Phobia

INTRODUCTION:
  • Marked and persistent fear of objects or situations, exposure to which results in an immediate anxiety reaction.
  • The patient avoids the phobic stimulus, and this avoidance usually impairs occupational or social functioning
  • Panic attacks may be triggered by the phobic stimulus or may emerge spontaneously during the course of the illness.
  • Unlike patients with other anxiety disorders, individuals with phobias experience anxiety only in specific situations
  • Anxiety is usually dealt with the defense mechanism of repression.
  • When repression fails to function adequately, other secondary defence mechanisms of ego like displacement come into action.
'Extended definition' of Agoraphobia includes:
  • Fear of open spaces 
  • Fear of public places
  • Fear of crowded places
  • Fear of any place from where there is no easy escape to a safe place.
TYPES:
  • Social phobia – irrational fear of activities or social interaction
  1. Shy-Bladder: fear of urinating in public lavatory
  2. Erythro phobia: Fear of blushing.
  • Simple (specific) phobia – irrational fear of objects or situations
  1. Claustro phobia- Fear of closed spaces
  2. Acrophobia – fear of high places.
  3. Algophobia – fear of pain
  4. Arachnophobia- fear of spiders
  5. Xeno phobia –fear of strangers
  6. Zoophobia – fear of animals
  7. Sito phobia - fear of eating
  8. Thanatophobia – fear of death
  9. Cynophobia: fear of dogs
  10. Mysophobia: fear of dirt & germs
  11. Pyrophobia: fear of fire
  12. Ailurophobia: fear of cats 
MANAGEMENT:
Drugs used:

  • Anxiolytic drugs
  • TCA
  • SSRI
  • MAO inhibitors
  • Exposure therapy, a type of behavior therapy, is the most commonly used treatment of specific phobia. The therapist usually desensitizes the patient by a gradual exposure to the phobic stimulus. Relaxation and breathing control are important parts of the treatment.
  • Hypnosis is used to enhance the therapist's suggestions that the phobic object is not dangerous. At times, self-hypnosis can be taught so that the patient uses it as a method of relaxation when confronted with the phobic stimulus.
  • Medication is used in the treatment of a specific phobia only if it is associated with panic attacks and generalized anxiety. The pharmacologic treatment is then directed toward the panic attacks.
  • Supportive therapy may be used in helping the patient actively confront the phobic stimulus during treatment. It is usually used in addition to an ongoing treatment.
  • Modelling It is a procedure in which patient is asked to follow the therapist and do as he do
  • Systemic de-sensitization therapy ,,Psychodynamic therapy is used for phobia
Exam Question
  • The woman who cannot urinate in a restroom because of embarrassment is probably suffering from social phobia. 
  • Agoraphobia is a disorder characte­rized by Avoidance of situations in which it occurs ,Presence of panic symptoms, Avoidance of being outside alone
  • Phobia is neurosis
  • Commonest type of phobia seen in clinical practice is Agoraphobia
  • Displacement is the defense mechanism in phobia
  • Patient of contamination phobia was asked by therapist to follow behind and touch everything he touches in patients house Therapist kept talking quietly & calmly all the time .This procedure is called modelling
  • Systemic de-sensitization therapy is used for phobia
  • In Agoraphobia behavioural therapy is helpful
  • Thanatophobia – fear of death
  • Claustro phobia- Fear of closed spaces
  • Acrophobia – fear of high places.
  • Definitive treatment of all types of phobias is behavioural therapy
  • Systemic desensitization,Psychodynamic therapy,Exposure therapy are the method of treating Agoraphobia
  • SSRI is first line treatment for Panic disorder, Social phobia, Post traumatic stress disorder

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