific ( Simple ) Phobias

Inappropriately anxious in the presence of one or more particular objects or situations.

Symptoms of anxiety

Avoidance of circumstances that provoke anxiety

Anticipatory Anxiety

Eg. Phobia of heights

Spider phobia

Phobia of illnesses

Phobia of dental treatment

phobia of flying

Prevalence

Life time prevalence

Men 4 %

Women 13 %

Aetiology

Continuation of childhood phobias

Genetic

Following a stressful experience

Psychoanalytic explanation

Management

Assess severity and level of incapacitation

Behaviour Therapy

graded exposure with relaxation training

Agoraphobia

Anxiety when - away from home

- in crowds

- situations they can’t leave easily

- open spaces

- social situations

eg. Buses

Super markets

Cinemas

Anxiety symptoms

Anxious cognitions about fainting

and loss of control

Panic attacks

Panic Attacks

Shortness of breathChokingPalpitationsSweatingDizziness, unsteady feelings, faintnessNausea, abdominal distressNumbness, tingling sensationFlushes or chillsTrembling or shakingFear of dying

Fear of going crazy or losing control

As the illness progresses the patient tends to avoid more and more situations

Severe cases

“ Housebound Housewife syndrome”

Less anxious when accompanied by a trusted companion

- Child

- Dog

- Object

Anticipatory Anxiety

Avoidance

Other anxiety symptoms like depersonalization

Depressive symptoms

Onset - early and middle twenties mid thirties

Women > Men

Agoraphobia without panic disorder 1.7 % in men 3.8 % in women

Life time prevalence 6 - 10 %

Aetiology

Cognitive theories - people who are unreasonably fearful

Biological theories - Normal inhibitory mechanisms are defective

Psychoanalytic theories

Personality -

Dependent

Avoidance rather than

confronting problems

Overprotective family

can maintain symptoms

Management

Assess

Find out the severity of the problem

Psychological Management

Behaviour Therapy – exposure and relaxation training

Cognitive Behaviour Therapy

Chemotherapy

Anxiolytic drugs - not regularly

Antidepressant drugs

Tricyclics eg . Imipramine

SSRIs

MAOIs

Social phobia

Excessive, inappropriate anxiety in places where patient feels he is observed or could be criticized .

They avoid such situations eg . Parties Canteens SeminarsAvoidance and escape make situation

worse.

Prevalence

One year prevalence

Women – 9 %

Men – 7 %

Onset usually between 17 and 30 years.

The symptoms can last for several years.

Aetiology

Genetic Factor

Cognitive Factor

self critical

perfectionist

low self esteem

Treatment

Psychological Treatment

Cognitive Behaviour Therapy

Social skills training

Relaxation training

Exposure

Drug Treatment