Task 3 Specific
Phobia
1. What is Specific Phobia? (DSM)
DSM.5 criteria
A. Marked fear of certain objects, stimuli or situations.
B. Actual or anticipated exposure provokes an immediate, intense anxiety
reaction, which can be similar to a full-blown or limited-symptom panic attack.
C. Dominant response tendency is avoidance.
D. Fear of anxiety is out of proportion to the actual danger posed by the object or
situation.
E. Fear of anxiety is persistent.
F. Fear of anxiety leads to functional impairment in either persona, social, or
occupational domains.
G. Not explained by other anxiety/mood disorders, substances or organic
pathology.
Adams, T. G., Sawchuk, C. N., Cisler, J. M., Lohr, J. M. and Olatunji, B. O. (2014)
Specific Phobias, in The Wiley Handbook of Anxiety Disorders
Specific phobias are defined as a marked fear of certain objects, stimuli, or
situations. Typically the full intensity of the fear is experienced upon actual
exposure to the phobic trigger, specific phobias may also be characterized by a
similarly intense reaction even in anticipation of coming into contact with the
feared object or situation.
Natural course
The natural course for the average specific phobia involves early onset, a chronic
course and severity in the mild to moderate range. The age of onset and
chronicity vary as a function of subtype.
Animal and BII phobias tend to onset earlier than natural environment and
situational phobias.
Phobias tend to be chronic and rarely (16%) remit without intervention.
Time from fear to phobia 6 – 13 years.
Impairment
A diagnosis of specific phobia can result in significant impairments in several life
domains. Research found a positive linear relation between the number of
specific fears (i.e., 1 vs. 2–3 vs. 4–5, etc.) and the degree of social and
occupational impairment, suggesting impairment significantly grows with the
number of fears.
Significantly poorer mental and physical quality of life than those without a
specific phobia.
11% more days of work than those without a diagnosis of special phobia.
All subtypes are associated with greater interference in daily life and social
functioning.
o Situational phobias, and the fear of being alone, were associated
with the most interference, the highest probability of seeking
professional help, and the highest use of medication.
Weinig onderzoek naar gedaan in vergelijking met andere anxiety
disorders. This may be partially due to the misconception that individuals
with specific phobias suffer few impairments.
2. Epidemiology, comorbidity and differential diagnosis?
,Adams, T. G., Sawchuk, C. N., Cisler, J. M., Lohr, J. M. and Olatunji, B. O. (2014)
Specific Phobias, in The Wiley Handbook of Anxiety Disorders
Epidemiology
Specific fears are very common: 41% to 50% of the general population
experience specific fears during their lifetime. These fears are however rarely
sufficient to warrant a phobia diagnosis.
Specific phobia is one of the most prevalent psychological disorders.
Suggest an overall lifetime prevalence of +/- 12% and a 12-month prevalence
of 9%.
Situational phobias are the most common, followed by natural environment,
animal, and BII phobias. Fear of heights was the most common.
Specific phobias are more common among adolescents and less common
among older adult populations.
The rates of specific phobia are also higher among females compared to
males.
Differential diagnosis
Several well-validated, structured clinical interviews have been developed for the
diagnosis of specific phobias and co-occurring disorders. In addition to clinical
interviews, the following questions can assist in the recognition of phobic cues,
symptoms and behaviours:
Furthermore, self-report measures and behavioural observation can be efficient
means for gathering specific information.
Borkovec (1976) identified 3 components of the process of anxiety:
motoric escape and avoidance
physiologic activation of the sympathic branch of the autonomic nervous
system
cognitive appraisals of threat and ham
In specific phobia, physiologic activation is the pre-potent response domain
which serves to cue and motivate escape when in the presence of the feared
object, and avoidance in anticipation (afwachting) of its occurrence. The
cognitive component is tertiary and addresses overestimation of threat and
harm. This cognitive component can be seen as “irrational”. Despite awareness
of the low objective risk, the organization of phobic concerns is represented as a
well-organized propositional network where the motoric and physiologic features
of the phobic response are the most pre-potent.
The phobic knows explicitly what she is afraid of, but she also knows
“how” she is afraid of it. It is these features that contribute to the
distinctiveness of specific phobia relative to other anxiety disorders and
aversions.
The most common differentials include:
, Panic disorder – high anticipatory anxiety across a range of situations;
recurrent, unexpected panic attacks in the absence of any phobic cues; and
interpretation of physical symptoms as dangerous.
o It is the panic response itself rather than the triggers for it that
distinguishes panic disorder from specific phobia.
Social anxiety disorder – focus of concern over being embarrassed and
negatively evaluated by others.
o the content of the fear network is interpersonal: responsivity to
facial cues, voice inflection and complex social exchange is the
substance (kern) of the fear reaction.
Obsessive-compulsive disorder – experience of intrusive, unwanted thoughts;
avoidance of objects related to obsessional theme.
o Obsessions are far more chronic and repetitive and, at times, are
much more bizarrely themed than more basic threat cognitions in
specific phobias.
o Similarly, compulsions, while similar in function, are also much more
complex, repetitive, and bizarre when compared to escape and
avoidance in specific phobias.
Posttraumatic stress disorder – onset following a potential life-threatening
stressor; emotional numbing and re-experiencing the trauma.
o PTSD also shares physiologic arousal, specific cues, and cognitive
overestimation of physical threat in the future environment, but its
occurrence requires a direct experience that elicited objective harm
or the induction of terror when indirectly experienced.
Direct experience is neither a feature of, nor necessary for,
specific phobia.
Generalized anxiety disorder
o GAD is characterized of pervasive, vague, context-independent
concerns of future danger and absence of safety
Specific phobia is daarentegen juist gericht op iets specifieks.
Separation anxiety disorder among children – the focus of fear involves
perceived and actual separation from specific family members and loved
ones.
Hamm, A. O. (2014). Specific Phobias: Assessment and Treatment, in The Wiley
Handbook of Anxiety Disorders (eds P. Emmelkamp and T. Ehring, pp 898—910)
Specific Phobia situational type vs. agoraphobia
Agoraphobic situations resemble to a great extent those situations that are
feared and avoided in specific phobias situational type, with the only
difference being that fear and avoidance have to be reported for two or more
situations to meet the criteria for the diagnosis of agoraphobia.
In their recommendations for DSM-5, LeBeau et al. (2010) conclude that there
is evidence that agoraphobia should be removed from its exclusive
association with panic disorder and therefore agoraphobia is indeed coded as
a separate disorder in the DSM-5, but it is still an open question whether
agoraphobia should be categorized as a subtype of specific phobia.
One important feature that discriminates between patients with specific
phobia and patients with other anxiety disorders is the cued fear response,
which increases with the proximity of the feared object or situation and fades
away as soon as the cue disappears.
Adams, T. G., Sawchuk, C. N., Cisler, J. M., Lohr, J. M. and Olatunji, B. O. (2014)
Specific Phobias, in The Wiley Handbook of Anxiety Disorders
Comorbidity
Phobia
1. What is Specific Phobia? (DSM)
DSM.5 criteria
A. Marked fear of certain objects, stimuli or situations.
B. Actual or anticipated exposure provokes an immediate, intense anxiety
reaction, which can be similar to a full-blown or limited-symptom panic attack.
C. Dominant response tendency is avoidance.
D. Fear of anxiety is out of proportion to the actual danger posed by the object or
situation.
E. Fear of anxiety is persistent.
F. Fear of anxiety leads to functional impairment in either persona, social, or
occupational domains.
G. Not explained by other anxiety/mood disorders, substances or organic
pathology.
Adams, T. G., Sawchuk, C. N., Cisler, J. M., Lohr, J. M. and Olatunji, B. O. (2014)
Specific Phobias, in The Wiley Handbook of Anxiety Disorders
Specific phobias are defined as a marked fear of certain objects, stimuli, or
situations. Typically the full intensity of the fear is experienced upon actual
exposure to the phobic trigger, specific phobias may also be characterized by a
similarly intense reaction even in anticipation of coming into contact with the
feared object or situation.
Natural course
The natural course for the average specific phobia involves early onset, a chronic
course and severity in the mild to moderate range. The age of onset and
chronicity vary as a function of subtype.
Animal and BII phobias tend to onset earlier than natural environment and
situational phobias.
Phobias tend to be chronic and rarely (16%) remit without intervention.
Time from fear to phobia 6 – 13 years.
Impairment
A diagnosis of specific phobia can result in significant impairments in several life
domains. Research found a positive linear relation between the number of
specific fears (i.e., 1 vs. 2–3 vs. 4–5, etc.) and the degree of social and
occupational impairment, suggesting impairment significantly grows with the
number of fears.
Significantly poorer mental and physical quality of life than those without a
specific phobia.
11% more days of work than those without a diagnosis of special phobia.
All subtypes are associated with greater interference in daily life and social
functioning.
o Situational phobias, and the fear of being alone, were associated
with the most interference, the highest probability of seeking
professional help, and the highest use of medication.
Weinig onderzoek naar gedaan in vergelijking met andere anxiety
disorders. This may be partially due to the misconception that individuals
with specific phobias suffer few impairments.
2. Epidemiology, comorbidity and differential diagnosis?
,Adams, T. G., Sawchuk, C. N., Cisler, J. M., Lohr, J. M. and Olatunji, B. O. (2014)
Specific Phobias, in The Wiley Handbook of Anxiety Disorders
Epidemiology
Specific fears are very common: 41% to 50% of the general population
experience specific fears during their lifetime. These fears are however rarely
sufficient to warrant a phobia diagnosis.
Specific phobia is one of the most prevalent psychological disorders.
Suggest an overall lifetime prevalence of +/- 12% and a 12-month prevalence
of 9%.
Situational phobias are the most common, followed by natural environment,
animal, and BII phobias. Fear of heights was the most common.
Specific phobias are more common among adolescents and less common
among older adult populations.
The rates of specific phobia are also higher among females compared to
males.
Differential diagnosis
Several well-validated, structured clinical interviews have been developed for the
diagnosis of specific phobias and co-occurring disorders. In addition to clinical
interviews, the following questions can assist in the recognition of phobic cues,
symptoms and behaviours:
Furthermore, self-report measures and behavioural observation can be efficient
means for gathering specific information.
Borkovec (1976) identified 3 components of the process of anxiety:
motoric escape and avoidance
physiologic activation of the sympathic branch of the autonomic nervous
system
cognitive appraisals of threat and ham
In specific phobia, physiologic activation is the pre-potent response domain
which serves to cue and motivate escape when in the presence of the feared
object, and avoidance in anticipation (afwachting) of its occurrence. The
cognitive component is tertiary and addresses overestimation of threat and
harm. This cognitive component can be seen as “irrational”. Despite awareness
of the low objective risk, the organization of phobic concerns is represented as a
well-organized propositional network where the motoric and physiologic features
of the phobic response are the most pre-potent.
The phobic knows explicitly what she is afraid of, but she also knows
“how” she is afraid of it. It is these features that contribute to the
distinctiveness of specific phobia relative to other anxiety disorders and
aversions.
The most common differentials include:
, Panic disorder – high anticipatory anxiety across a range of situations;
recurrent, unexpected panic attacks in the absence of any phobic cues; and
interpretation of physical symptoms as dangerous.
o It is the panic response itself rather than the triggers for it that
distinguishes panic disorder from specific phobia.
Social anxiety disorder – focus of concern over being embarrassed and
negatively evaluated by others.
o the content of the fear network is interpersonal: responsivity to
facial cues, voice inflection and complex social exchange is the
substance (kern) of the fear reaction.
Obsessive-compulsive disorder – experience of intrusive, unwanted thoughts;
avoidance of objects related to obsessional theme.
o Obsessions are far more chronic and repetitive and, at times, are
much more bizarrely themed than more basic threat cognitions in
specific phobias.
o Similarly, compulsions, while similar in function, are also much more
complex, repetitive, and bizarre when compared to escape and
avoidance in specific phobias.
Posttraumatic stress disorder – onset following a potential life-threatening
stressor; emotional numbing and re-experiencing the trauma.
o PTSD also shares physiologic arousal, specific cues, and cognitive
overestimation of physical threat in the future environment, but its
occurrence requires a direct experience that elicited objective harm
or the induction of terror when indirectly experienced.
Direct experience is neither a feature of, nor necessary for,
specific phobia.
Generalized anxiety disorder
o GAD is characterized of pervasive, vague, context-independent
concerns of future danger and absence of safety
Specific phobia is daarentegen juist gericht op iets specifieks.
Separation anxiety disorder among children – the focus of fear involves
perceived and actual separation from specific family members and loved
ones.
Hamm, A. O. (2014). Specific Phobias: Assessment and Treatment, in The Wiley
Handbook of Anxiety Disorders (eds P. Emmelkamp and T. Ehring, pp 898—910)
Specific Phobia situational type vs. agoraphobia
Agoraphobic situations resemble to a great extent those situations that are
feared and avoided in specific phobias situational type, with the only
difference being that fear and avoidance have to be reported for two or more
situations to meet the criteria for the diagnosis of agoraphobia.
In their recommendations for DSM-5, LeBeau et al. (2010) conclude that there
is evidence that agoraphobia should be removed from its exclusive
association with panic disorder and therefore agoraphobia is indeed coded as
a separate disorder in the DSM-5, but it is still an open question whether
agoraphobia should be categorized as a subtype of specific phobia.
One important feature that discriminates between patients with specific
phobia and patients with other anxiety disorders is the cued fear response,
which increases with the proximity of the feared object or situation and fades
away as soon as the cue disappears.
Adams, T. G., Sawchuk, C. N., Cisler, J. M., Lohr, J. M. and Olatunji, B. O. (2014)
Specific Phobias, in The Wiley Handbook of Anxiety Disorders
Comorbidity
