Phobias

These questions and answers reach both specific and social phobias. Main sources are

First and Tasman’s book, 2003, and 10th Edition of Sadock and Sadock.

As of 4Sep08

Phobia - dx

• Q. DSM-IV-TR, list five criteria for specific phobia in adults, what are they?

Phobia – dx - 1

Ans.

• 1. Excessive and persistent fear, cued by an object or situation.

• 2. Exposure to the object or situation causes anxiety response.

• 3. Pt recognizes the fear is unreasonable.

• 4. see next slide

phobia – dx - 2

• 4. The phobic situation is avoided or endured with intense distress.

• 5. [usually DSM expectation that] causes dysfunction or distress.

Phobias -- < 18 y/o

• Q. How does the above criteria differ in those under 18? There are three ways,

Phobias – dx - < 18 y/o

Ans.

• #2 above may be expressed by crying, tantrums, freezing, or clinging

• #3 above may not be present.

• Additional criteria of duration of six months.

Types

• Q. Besides social phobia, what are DSM’s other four types of phobias?

Types

Ans.

• -- animal type

• -- Environment type [e.g., heights]

• -- blood-injection type

• -- situation type [e.g., elevators]

• [of course, “Other”]

Social phobia - name

• Q. Another name for social phobia?

Social phobia - name

• Ans. Social anxiety disorder.

Generalized

• Q. When applied to social phobia, what does the specifier “generalized” mean?

Generalized

Ans. Phobia pertains to most social situations, includes both public performance and social interactions.

Sympathetic and parasympathetic

• Q. Which involve sympathetic system over-reacting and which involves parasympathetic?

Sympathetic and parasympathetic

Ans. All involve sympathetic except blood-injection type when the parasympathetic over-reacts.

Vasovagel response

• Q. Vasovagel response is associated which phobia/phobias?

Vasovagel response

Ans. Blood-injection-injury type.

Gender – specific phobias

• Q. Gender breakdown?

Gender – specific phobias

Ans. 2/3 are female. Even higher percentage female with animal phobias, natural environment phobias, and situational phobias.

Gender – social phobia

• Q. Which gender is more prevalent in social phobia?

Gender – social phobia

Ans. Women > men, but only slightly so.

Specific phobias onset - age

• Q. Age of onset?

Specific Onset - age

Ans. Childhood.

Social phobia - onset

• Q. What age is most common onset of social phobia?

Social phobia - onset

Ans. Adolescents.

Specific & social phobias – familial.

• Q. Familial pattern?

Specific & social phobias - familial

Ans. Increased risk if a member of the family has a specific phobia.

Phobias – prevalence

• Q. What is prevalence of phobias?

Phobias - prevalence

Ans. Specific phobia in cross-section of populations: 5%. Social phobia: 10%. But depends on circumstances. Many with a snake phobia may have no reason to be in the neighborhood of snakes. Many with social phobia as to public speaking may have no reason to need to speak in public events.

Treatment of social phobia

• Q. Very generally, usual treatments of social phobia is?

Treatment of social phobia

Ans. Meds and CBT.

Treatment of specific phobias

• Q. Very generally, what is the treatment of specific phobias?

Treatment of specific phobias

Ans. CBT. Meds can help with the immediate situation. CBT has long-term benefit.

Meds used in social phobia

• Q. What classes of meds are used for social phobia?

Meds used in social phobia - 1

Ans. Classes:• -- SSRIs• -- Benzodiazepines• -- Venlafaxine• -- BuspironeSee next screen

Meds used in social phobias - 2

• -- Beta-blockers [used, especially for performance anxiety, e.g., propranolol, but have not done well in controlled trials]

[MAOIs , phenelzine, and gabapentin have some support in the face of failure of first choices.]

FDA approved for social phobia

• Q. Which meds are FDA approved?

FDA approved for social phobia

Ans.

• Paroxetine

• Sertraline

• Venlafaxine

Psychotherapy – specific phobias

• Q. What specific type of CBT is used for most specific phobias?

Psychotherapy – specific and social phobias

Ans. In vivo exposure. Many therapies involve a gradation of exposure until the individual is comfortable with the extreme without medications [or drinks], e.g., social phobia in which the individual increases social exposure gradually to where she has a party at home and invites all her co-workers.