What is Phobic disorders

A phobia is the irrational fear of an object or situation. The patient is often aware that their fear is irrational but remains powerless to control their reaction.

Anxiety disorders are classified according to whether the anxiety is persistent (general anxiety) or episodic, with the episodic conditions classified according to whether the episodes are regularly triggered by the same cue (phobia) or not (panic disorder).

Statistics on Phobic disorders

This is the most common form of anxiety disorder. The prevalence of all phobias is 8%, with many patients having more than one. Phobias are most likely to begin in late childhood and continue into adulthood if left untreated. Women have twice the prevalence of most phobias than men.

Risk Factors for Phobic disorders

As with most anxiety disorders, the only known risk factor is a family history of anxiety disorder. Many types of phobia run in families, expecially those relating to blood injection and certain types of injury.

Progression of Phobic disorders

Phobias generally arise from a bad experience with a previously benign stimulus. For example, a person who has been previously trapped in an elevator runs a greater risk of devloping a phobia of elevators. In children, however, phobias usually arise from imagined threats to their personal safety (e.g. stories of ghosts told in the playground).

Most phobias will last indefinitely until the patient decided to overcome their specific fear of an object or social situation. Certain phobias such as the fear of spiders (arachnophobia) is quite easily managed by the complete avoidance of spiders. Patients with such as specific phobia need not suffer social or occupational dysfunction to avoid the stimulus. Patients who fear social ridicule (social phobia) are more likely to suffer social and occupational harm, for the phobia prevents their participation in activities of everyday life.

How is Phobic disorders Diagnosed?

There are no specific investigations for phobic illness. If the patient appears to suffer from generalised anxiety which is exacerbated by certain phobias, a limited number of tests are performed to exclude medical conditions that bring about feelings of anxiety. These may include a number of different blood tests for hormone balance and a blood sugar level. An ECG is also typically performed to exclude any heart problem that may be causing a patient’s palpitations.

Prognosis of Phobic disorders

Most phobias will tend to develop in late childhood and continue through adult life unless the patient seeks appropriate therapy. If the phobia stimulus is easy to avoid, the patient may live their entire life by avoiding the object or situation. If the phobia is less easy to avoid, the patient is more likely to seek help to resolve their apparent fears. The prognosis with therapy is excellent for most forms of phobic illness. The prognosis is less promising for the condition of agoraphobia, which is most resistant to behavioural therapy and psychotherapy.

How is Phobic disorders Treated?

As with most psychiatric illness, panic disorder is best treated with both psychotherapy and anti-anxiety medications. There are a number of types of psychotherapy suitable for the treatment of panic disorder. These include relaxation therapy, behaviour therapy and cognitive behavioural therapy.

Medications are used to assist psychotherapy as a primary form of treatment.

Medications such as sedatives and antidepressants are used in this setting to reduce the frequency and severity of panic attacks. The most commonly used sedatives are the benzodiazepines such as diazepam, however their use beyond 4-6 weeks is discouraged with the emergence of dependence beyond this duration. The most commonly used antidepressant for this condition are the SSRI’s such as flluoxetine and sertraline.

Antidepressant medications will usually require three months of therapy to achieve adequate effect, but have the advantage that they do not induce patient dependency.
Another class of drugs commonly used for panic disorder are the beta-blockers. These drugs block the body’s response to anxiety, preventing the occurrence of palpitations, sweating and tremor in the event of a panic attack. They can also be taken in anticipation of stressful situations to reduce the effect of anxiety on the body.

Phobic disorders References

[1] American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association Press; 1994.
[2] eMedicine.
[3] Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 2002.
[4] Medline Plus.
[5] Sadock BJ., Sadock VA. Kaplan and Sadock’s Pocket Handbook of Clinical Psychiatry 3rd edition. Lippincott Williams and Wilkins 1996.

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