Phobic Anxiety Disorders Overview
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Questions and Answers

Cognitive behavioral therapy (CBT) is the only recommended treatment for social phobia.

False

Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line medication for social phobia.

True

Only 10% of people with social phobia seek treatment after experiencing symptoms for many years.

False

Dynamic psychotherapy focuses on behavioral changes rather than unconscious thoughts and feelings.

<p>False</p> Signup and view all the answers

Beta-blockers specifically target the psychological symptoms of social phobia.

<p>False</p> Signup and view all the answers

Self-help strategies such as books can aid people with social phobia in managing their anxiety.

<p>True</p> Signup and view all the answers

The National Institute for Health and Care Excellence recommends individual cognitive behavioral therapy as the first choice for social phobia treatment.

<p>True</p> Signup and view all the answers

Benzodiazepines are recommended for long-term management of social phobia symptoms.

<p>False</p> Signup and view all the answers

Prepared learning suggests that certain phobias, such as fear of snakes, are acquired primarily through observational learning.

<p>False</p> Signup and view all the answers

The amygdala shows reduced hyperactivity with successful treatment of phobias.

<p>True</p> Signup and view all the answers

Exposure therapy typically results in the complete loss of phobias for all patients.

<p>False</p> Signup and view all the answers

D-cycloserine, when used with behavior therapy, may enhance fear extinction in phobic patients.

<p>True</p> Signup and view all the answers

Social phobia primarily involves excessive comfort in social situations.

<p>False</p> Signup and view all the answers

Ongoing depressive disorders can complicate the diagnosis of specific phobias.

<p>True</p> Signup and view all the answers

Virtual reality exposure therapy has no significant advantage over traditional exposure therapy methods.

<p>False</p> Signup and view all the answers

Anticipation of a phobic stimulus activates the anterior cingulate cortex and the insular cortex.

<p>True</p> Signup and view all the answers

Specific phobias that originate in childhood tend to have a better prognosis compared to those arising in adulthood.

<p>False</p> Signup and view all the answers

Pharmacotherapy is widely recognized as the most effective treatment for specific phobias.

<p>False</p> Signup and view all the answers

Specific phobias cause anxiety in the presence of any situation or object.

<p>False</p> Signup and view all the answers

Anticipatory anxiety is uncommon in individuals with specific phobia.

<p>False</p> Signup and view all the answers

In DSM-5, panic disorder and agoraphobia are considered the same diagnosis.

<p>False</p> Signup and view all the answers

A specific phobia can be referred to by its simpler name rather than its traditional Greek name.

<p>True</p> Signup and view all the answers

Around 10% of adults have a fear of dental treatment.

<p>False</p> Signup and view all the answers

Phobic disorders can lead to serious avoidance behaviors, such as avoiding dental treatment altogether.

<p>True</p> Signup and view all the answers

Circumstances that provoke anxiety in phobic disorders can include natural phenomena like thunder.

<p>True</p> Signup and view all the answers

Phobic anxiety disorders can occur only in a few specific circumstances in some individuals.

<p>True</p> Signup and view all the answers

The incidence of agoraphobia increased to 4.0% based on diagnostic criteria introduced in 2010.

<p>False</p> Signup and view all the answers

In clinical samples, agoraphobia without panic is less frequently observed compared to its presence in the community.

<p>True</p> Signup and view all the answers

Cognitive hypothesis suggests that anxiety attacks are triggered solely by biological factors.

<p>False</p> Signup and view all the answers

Agoraphobia tends to have a chronic course if it lasts longer than a year.

<p>True</p> Signup and view all the answers

Some evidence supports the biological theory linking childhood overprotection to the onset of agoraphobia.

<p>False</p> Signup and view all the answers

Cognitive behavior therapy is discussed in Chapter 24 for treating agoraphobia and panic disorders.

<p>True</p> Signup and view all the answers

Agoraphobic patients typically exhibit a desire to confront their problems directly.

<p>False</p> Signup and view all the answers

Avoidance learning is recognized as the only explanation for the spread and maintenance of agoraphobia.

<p>False</p> Signup and view all the answers

Agoraphobia onset typically occurs in the early to mid-twenties.

<p>True</p> Signup and view all the answers

Anticipatory anxiety for agoraphobic patients can occur significantly before entering a feared situation.

<p>True</p> Signup and view all the answers

Panic attacks in agoraphobia can only occur in response to environmental stimuli.

<p>False</p> Signup and view all the answers

Agoraphobic patients often become increasingly dependent on family members for support as the condition progresses.

<p>True</p> Signup and view all the answers

Situations that trigger anxiety in agoraphobic patients have no common themes.

<p>False</p> Signup and view all the answers

Depressive symptoms are uncommon in agoraphobia.

<p>False</p> Signup and view all the answers

The first episode of agoraphobia typically occurs during a calm moment without any prior anxiety.

<p>False</p> Signup and view all the answers

Variability in anxiety levels for agoraphobic patients is solely due to the severity of symptoms.

<p>False</p> Signup and view all the answers

Agoraphobic patients may experience feelings of depersonalization.

<p>True</p> Signup and view all the answers

Once agoraphobia develops, panic attacks are guaranteed to occur in every situation involved.

<p>False</p> Signup and view all the answers

Social phobia is limited to public speaking situations and does not occur in other contexts.

<p>False</p> Signup and view all the answers

In DSM-5, symptoms of social phobia must persist for a minimum of 3 months.

<p>False</p> Signup and view all the answers

Agoraphobia and panic disorder can coexist with social phobia in a patient.

<p>True</p> Signup and view all the answers

The ICD-10 emphasizes symptoms of social phobia more than DSM-5.

<p>True</p> Signup and view all the answers

Social phobia is characterized by a marked fear of being the focus of attention.

<p>True</p> Signup and view all the answers

Blushing and trembling are common symptoms experienced by those with social phobia.

<p>True</p> Signup and view all the answers

Comorbid depressive disorders are rare among individuals with social phobia.

<p>False</p> Signup and view all the answers

The anxiety experienced in social phobia is typically in proportion to the actual threat posed.

<p>False</p> Signup and view all the answers

Patients with social phobia will often avoid social situations where they might feel scrutinized.

<p>True</p> Signup and view all the answers

In DSM-5, being diagnosed with social phobia requires the symptoms to impact daily functioning.

<p>True</p> Signup and view all the answers

Most patients with agoraphobia have panic attacks that are exclusively situational.

<p>False</p> Signup and view all the answers

In ICD-10, agoraphobia is diagnosed as either with or without panic disorder.

<p>True</p> Signup and view all the answers

Social phobia can lead to avoidance of crowded places due to perceived scrutiny.

<p>True</p> Signup and view all the answers

Agoraphobia does not share symptoms with generalized anxiety disorder (GAD).

<p>False</p> Signup and view all the answers

A patient with paranoid delusions may avoid public spaces, exhibiting symptoms similar to agoraphobia.

<p>True</p> Signup and view all the answers

The lifetime prevalence of agoraphobia without panic in Europe is estimated to be around 6%.

<p>False</p> Signup and view all the answers

Symptoms of agoraphobia must arise from another mental disorder to be classified as agoraphobia.

<p>False</p> Signup and view all the answers

The DSM-5 requires a minimum of one autonomic arousal symptom to diagnose agoraphobia.

<p>False</p> Signup and view all the answers

The criteria for panic disorder in DSM-5 are discussed in detail later in the chapter.

<p>True</p> Signup and view all the answers

In DSM-5, agoraphobia requires a persistent fear lasting less than six months.

<p>False</p> Signup and view all the answers

Patients with schizophrenia are more likely to have evident social phobia due to their unquestioned belief in delusions.

<p>False</p> Signup and view all the answers

Body dysmorphic disorder is often clearly diagnosed based on the patient's self-reported experiences.

<p>True</p> Signup and view all the answers

Social phobia typically involves a gradual onset and a long-lasting experience compared to avoidant personality disorder.

<p>False</p> Signup and view all the answers

Inadequate social skills can lead to secondary anxiety but is classified solely as a phobic disorder.

<p>False</p> Signup and view all the answers

Some individuals who exhibit normal shyness can still qualify for a diagnosis of social phobia.

<p>False</p> Signup and view all the answers

The lifetime prevalence rate of social phobia is approximately 12%, which is notably lower than that of specific phobia.

<p>False</p> Signup and view all the answers

Genetic factors play a negligible role in the prevalence of social phobia among individuals with affected relatives.

<p>False</p> Signup and view all the answers

Conditioning can trigger social phobia following sudden anxiety episodes related to specific social situations.

<p>True</p> Signup and view all the answers

Cognitive factors influencing social phobia include a strong fear of receiving negative evaluations from others.

<p>True</p> Signup and view all the answers

Safety behaviors, such as avoiding eye contact, can hinder normal interaction in people with social phobia.

<p>True</p> Signup and view all the answers

Benzodiazepines are recommended for long-term use in treating panic disorder.

<p>False</p> Signup and view all the answers

SSRIs are considered the first-line treatment for panic disorder and agoraphobia due to their safety and tolerability.

<p>True</p> Signup and view all the answers

Patients with agoraphobia often understand the disorder as a lack of determination to overcome normal anxiety.

<p>True</p> Signup and view all the answers

Alprazolam is never used in the treatment of agoraphobia with frequent panic attacks.

<p>False</p> Signup and view all the answers

The excessive sensitivity of the 'alarm system' in panic attacks can be attributed to chronic stress.

<p>True</p> Signup and view all the answers

Maintaining medication for several months after a clinical response does not affect relapse rates.

<p>False</p> Signup and view all the answers

Antidepressant drugs are often prescribed for patients who are not depressed but have panic attacks.

<p>True</p> Signup and view all the answers

Self-help books are a discouraged source of information for those with agoraphobia.

<p>False</p> Signup and view all the answers

The treatment of choice for established agoraphobia is likely a combination of exposure therapy and cognitive therapy.

<p>True</p> Signup and view all the answers

Behaviour therapy is generally misunderstood by friends and family of patients with agoraphobia.

<p>False</p> Signup and view all the answers

The fear of flying can affect both passengers and pilots.

<p>True</p> Signup and view all the answers

The age of onset for blood phobia is typically around 12 years old.

<p>False</p> Signup and view all the answers

People with a phobia of choking often have a normal gag reflex.

<p>False</p> Signup and view all the answers

Treatment for phobia of illness is primarily focused on cognitive restructuring.

<p>False</p> Signup and view all the answers

Genetic factors play a role in the development of specific phobias.

<p>True</p> Signup and view all the answers

Most childhood phobias will disappear by early adulthood.

<p>True</p> Signup and view all the answers

Neurally mediated syncope can occur even without the specific blood injury stimulus.

<p>True</p> Signup and view all the answers

Desensitization treatment uses muscle tension to help prevent syncope in phobia of blood and injury.

<p>True</p> Signup and view all the answers

The prevalence of specific phobias in men is higher than in women.

<p>False</p> Signup and view all the answers

Psychoeducation is confirmed to be necessary for the success of virtual reality programs in treating phobias.

<p>False</p> Signup and view all the answers

Study Notes

Overview of Phobic Anxiety Disorders

  • Phobic anxiety disorders have core symptoms similar to Generalized Anxiety Disorder (GAD), but anxiety is triggered by specific objects or situations.
  • Avoidance of anxiety-provoking circumstances and anticipatory anxiety are characteristic features.
  • Anxiety can arise from situations (e.g., crowded places), objects (e.g., spiders), and natural phenomena (e.g., thunder).
  • The three main types of phobic syndromes are specific phobia, social phobia, and agoraphobia.

Classification of Phobic Disorders

  • ICD-10 and DSM-5 classify phobic disorders into specific phobia, social phobia, and agoraphobia.
  • In ICD-10, agoraphobia is diagnosed as ‘with panic disorder’ or ‘without panic disorder’.
  • DSM-5 treats panic disorder and agoraphobia as separate diagnoses, allowing for dual diagnoses.

Specific Phobia

  • Specific phobia involves inappropriate anxiety triggered by particular objects or situations, leading to behavioral avoidance.
  • DSM-5 recognizes five types: animal-related, natural environment, blood/injection/injury, situational, and other provoking agents.
  • Specific phobia can be denoted with the name of the stimulus (e.g., arachnophobia for spider phobia).

Phobia of Dental Treatment

  • Approximately 5% of adults exhibit a fear of dental treatment, often avoiding it entirely.

Prepared Learning and Neural Mechanisms

  • Prepared learning suggests an innate predisposition to fear certain stimuli; it is evident in animals and possibly influences human fears.
  • Imaging studies show hyperactivity in the amygdala when confronted with feared stimuli, with reduced activity post-treatment.
  • Anticipation of phobic stimuli activates the anterior cingulate cortex and insular cortex.

Differential Diagnosis for Specific Phobia

  • Clinical differentiation is usually straightforward, but consideration of comorbid depressive disorders is important.
  • Obsessional disorders may present with similar symptoms, revealing underlying obsessional thoughts during evaluation.

Prognosis of Specific Phobia

  • Phobias originating in childhood are likely to persist into adulthood, while those arising from adulthood stressors generally have a better prognosis.

Treatment Approaches

  • Exposure therapy is the primary treatment, typically reducing phobia intensity but not necessarily leading to complete resolution.
  • Repeated exposure is crucial for effective outcomes; some patients may require benzodiazepines for short-term relief before therapy.
  • Virtual reality exposure therapy shows promise as an alternative treatment modality.
  • D-cycloserine, a partial NMDA receptor agonist, may enhance exposure treatment effectiveness.

Social Phobia

  • Social phobia is characterized by anxiety in social situations, fearing criticism or embarrassment from others.
  • Avoidance behaviors may lead to significant social impairment.
  • Generalized social phobia involves anxiety in many situations, while performance-only social phobia is restricted to public speaking or performance.

Diagnostic Criteria and Differential Diagnosis for Social Phobia

  • ICD-10 and DSM-5 share similar diagnostic criteria with emphasis on persistent and disproportionate fear.
  • Differential diagnosis includes assessing for agoraphobia, panic disorder, generalized anxiety disorder, and depression.

Epidemiology and Aetiology of Social Phobia

  • Lifetime prevalence for social phobia is around 12% in the community.
  • Genetic factors suggest higher prevalence among first-degree relatives.
  • Conditioning and cognitive factors, such as fear of negative evaluation and high social performance standards, contribute to the development of social phobia.

Course and Prognosis of Social Phobia

  • Usually begins in childhood or adolescence and often remains untreated for years; only about 50% seek help.

Treatment Options for Social Phobia

  • Cognitive Behavioral Therapy (CBT) is the recommended psychological treatment, addressing negative thought patterns.
  • SSRIs like fluoxetine, sertraline, and venlafaxine are first-line medications, with other options including phenelzine and benzodiazepines providing symptomatic relief.
  • Understanding the maladaptive nature of anxiety helps patients manage symptoms; self-help resources are also recommended.### Treatment Options
  • Cognitive Behavioral Therapy (CBT) is recommended as the first-line treatment for social phobia.
  • Other psychological therapies may be considered if CBT is not desired.

Clinical Features of Agoraphobia

  • Patients experience anxiety when away from home, in crowds, or in hard-to-leave situations.
  • Symptoms include avoidance and heightened anxiety anticipating these situations.

Anxiety Symptoms

  • Key features include panic attacks, which can be triggered or occur spontaneously.
  • Common anxious thoughts involve fears of fainting or losing control.

Anxiety-Inducing Situations

  • Common themes in provoking anxiety include distance from home, crowding, and confinement.
  • Anxiety-inducing places include public transport, shops, and confined settings (e.g., theaters, hairdressers).
  • Severe cases may lead to confinement at home; patients often feel less anxious when accompanied by trusted companions.

Anticipatory Anxiety

  • Anticipatory anxiety can occur hours before entering feared situations, complicating the perception of anxiety.

Other Symptoms

  • Depressive symptoms are common, often as a result of limitations imposed by anxiety.
  • Severe symptoms of depersonalization can also arise.

Onset and Course

  • Typical onset occurs in early to mid-twenties, with a secondary peak in mid-thirties.
  • Initial episodes often occur unexpectedly while engaging in daily activities (e.g., waiting for transport, shopping).

Impact on Relationships

  • Patients may become increasingly dependent on family members for assistance, affecting familial relationships.

Diagnostic Considerations

  • Diagnosis of agoraphobia often coexists with panic disorder; criteria differ between ICD-10 and DSM-5.
  • Thorough assessment is needed to distinguish from social phobia, generalized anxiety disorder, and depressive disorders.

Epidemiology

  • Lifetime prevalence of agoraphobia is approximately 0.6%; higher incidence observed in women compared to men.
  • Community prevalence of agoraphobia without panic is evident despite rarity in clinical settings.

Etiology

  • Initial anxiety often triggered by panic attacks in public settings.
  • Explanations include cognitive hypotheses (irrational fear), biological theories (anxiety response), and psychoanalytic theory (unconscious conflicts).

Theories of Spread and Maintenance

  • Learning theories suggest avoidance is reinforced through conditioning.
  • Family dynamics such as overprotection can contribute to the persistence of agoraphobia.

Prognosis

  • Short-term cases of agoraphobia are common; chronic cases generally extend beyond five years.

Treatment Strategies

  • Treatment interventions generally focus on panic disorder, as agoraphobia without panic is less frequently researched.
  • Exposure Therapy is effective when combined with anxiety management.

Medication Options

  • Benzodiazepines are recommended for short-term relief but not for long-term use due to dependency risk.
  • Antidepressants, particularly SSRIs, are recommended for their safety and efficacy in treating concurrent anxiety and depression.

Patient Education

  • Educating patients and families about the nature of agoraphobia is crucial for understanding and support.
  • Medication should be viewed as a means to reduce sensitivity in the anxiety response system.

Behavioral Management

  • Encouragement to face avoidance situations is important for recovery.
  • A combination of exposure and cognitive therapy is recommended for established cases.

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Explore the key characteristics and symptoms of phobic anxiety disorders in this quiz. Understand how these disorders manifest in specific circumstances and differentiate them from generalized anxiety disorder. Test your knowledge on how anxiety levels vary across different situations.

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