Phobic Anxiety Disorders Overview

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

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

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

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

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

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

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

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

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

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The amygdala shows reduced hyperactivity with successful treatment of phobias.

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

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

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Social phobia primarily involves excessive comfort in social situations.

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Ongoing depressive disorders can complicate the diagnosis of specific phobias.

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

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

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

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

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

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Anticipatory anxiety is uncommon in individuals with specific phobia.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Depressive symptoms are uncommon in agoraphobia.

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

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

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Agoraphobic patients may experience feelings of depersonalization.

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

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

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

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

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

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

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

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Comorbid depressive disorders are rare among individuals with social phobia.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The fear of flying can affect both passengers and pilots.

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

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

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

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

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Most childhood phobias will disappear by early adulthood.

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

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

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

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

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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 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.

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.

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.

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

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.