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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. In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
- The person recognizes that the fear is excessive or unreasonable. In children, this feature may be absent.
- The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
Specific Phobia – DSM 5 Criteria
- Fear or anxiety about a specific object or situation (In children fear/anxiety can be expressed by crying, tantrums, freezing, or clinging)
- The phobic object or situation almost always provokes immediate fear or anxiety
- The phobic object or situation is avoided or endured with intense fear or anxiety
- The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
- The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
- The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not better explained by symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms; objects or situations related to obsessions; reminders of traumatic events; separation from home or attachment figures; or social situations
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 water (aquaphobia), 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 – this includes fear of medical procedures, including needles and injections (trypanophobia), fear of blood (hemophobia) and fear of getting injured.
- Other – children's fears of loud sounds or costumed characters.
The terms "distress" and "impairment" as defined by the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition" (DSM-IV-TR) should also take into account the context of the person's environment if attempting a diagnosis. The DSM-IV-TR states that if a feared stimulus, whether it be an object or a social situation, is absent entirely in an environment, a diagnosis cannot be made. An example of this situation would be an individual who has a fear of mice but lives in an area devoid of mice. Even though the concept of mice causes marked distress and impairment within the individual, because the individual does not usually encounter mice, no actual distress or impairment is ever experienced. Proximity to, and ability to escape from, the stimulus should also be considered. As the phobic person approaches a feared stimulus, anxiety levels increase, and the degree to which the person perceives they might escape from the stimulus affects the intensity of fear in instances such as riding an elevator (e.g. anxiety increases at the midway point between floors and decreases when the floor is reached and the doors open).
There are various methods used to treat phobias. These methods include systematic desensitization, progressive relaxation, virtual reality, modeling, medication and hypnotherapy.
There are two assessment tools used to diagnose emetophobia; the Specific Phobia of Vomiting inventory and the Emetophobia Questionnaire. The Specific Phobia of Vomiting Inventory and the Emetophobia Questionnaire are both self-report questionnaires that focus on a different range of symptoms.
There have been a limited number of studies in regard to emetophobia. Victims of the phobia usually experience fear before vomiting, but feel less afterwards. The fear comes again however, if the victim fears they will throw up again.
The most common treatment for serious cases is behavior therapy—specifically, systematic desensitization.
Several other self-help treatments exist, mainly involving exposure therapy and relaxation techniques while driving. Additional driving training and practice with a certified teacher also help many to become more confident and less likely to suffer from anxiety.
One of the emerging methods of treating this fear is through the use of virtual therapy.
With repeated exposure, all of the subjects displayed significantly less variance from normal in heart rate acceleration, depression readings, subjective distress, and post-traumatic stress disorder ratings.
There are many ways to treat phobophobia, and the methods used to treat panic disorders have been shown to be effective to treat phobophobia, because panic disorder patients will present in a similar fashion to conventional phobics and perceive their fear as totally irrational. Also, exposure based techniques have formed the basis of the armamentarium of behaviour therapists in the treatment of phobic disorders for many years, they are the most effective forms of treatment for phobic avoidance behavior. Phobics are treated by exposing them to the stimuli which they specially fear, and in case of phobophobia, it is both the phobia they fear and their own sensations. There are two ways to approach interoceptive exposure on patients:
- Paradoxical intention: This method is especially useful to treat the fear towards the phobophobia and the phobia they fear, as well as some of the sensations the patient fears. This method exposes the patient to the stimuli that causes the fear, which they avoid. The patient is directly exposed to it bringing them to experience the sensations that they fear, as well as the phobia. This exposure based technique helps the doctor by guiding the patient to encounter their fears and overcome them by feeling no danger around them.
- Symptoms artificially produced: This method is very useful to treat the fear towards the sensations encountered when experiencing phobophobia, the main feared stimuli of this anxiety disorder. By ingestion of different chemical agents, such as caffeine, CO-O or adrenalin, some of the symptoms the patient feels when encountering phobophobia and other anxiety disorders are triggered, such as hyperventilation, heart pounding, blurring of vision and paresthesia, which can lead to the controlling of the sensations by the patients. At first, panic attacks will be encountered, but eventually, as the study made by Doctor Griez and Van den Hout shows, the patient shows no fear to somatic sensations and panic attacks and eventually of the phobia feared.
Cognitive modification is another method that helps considerably to treat phobophobics. When treating the patients with the method, doctors correct some wrong information the patient might have about his disease, such as their catastrophic beliefs or imminent disaster by the feared phobia. Some doctors have even agreed that this is the most helpful component, since it has shown to be very effective especially if combined with other methods, like interoceptive exposure. The doctor seeks to convince patients that their symptoms do not signify danger or loss of control, for example, if combined with the interoceptive exposure, the doctor can show them that there is no unavoidable calamity and if the patient can keep themselves under control, they learn by themselves that there is no real threat and that it is just in their mind. Cognitive modification also seeks to correct other minor misconceptions, such as the belief that the individual will go crazy and may need to be "locked away forever" or that they will totally lose control and perhaps "run amok". Probably, the most difficult aspect of cognitive restructuring for the majority of the patients will simply be to identify their aberrant beliefs and approach them realistically.
Relaxation and breathing control techniques are used to produce the symptoms naturally. The somatic sensations, the feared stimuli of phobophobia, are sought to be controlled by the patient to reduce the effects of phobophobia. One of the major symptoms encountered is that of hyperventilation, which produce dizziness, faintness, etc. So, hyperventilation is induced in the patients in order to increase their CO levels that produce some of this symptoms. By teaching the patients to control this sensations by relaxing and controlling the way they breathe, this symptoms can be avoided and reduce phobophobia. This method is useful if combined with other methods, because alone it doesn't treat other main problems of phobophobia.
Phobias of this sort can usually be treated by different types of therapies, including: cognitive behavioral therapy (CBT), psychotherapy, behavior therapy and exposure therapy.
Practice may play an important part in overcoming fear. It may be helpful to sufferers to increase phone usage at a slow pace, starting with simple calls and gradually working their way up. For example, they may find it easier to start with automated calls, move on to conversations with family and friends, and then further extend both the length of conversations and the range of people with whom conversations are held.
There are several options for treatment of scopophobia. With one option, desensitization, the patient is stared at for a prolonged period and then describes their feelings. The hope is that the individual will either be desensitized to being stared at or will discover the root of their scopophobia.
Exposure therapy, another treatment commonly prescribed, has five steps:
- Evaluation
- Feedback
- Developing a fear hierarchy
- Exposure
- Building
In the evaluation stage, the scopophobic individual would describe their fear to the therapist and try to find out when and why this fear developed. The feedback stage is when the therapist offers a way of treating the phobia. A fear hierarchy is then developed, where the individual creates a list of scenarios involving their fear, with each one becoming worse and worse. Exposure involves the individual being exposed to the scenarios and situations in their fear hierarchy. Finally, building is when the patient, comfortable with one step, moves on to the next.
As with many human health problems support groups exist for scopophobic individuals. Being around other people who face the same issues can often create a more comfortable environment.
Other suggested treatments for scopophobia include hypnotherapy, neuro-linguistic programming (NLP), and energy psychology. In extreme cases of scopophobia, it is possible for the subject to be prescribed anti–anxiety medications. Medications may include benzodiazepines, antidepressants, or beta-blockers.
Coping strategies may consist of planning the conversation ahead of time and rehearsing, writing or noting down what needs to be said. This may be helped by having privacy in which to make a call.
Associated avoidance behavior may include asking others (e.g. relatives at home) to take phone calls and exclusively using answering machines. The rise in the use of electronic text-based communication (the Internet, email and text messaging) has given many sufferers alternative means of communication that they tend to find considerably less stressful than the phone. However, some individuals experience "textphobia", a fear or anxiety of texting or messaging, and also avoid those forms of communication.
Sufferers may find it helpful to explain the nature of the phobia to friends, so that a failure to respond to messages is not misinterpreted as rudeness or an unwillingness to communicate.
Phobophobia is the fear of phobia(s) and, more specifically, of the internal sensations associated with that phobia and anxiety, which binds it closely to other anxiety disorders, especially with generalized anxiety disorders (free floating fears) and panic attacks. It is a condition in which anxiety disorders are maintained in an extended way, which combined with the psychological fear generated by phobophobia of encountering the feared phobia would ultimately lead to the intensifying of the effects of the feared phobia that the patient might have developed, such as agoraphobia, and specially with it, and making them susceptible to having an extreme fear of panicking. Phobophobia comes in between the stress the patient might be experiencing and the phobia that the patient has developed as well as the effects on his life, or in other words, it is a bridge between anxiety/panic the patient might be experiencing and the type of phobia he/she fears, creating an intense and extreme predisposition to the feared phobia. Nevertheless, phobophobia is not necessarily developed as part of other phobias, but can be an important factor for maintaining them.
Phobophobia differentiates itself from other kind of phobias by the fact that there is no environmental stimulus per se, but rather internal dreadful sensations similar to psychological symptoms of panic attacks. The psychological state of the mind creates an anxious response that has itself a conditioned stimuli leading to further anxiety, resulting in a vicious cycle. Phobophobia is a fear experienced before actually experiencing the fear of the feared phobias its somatic sensations that precede it, which is preceded by generalized anxiety disorders and can generate panic attacks. Like all the phobias, the patients avoids the feared phobia in order to avoid the fear of it.
The most common methods for the treatment of specific phobias are systematic desensitization and in vivo or exposure therapy.
Autophobia is a form of anxiety that can cause a minor to extreme feeling of danger or fear when alone. There is not a specific treatment to cure autophobia as it affects each person differently. Most sufferers are treated with psychotherapy in which the amount of time that they are alone is slowly increased. There are no conclusive studies currently that support any medications being used as treatment. If the anxiety is too intense medications have been used to aid the patient in a continuation of the therapy.
It is not uncommon for sufferers to be unaware that they have this anxiety and to dismiss the idea of seeking help. Much like substance abuse, autophobia is mental and physical and requires assistance from a medical professional. Medication can be used to stabilize symptoms and inhibit further substance abuse. Group and individual therapy is used to help ease symptoms and treat the phobia.
In mild cases of autophobia, treatment can sometimes be very simple. Therapists recommend many different remedies to make patients feel as though they are not alone even when that is the case, such as listening to music when running errands alone or turning on the television when at home, even if it is just for background noise. Using noise to interrupt the silence of isolated situations can often be a great help for people suffering from autophobia.
However, it is important to remember that just because a person may feel alone at times does not mean that they have autophobia. Most people feel alone and secluded at times; this is not an unusual phenomenon. Only when the fear of being alone beings to interrupt how a person lives their daily life does the idea of being autophobic become a possibility.
Because they can produce a fear of both suffocation and restriction, MRI scans often prove difficult for claustrophobic patients. In fact, estimates say that anywhere from 4–20% of patients refuse to go through with the scan for precisely this reason. One study estimates that this percentage could be as high as 37% of all MRI recipients. The average MRI takes around 50 minutes; this is more than enough time to evoke extreme fear and anxiety in a severely claustrophobic patient.
This study was conducted with three goals: 1. To discover the extent of anxiety during an MRI. 2. To find predictors for anxiety during an MRI. 3. To observe psychological factors of undergoing an MRI. Eighty patients were randomly chosen for this study and subjected to several diagnostic tests to rate their level of claustrophobic fear; none of these patients had previously been diagnosed with claustrophobia. They were also subjected to several of the same tests after their MRI to see if their anxiety levels had elevated. This experiment concludes that the primary component of anxiety experienced by patients was most closely connected to claustrophobia.
This assertion stems from the high Claustrophobic Questionnaire results of those who reported anxiety during the scan. Almost 25% of the patients reported at least moderate feelings of anxiety during the scan and 3 were unable to complete the scan at all. When asked a month after their scan, 30% of patients (these numbers are taken of the 48 that responded a month later) reported that their claustrophobic feelings had elevated since the scan. The majority of these patients claimed to have never had claustrophobic sensations up to that point. This study concludes that the Claustrophobic Questionnaire (or an equivalent method of diagnosis) should be used before allowing someone to have an MRI.
According to Child and Adolescent Mental Health, approximately 5 percent of children suffer from specific phobias and 15 percent seek treatment for anxiety-related problems. In recent years the number of children with clinically diagnosed phobias has gradually increased. Researchers are finding that the majority of these diagnoses come anxiety related phobias or society phobias.
Specific phobias are more prevalent in girls than in boys. Likewise, specific phobias are also more prevalent in older children than younger.
This method was developed in 1979 by interpreting the files of patients diagnosed with claustrophobia and by reading various scientific articles about the diagnosis of the disorder. Once an initial scale was developed, it was tested and sharpened by several experts in the field. Today, it consists of 20 questions that determine anxiety levels and desire to avoid certain situations. Several studies have proved this scale to be effective in claustrophobia diagnosis.
Whether utilizing systematic desensitization therapy or exposure therapy, several factors will determine how many sessions will be required to completely remove the phobia; however, some studies (such as a follow-up study done by Dr. Öst in 1996) have shown that those who overcome their phobia are usually able to maintain the improvement over the long-term. As avoidance contributes to the perpetuation of the phobia, constant, yet safe, real world interaction is recommended during and after therapy in order to reinforce positive exposure to the animal.
"Vertigo" is often used (incorrectly) to describe a fear of heights, but it is more accurately a spinning sensation that occurs when one is not actually spinning. It can be triggered by looking down from a high place, or by looking straight up at a high place or tall object, but this alone does not describe vertigo. True vertigo can be triggered by almost any type of movement (e.g. standing up, sitting down, walking) or change in visual perspective (e.g. squatting down, walking up or down stairs, looking out of the window of a moving car or train). Vertigo is called "height vertigo" when the sensation of vertigo is triggered by heights.
Also noted in the emetophobia internet survey was information about medications. People were asked whether they would consider taking anxiety medication to potentially help their fear, and many in the study answered they wouldn't for fear that the drugs would make them nauseated. Others, however, stated that some psychotropic medications (such as benzodiazepines and antidepressants) did help with their phobia, and some said gastrointestinal medications were also beneficial.
There are three major categories of driving phobia, distinguished by their onset.
The first and most common cause of a fear of driving is traffic accidents. These situations cause PTSD driving phobia, where the fear develops in response to a traumatic event. Usually, situations like these trigger a fear of driving in only specific situations related to the original cause, though it also can trigger a fear of driving entirely.
The second most common form is driving phobia as a specific phobia. Because driving does involve some danger and the possibility of a collision, there does exist some fear or caution in many rational people. However, for some the fear of crashing, losing control over the car, being criticized or being in a dangerous situation will cause panic. It is classified as a phobia when the anxiety does not rationally reflect the amount of danger.
The least common category is an extension of agoraphobia, the anxiety of having a panic attack while being in crowds or public places. One manifestation of agoraphobia is the inability to travel long distances away from home. When driving, an agoraphobe may feel that he is putting himself into a fearful situation, and driving phobia may develop.
The medical literature suggests a number of treatments that have been proven effective for specific cases of needle phobia, but provides very little guidance to predict which treatment may be effective for any specific case. The following are some of the treatments that have been shown to be effective in some specific cases.
- Ethyl Chloride Spray (and other freezing agents). Easily administered, but provides only superficial pain control.
- Jet Injectors. Jet Injectors work by introducing substances into the body through a jet of high pressure gas as opposed to by a needle. Though these eliminate the needle, some people report that they cause more pain. Also, they are only helpful in a very limited number of situations involving needles i.e. insulin and some inoculations.
- Iontophoresis. Iontophoresis drives anesthetic through the skin by using an electric current. It provides effective anesthesia, but is generally unavailable to consumers on the commercial market and some regard it as inconvenient to use.
- EMLA. EMLA is a topical anesthetic cream that is a eutectic mixture of lidocaine and prilocaine. It is a prescription cream in the United States, and is available without prescription in some other countries. Although not as effective as iontophoresis, since EMLA does not penetrate as deeply as iontophoresis-driven anesthetics, EMLA provides a simpler application than iontophoresis. EMLA penetrates much more deeply than ordinary topical anesthetics, and it works adequately for many individuals.
- Ametop. Ametop gel appears to be more effective than EMLA for eliminating pain during venepuncture.
- Lidocaine/tetracaine patch. A self-heating patch containing a eutectic mixture of lidocaine and tetracaine is available in several countries, and has been specifically approved by government agencies for use in needle procedures. The patch is sold under the trade name "Synera" in the United States and "Rapydan" in European Union. Each patch is packaged in an air-tight pouch. It begins to heat up slightly when the patch is removed from the packaging and exposed to the air. The patch requires 20 to 30 minutes to achieve full anesthetic effect. The Synera patch was approved by the United States Food and Drug Administration on 23 June 2005.
- Behavioral therapy. Effectiveness of this varies greatly depending on the person and the severity of the condition. There is some debate as to the effectiveness of behavioral treatments for specific phobias (like blood, injection, injury type phobias), though some data are available to support the efficacy of approaches like exposure therapy. Any therapy that endorses relaxation methods may be contraindicated for the treatment of fear of needles as this approach encourages a drop in blood pressure that only enhances the vasovagal reflex. In response to this, graded exposure approaches can include a coping component relying on applied tension as a way to prevent complications associated with the vasovagal response to specific blood, injury, injection type stimulus.
- Nitrous Oxide (Laughing Gas). This will provide sedation and reduce anxiety for the patient, along with some mild analgesic effects.
- Inhalation General Anesthesia. This will eliminate all pain and also all memory of any needle procedure. On the other hand, it is often regarded as a very extreme solution. It is not covered by insurance in most cases, and most physicians will not order it. It can be risky and expensive and may require a hospital stay.
- Benzodiazepines, such as diazepam (Valium) or lorazepam, may help alleviate the anxiety of needle phobics, according to Dr. James Hamilton. These medications have an onset of action within 5 to 15 minutes from ingestion. A relatively large oral dose may be necessary.
Fear of needles, especially in its more severe forms, is often comorbid with other phobias and psychological ailments; for example, iatrophobia, or an irrational fear of doctors, is often seen in needle phobic patients.
A needle phobic patient does not need to physically be in a doctor's office to experience panic attacks or anxiety brought on by needle phobia. There are many triggers in the outside world that can bring on an attack through association. Some of these are blood, injuries, the sight of the needle physically or on a screen, paper pins, examination rooms, hospitals, white lab coats, hospital gowns, doctors, dentists, nurses, the antiseptic smell associated with offices and hospitals, the sight of a person who physically resembles the patient's regular health care provider, or even reading about the fear.
Though some fears are inborn, the majority are learned. Phobias develop through negative experiences and through observation. One way children begin to develop fears is by witnessing or hearing about dangers. Ollendick proposes while some phobias may originate from a single traumatizing experience, others may be caused by simpler, or less dramatic, origins such as observing another child’s phobic reaction or through the exposure to media that introduces phobias.
- 2% of parents linked their child’s phobia to a [direct conditioning episode]
- 26% of parents linked their child’s phobia to a [vicarious conditioning episodes]
- 56% of parents linked their child’s phobia to their child’s very first contact with water
- 16% of parents could not directly link their child’s phobia
In addition to asking about the origins of a child’s fear, the questionnaire asked if parents believed that “information associated with adverse consequences was the most influential factor in the development of their child’s phobia.” The results were as followed:
- 0% of parents though it was the most influential factor
- 14% of parents though it was somewhat influential
- 86% of parents though it had little to no influence
Autophobia, also called monophobia, isolophobia, or eremophobia, is the specific phobia of isolation; a morbid fear of being egotistical, or a dread of being alone or isolated. Sufferers need not be physically alone, but just to believe that they are being ignored or unloved. Contrary to what would be implied by a literal reading of the term, "autophobia" does not describe a "fear of oneself". The disorder typically develops from and is associated with other anxiety disorders.
Autophobia can be associated with or accompanied by several other phobias such as agoraphobia, and is generally considered to be a part of the agoraphobic cluster. This means that autophobia has a lot of the same characteristics as certain anxiety disorders and hyperventilation disorders. The main concern of people with phobias in the agoraphobic cluster is getting help in case of emergency. This means people might be afraid of going out in public, being caught in a crowd, being alone, or being stranded.
Autophobia is not to be confused with agoraphobia (fear of being in public, or caught in large crowds), self-hatred, or social anxiety although it can be closely related to these things. It is its own phobia that tends to be accompanied by other anxiety disorders and phobias.
The fear of spiders can be treated by any of the general techniques suggested for specific phobias. The first line of treatment is systematic desensitization – also known as exposure therapy – which was first described by South African psychiatrist Joseph Wolpe. Before engaging in systematic desensitization it is common to train the individual with arachnophobia in relaxation techniques, which will help keep the patient calm. Systematic desensitization can be done in vivo (with live spiders) or by getting the individual to imagine situations involving spiders, then modelling interaction with spiders for the person affected and eventually interacting with real spiders. This technique can be effective in just one session.
Recent advances in technology have enabled the use of virtual or augmented reality spiders for use in therapy. These techniques have proven to be effective.