Specific phobia

Specific phobia is an anxiety disorder, characterized by an unreasonable fear associated with a specific object or situation. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear.[1]

The fear or anxiety may be triggered both by the presence and the anticipation of the specific object or situation. In most adults, the person may logically know the fear is unreasonable but still find it difficult to control the anxiety. Thus, this condition may significantly impair the person's functioning and even physical health.

The cause of specific phobias can vary based on the phobia itself, but can include genetics, environmental influences, conditioning, and other indirect pathways.[2] Causes can be both experiential and non-experiential; for example, there appears to be a stronger genetic component to blood-injection-injury phobias compared to animal phobias, which are more likely to stem from an experience.[3]

Signs and Symptoms

A person who encounters that of which they are phobic will often show signs of fear or express discomfort.[4]  In some cases, it can result in a panic attack.[4] The fear or anxiety associated with specific phobia can manifest in physical symptoms such as an increased heart rate, shortness of breath, muscle tension, or sweating.[5]

Diagnosis

Specific Phobia – DSM 5 Criteria[6]

  • 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

Types

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

Treatment

Cognitive behavioral therapy (CBT), a short term, skills-focused therapy that aims to help people diffuse unhelpful emotional responses by helping people consider them differently or change their behavior, is effective in treating specific phobias.[9] Exposure therapy is a particularly effective form of CBT for many specific phobias, however, treatment acceptance and high drop-out rates have been noted as concerns.[10] Other interventions have been successful for particular types of specific phobia, such as virtual reality exposure therapy (VRET) for spider, dental, and height phobias, applied muscle tension (AMT) for needle phobia, and psychoeducation with relaxation exercises for fear of childbirth.[11]

Pharmacotherapeutics

As of late 2020, there is limited evidence for the use of pharmacotherapy in the treatment of specific phobia. The selective serotonin re-uptake inhibitors (SSRIs), paroxetine and escitalopram, have shown preliminary efficacy in small randomized controlled clinical trials.[4] However, these trials were too small to show any definitive benefits of anxiolytic medication alone in treating phobia.[12] Benzodiazepines are occasionally used for acute symptom relief, but have not been shown to be effective for long term treatment.[12] There are some findings suggesting that adjuvant use of the NMDA receptor partial agonist, d-cycloserine, with virtual reality exposure therapy may improve specific phobia symptoms more than virtual reality exposure therapy alone. As of 2020, studies on the use of adjunct d-cycloserine are inconclusive.[12]

Epidemiology

Specific phobia affects up to 12% of people at some point in their life.[13] Specific phobias have a lifetime prevalence rate of 7.4% and a one-year prevalence of 5.5% according to data collected from 22 different countries.[14] In the USA, the lifetime prevalence rate is 12.5% and a one-year prevalence rate of 9.1%.[14] The usual age of onset is childhood to adolescence. Women are twice as likely to experience specific phobias compared with men.[15]

See also
  • List of phobias

References
  1. Eaton WW, Bienvenu OJ, Miloyan B (August 2018). "Specific phobias". The Lancet. Psychiatry. 5 (8): 678–686. doi:10.1016/S2215-0366(18)30169-X. PMC 7233312. PMID 30060873.
  2. Muris P, Merckelbach H (2012). "Specific Phobia: Phenomenology, Epidemiology, and Etiology". In Davis III TE, Ollendick TH, Öst LG (eds.). Intensive One-Session Treatment of Specific Phobias. Autism and Child Psychopathology Series. New York, NY: Springer. pp. 3–18. doi:10.1007/978-1-4614-3253-1_1. ISBN 978-1-4614-3253-1.
  3. Shimada-Sugimoto M, Otowa T, Hettema JM (July 2015). "Genetics of anxiety disorders: Genetic epidemiological and molecular studies in humans". Psychiatry and Clinical Neurosciences. 69 (7): 388–401. doi:10.1111/pcn.12291. PMID 25762210.
  4. Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M, et al. (2014). "Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders". BMC Psychiatry. 14 Suppl 1 (Suppl 1): S1. doi:10.1186/1471-244X-14-S1-S1. PMC 4120194. PMID 25081580.
  5. LeBeau RT, Glenn D, Liao B, Wittchen HU, Beesdo-Baum K, Ollendick T, Craske MG (February 2010). "Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V". Depression and Anxiety. 27 (2): 148–67. doi:10.1002/da.20655. PMID 20099272. S2CID 16835235.
  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  7. ^ a b c d e "Oxford Textbook of Psychopathology" by Theodore Millon, Paul H. Blaney, Roger D. Davis (1999) ISBN 0-19-510307-6, p. 82
  8. DSM-IV-TR 300.29, p. 445.
  9. Kaczkurkin AN, Foa EB (September 2015). "Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence". Dialogues in Clinical Neuroscience. 17 (3): 337–46. doi:10.31887/DCNS.2015.17.3/akaczkurkin. PMC 4610618. PMID 26487814.
  10. Choy Y, Fyer AJ, Lipsitz JD (April 2007). "Treatment of specific phobia in adults". Clinical Psychology Review. 27 (3): 266–86. doi:10.1016/j.cpr.2006.10.002. PMID 17112646.
  11. Thng CE, Lim-Ashworth NS, Poh BZ, Lim CG (2020-03-19). "Recent developments in the intervention of specific phobia among adults: a rapid review". F1000Research. 9: 195. doi:10.12688/f1000research.20082.1. PMC 7096216. PMID 32226611.
  12. Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, et al. (May 2014). "Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology". Journal of Psychopharmacology. 28 (5): 403–39. doi:10.1177/0269881114525674. PMID 24713617. S2CID 28893331.
  13. Craske MG, Stein MB (December 2016). "Anxiety". Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358. S2CID 208789585.
  14. Wardenaar KJ, Lim CC, Al-Hamzawi AO, Alonso J, Andrade LH, Benjet C, et al. (July 2017). "The cross-national epidemiology of specific phobia in the World Mental Health Surveys". Psychological Medicine. 47 (10): 1744–1760. doi:10.1017/S0033291717000174. PMC 5674525. PMID 28222820.
  15. Cameron, Alasdair (2004). Crash Course Psychiatry. Elsevier Ltd. ISBN 978-0-7234-3340-8.
Classification
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