Specific phobia

Posted by Melkiory John

A specific phobia is a generic term for any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations. As a result, the affected persons tend to actively avoid direct contact with the objects or situations and, in severe cases, any mention or depiction of them. So it is disabling to their daily lives.
The fear or anxiety may be triggered both by the presence and the anticipation of the specific object or situation. A person who encounters that of which they are phobic will often show signs of fear or express discomfort. In some cases it can result in a panic attack. In most adults this kind of phobia is consciously recognized by the person. Still, anxiety and avoidance are difficult to control and may significantly impair the person's functioning and even physical health.

Epidemiology

Specific phobias have a one-year prevalence of 4.4% in the USA.^[1] The usual age of onset is childhood to adolescence. Women are twice as likely to suffer from specific phobias as men.^[2]
Evolutionary theory argues that infants or children develop specific phobias that could possible harm them, so their phobias alert them to this sense of danger. The most common co-occurring disorder for children with a specific phobia is another anxiety disorder. Although comorbidity is frequent for children with specific phobias, it tends to be lower than for other anxiety disorders. Onset is typically between 7-9 years of age. Specific phobias can occur at any age but seem to peak between 10 and 13 years of age.

Categories of specific phobias

According to the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders, phobias can be classified under the following general categories:

• Animal type – Fear of dogs, cats, rats and/or mice, pigs, cows, birds, spiders, or snakes.
• Natural environment type – Fear of heights (acrophobia), lightning and thunderstorms (astraphobia), or aging (gerascophobia).
• Situational type – Fear of small confined spaces (claustrophobia), or the dark (nyctophobia).
• Blood/injection/injury type – Fear of medical procedures, including needles and injections (Trypanophobia).
• Other – Fear of contracting an illness; children's fears of loud sounds or costumed characters.^[3]

Diagnosis

Main Features of Diagnostic Criteria for Specific Phobia in the DSM-IV-TR:

• 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).
• Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack.

Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.

• The person recognizes that the fear is excessive or unreasonable.

Note: In children, this feature may be absent.

• The phobic situation(s) is avoided or else is endured with intense anxiety or distress.

Treatment

Cognitive Behavioral Therapy (CBT)- a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures
One-Session Treatment (OST)- a variant of cognitive-behavioral therapy, combines graduated in vivo exposure, participant modeling, reinforcement, psychoeducation, cognitive challenges, and skills training in an intensive treatment model. Treatment is maximized to one 3-hour session. The success of the treatment is could be affected by the therapeutic relationship, motivation, and expectations towards the treatment and their possible relations with the outcome