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 breath Choking Palpitations Sweating Dizziness, unsteady feelings, faintness Nausea, abdominal distress Numbness, tingling sensation Flushes or chills Trembling or shaking Fear 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 %

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 Seminars Avoidance 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