Phobic disorders

Phobic disorders comprise a group of disorders having in common persistently recurring, irrational severe anxiety of specific objects, activities, or situations with secondary avoidance behavior of the phobic stimulus. Phobias are relatively commonplace, and the diagnosis of a phobic disorder is made only when fear or avoidance behavior is a significant source of distress to the individual or interferes with social or occupational functioning.

The phobic disorders listed in DSM-III include three separate disorders—agoraphobia, social phobia and simple phobia.

Agoraphobia definition Agoraphobia, the fear of being alone or in public places, may occur rarely in the absence of panic disorder, but it is almost invariably preceded by that condition.

Social phobias definition

Social phobias are persistent irrational fears and the need to avoid any situation where one might be exposed to scrutiny by others and potentially be embarrassed or humiliated. Even the possibility of such a situation evokes anticipatory anxiety. The individual is aware that this fear is excessive. Common examples are excessive fear of public speaking and anxiety induced by eating in restaurants or by any public performance. The resulting anxiety may actually impair performance and thereby potentiate the phobic disorder.

Epidemiology and pathogenesis

Social phobias are relatively rare, and there is no evidence for a genetic or familial transmission. Social phobias presumably arise from stressful life events occurring during early development. The disorder usually begins in late childhood or early adolescence and tends to be chronic and to wax and wane in severity.

Complications

Complications are rare and the disorder is not often incapacitating; it may lead to sedative or hypnotic drug and alcohol abuse and addiction, and to problems in professional advancement.

Treatment

Treatment of social phobia is primarily behavioral, with use of such techniques as relaxation therapy, systematic desen-sitization, and related techniques. Pharmacotherapy with beta blockers, i.e., propranolol or atenolol and/or alprazolam, may also be helpful.

Simple phobia definition

Simple phobias are persistent irrational fears and avoidance of specific objects or situations.

Clinical features

The individual experiences significant distress when confronted with the phobic stimulus or even the possibility of confrontation with the phobic stimulus and also recognizes this fear and anxiety as irrational and excessive. When confronted with the phobic stimulus the individual may experience symptoms identical to those of panic attacks. Common examples include fear of heights (acrophobia), fear of closed spaces (claustrophobia), and fear of animals. Fear of the possibility of exposure to the phobic stimulus will often cause the individual to attempt to elicit significant information, e.g., if the party or restaurant is at the top of a high-rise building; if they have a dog.

Age of onset is variable, but the disorder often begins in childhood. Simple phobias that begin in childhood may disappear without treatment, but may persist into adulthood. Although phobias are relatively common in the general population, they rarely result in significant impairment and individuals rarely seek treatment. Simple phobias are more common in women. Treatment, if required, is behavioral using relaxation therapy and systematic desensitization.