Specific Phobias

  1. Symptoms: persistent, irrational, and narrowly defined fear of a specific object or situation; complete avoidance of contact with said object or situation
  2. Diagnosis: The object or situation is actively avoided; the fear/anxiety is out of proportion with the actual danger posed by the object or situation; exposure must result in an immediate fear response; avoidance or distress associated with the phobia must interfere significantly with the person’s normal activities or relationships with others
  3. Course and Outcome: long-term outcome for anxiety disorders is mixed and unpredictable though some people do completely recover
  4. Frequency of Disorder: one year prevalence of 9% in adults (most common anxiety disorder); 50% rate of comorbidity rate of an anxiety disorder with another anxiety disorder or a mood disorder; 60% of people with a primary diagnosis of major depression also qualify for an anxiety disorder diagnosis; women have higher rates of relapse than men; women are three times more likely to experience a specific phobia; anxiety disorders are higher in elderly people in their 70s and 80s
  5. Etiology: maladaptive evolutionary anxiety and fears- though some anxiety/fear can be adaptive, it is maladaptive when it becomes excessive, becomes intense at an inappropriate time or place, the response systems become more harmful than helpful; social factors- stressful life events involving danger and interpersonal conflict;  stressful life events- high stress levels; childhood adversity- maternal prenatal stress, multiple maternal partner changes, parental indifference, physical abuse;  attachment relationships and separation anxiety;  learning processes- classical conditioning, such as after a traumatic experience, but can also develop in the absence of an direct experience with the feared object; cognitive factors-perceptions, memories, and attention influence the reaction to the environment;  perception of control- people who feel they are less in control of their environment are more likely to develop an anxiety disorder;  catastrophic misinterpretation- pertaining to bodily activities such as a rapid heart rate; attention to threat and biased information processing; genetic factors;  neurobiology-  response to stimuli by the amygdala
  6. Treatment(s): psychoanalytic psychotherapy;  systematic desensitization- recalling items that cause the least to the most fear for the patient;  interoceptive exposure- going through exercises that result in the same stimuli as when the fear or anxiety appears; relaxation and breathing retraining- tensing and releasing muscles with slow breathing, emphasis of the physiological effects of hyperventilation; cognitive therapy- teaching clients more useful ways of interpreting their environment; medications- benzodiazepines (Valium and Xanax) , azapirones, SSRIs (Prozac, Luvox, Zoloft, Paxil)
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