Phobic Disorders: Symptoms, Treatments and Research
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Although phobic disorder is certainly common, it has been more difficult to establish the extent to which it should be considered a "serious" mental disorder from a public health perspective.
Recent studies in understanding the behavioral, molecular, and anatomical bases of fear extinction in animals and humans are leading to new knowledge about the nature of fear and new treatments for anxiety disorders that affect millions of Americans (news release from SFN). In those people who suffer from phobic disorders (specific phobia, social phobia and agoraphobia) excessive and inappropriate fear and anxiety comprise the core symptoms of the disorder. Collectively, these disorders are the most common forms of psychiatric illness, surpassing rates of mood disorders and substance abuse
A study by Michael Davis, PhD, at Emory University (SFN News Release) that determined how human brain can used to treat such disorders. He found that a receptor for a particular protein called the N-methyl-D-aspartate (NMDA) receptor in a brain region called the amygdala is critical for the extinction of conditioned fear. Many medical professional believe and it also has been proved true in many cases that combination of drugs therapy and behavioral therapy has the most successful results.
2. Phobia - Definition
The term ‘Phobia’ was not used on its own until 1801 and in late 19th century it slowly gained acceptance in the sense it has today. The word ‘Phobia’ comes from the ancient Greek word ‘Phobos’, meaning “flight”,“fear” and “terror.
Phobia is a condition, which is described as an intense, obsessive, persistent and unrealistic fear of an external object or situation or feeling. In some cases avoiding such objects or situations that cause anxiety makes difficult to lead a normal and healthy life. There are hundreds of different types of phobias with technical name for each.
The symptoms of phobias are the same as those that would occur when facing an actual threat, leading to a reaction. In addition, there are other symptoms that go beyond the more "normal" fear response. Typical symptoms include:
· Anxiety reactions such as sweating, trembling, nausea, rapid heartbeat, worry, dread, or terror
· Intense fear of the object or situation, beyond an actual threat of danger
· Intense fear of being watched or judged (social phobia)
· Uncontrollable reactions that consume the mind and body
· Avoidance of the object or situation to an extreme that it may result in isolation
· Use of alcohol or substance in attempt to control feeling of anxiety
4. Classifications and Diagnosis of Phobia
In the past many attempts have been made to categorize phobia. According to (Beck et al. 119) a recent factor analytic study of the fear of 194 psychiatric patients at the center for Cognitive Therapy found that phobic disorder fell into three major categories. There is no diagnostic laboratory test for phobias. Diagnosis is based on the patient's account of their experiences.
i. Specific Phobia:- is a unrealistic and excessive fear of a specific situation or object such as flying, spiders, heights, insects etc. Exposure to the object or situation causes an immediate anxiety response or a panic attack. The person may have distress about having the phobia.
The most common specific phobias are:
o Claustrophobia – involves fear of such enclosed spaces such as elevators, buses, subways/trains
o Blood or injury phobia involves fear of blood, needles, doctors, dentist and any other medical type situations.
ii. Social Phobia: - also known as social anxiety disorder, is an excessive and unrealistic fear of embarrassment or humiliation is social situation. Typical situations feared or avoided by these individuals are parties meeting, eating in front of others, public speaking, conversation or meeting new people and any other related situations. The person knows that the fear is excessive and irrational. The condition disrupts their ability to function at work or school and causes them to withdraw from social activities and/or relationships, or the fact that they have the phobia causes them distress. Other mental disorders, a medical condition, or the effects of a drug do not cause fear and avoidance.
iii. Agoraphobia:- is a condition where the where person fears that escape or help would not be possible in case of a panic attack. This might be driving, public transport, trains, being alone, being in crowd or shopping. The individuals suffering from this anxiety avoid social situations with great distress or anxiety about having a panic attack.
5. Treatments for Phobic Disorder
Clinicians treat phobic disorders from a range of perspectives (e.g., insight-oriented therapy and hypnosis). However, there are two main approaches (Pharmacotherapy (drug therapy) and Cognitive-Behavioral therapy (CBT) are adapted by many psychiatrists, treatments with well-recognized observed support are proved to be successful. Although a few studies have compared these approaches to other treatments (e.g., analytic psychotherapy), these alternative approaches have not been effective as compare to CBT and medication. Psychodynamic therapy (or insight oriented therapy), not as rigorously studied, also is considered an effective treatment. However a careful interview and review of the patient's goals and level of pathology is assessed to determine the treatments or combination of treatments required.
Patient prognosis often is determined by several factors, including the following:
· Severity of diagnosis
· Level of functioning prior to onset of symptoms
· Degree of motivation for treatment
· Level of support (eg, family, friends, work, school)
· Ability to comply with medication and/or psychotherapeutic regimen
A person with phobias is very anxious and tense. Learning to relax helps the individual encounter the feared object or situation in a calmer state. Deep breathing, muscle relaxation, meditation, positive affirmations and other means may be included to help reduce symptoms.
6. Appropriateness of Treatment
There has been some evidence that many individuals with phobic disorders are not offered appropriate treatments. Health care professionals outside of specialized anxiety disorders clinics are less likely to use practical validated treatments. For example, Swinson et al. (1992) found that although the majority of patients with panic disorder and social phobia had tried psychotropic medications (89% and 75%, respectively), most had never received the treatments with the most empirical support. He suggests that general and emergency department physicians are needed to be educated for early recognition and intervention of the disease. Educational activities should also be targeted to other health and mental health care professionals, including psychologists, psychiatrists, occupational therapists, social workers, psychiatric nurses, et cetera.
(Ronald) illustrated the occurrence of phobias as a whole in US: Prevalence of 1 month is 6.2%. Prevalence of 6 months is 7.7%. Lifetime rate is 12.5%.
Occurrence of phobia by type is as follows: Specific phobia has a 6-month prevalence of 4.5-11.8%. Social phobia has a lifetime prevalence of 1.9-3.2%. Social phobia affects about 5.3 million adult Americans. Agoraphobia has a lifetime prevalence of 2.5-6.5%.
o Sex:- Specific phobia has a female-to-male ratio of 2:1. Social phobia is more common in women, but men seek treatment due to career issues. Agoraphobia has a female-to-male ratio of 2-3:1.
o Age:- Specific phobia: Age of onset depends on the phobia. In general, specific phobia appears earlier than social phobia or agoraphobia. Social phobia: Most social phobias begin before age 20 years. Agoraphobia: Agoraphobia usually begins in late adolescence to early adulthood.
o Race:- The occurrence of phobias appears equally distributed among races.
8. Future Research
In the past, researchers had a limited knowledge of how the brain can normally snuff out feelings of fear, which slowed down the development of treatments for phobia. Kibiuk suggests, “increasing discoveries that uncover some of the major biology behind the brain’s ability to overcome the emotion are knocking down this barrier. The progress is leading to:
· A clearer understanding of the brain mechanisms that manage our fears.
· New therapies for people with phobia that tap into specific brain mechanisms. “
Most of the treatments for phobia are based on behavioral techniques that involve steady exposure to the feared object or situation until a person overcome their physical reactions of fear. This process is slow, costly and does not always work, as the patients are feared of the treatment.
Kibiuk indicated that the recent research shows that some drugs used for depression that decrease anxiety and change brain chemicals can also be used to treat some phobia. However the medications do not help everyone. This system came from the animal studies indicate that learning and formation of new memory helps to overcome fear rather that erasing an old memory. For example, repeatedly exposing animals to a snake can help them overcome a developed fear of the reptiles. Over a period of time however, may permit the fear to resurface. This suggests that a fear does not become erased. Instead new learning is the key to keeping it at bay.
In the recent development, scientists found that the use of drug ‘D-cycloserine, enabled to cut the amount of behavioral therapy people required to overcome their phobias. Preliminary results of another patient study indicate that D-cycloserine also may help additional types of phobia, like social phobia.
Other researchers have identified additional methods that may target the fear control system and help those with phobia. For example, early results reveal that a compound that acts on another chemical in the system, dopamine, can accelerate the ability of mice to overcome fear. Several other strategies are also under investigation.
With continued progress, researchers believe they can create major improvements in treatment, making life a day in the park once again for many people.
In recent years we have come to recognize that phobic disorder is common highly co morbid with other conditions such as depression and, unfortunately, largely under recognized and under treated in primary care. However significant improvements and advancements have been made over the previous years. Scientists are investigating and trying to treat the cause of such disorders. There are various treatments available for the phobia disorder however it is important that the patient’s circumstances, level of anxiety and mental status is assessed in detail in order to diagnose with most effective therapy. Many researchers have criticized that the effectiveness of the treatment depends on the individual medical professionals. The studies show that the well organized observed support have high success rate. Therefore I have concluded from this research that there is still a great need for further research into human brain and different drug therapies that can be combined with Cognitive Behavioral Therapy and also the medical professionals need be well informed and trained to use these therapies in most effective manner.
Bibliography & Reference
, . "Advances In Understanding The Underpinnings Of Fear Extinction Provide New Knowledge About Anxiety Disorders And May Lead To New Treatments.." Society for Neuroscience 10 Nov 2004. 06 Mar 2005 .
Beck, Aaron T, Gary Emery, and Ruth Greenberg. Anxiety Disorders and Phobias. : Library of Congress, 1985.
Kibiuk, Lydia. "Phobia." The Journal of Neuroscience 01 Feb 2005. 05 Mar 2005 .
Myers, David . Psychology. 7th ed. : Worth, 2004.
Ronald, Albucher C. "Phobic Disorders." eMedicine 25 July 2004. 06 Mar 2005 .
Swinson, R.P., Cox, B.J., and Woszczyna, C.B. (1992). ‘Use of medical services and treatment for panic disorder with agoraphobia and for social phobia”. Canadian Medical Association Journal