Download - Specific Phobia: Anxiety Disorder
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Specific Phobia: Anxiety Disorder
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DSM-V Diagnostic Criteria• A. Marked fear or anxiety about a specific object or
situation (in children the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging)
• B. The phobic object or situation almost always provokes immediate fear or anxiety
• C. The phobic object or situation is actively avoided or endured with intense fear or anxiety
• D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
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DSM-V Diagnostic Criteria• E. The fear, anxiety or avoidance is persistent, typically lasting
for 6 months or more• F. The fear, anxiety, or avoidance causes clinically significant
distress or impairment in social, occupational, or other important areas of functioning
• G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in OCD); reminders of traumatic events (as in PTSD); separation from home or attachment figures (as in SAD); or social situations (as in social anxiety disorder)
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Specify if…• The code assigned is based on the phobic stimulus:• Animal (spiders, insects, dogs)• Natural environment (heights, storms, water)• Blood-injection-injury (needles, invasive medical
procedures)• Situational (airplanes, elevators, enclosed places)• Other (situations that may lead to choking or
vomiting; in children, loud sounds or costumed characters)
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Diagnostic Features
• Phobic stimulus• For diagnosis, response must be different
from “normal, transient fears that commonly occur in the population”
• Amount of fear/anxiety experienced may vary with proximity to the phobic stimulus
• Fear/anxiety may happen in anticipation of or in presence of actual stimulus
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Diagnostic Features
• Reaction may take form as a full or limited symptom panic attacks
• Fear/anxiety evoked nearly every time contact is made with phobic stimulus
• Fear/anxiety often expressed different in children and adults
• Immediate rather than delayed reaction when in contact with phobic stimulus
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Diagnostic Features
• Individual actively avoids phobic stimulus (intentionally behaves in ways that are designed to prevent/decrease contact with phobic stimulus)
• Avoidance behaviors are obvious or less obvious
• Physiological Arousal • Amygdala and related structures
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SP Prevalence
• 12 month community prevalence estimate for US ~7-9%
• European countries 6%• Asia, Africa, Latin American countries 2-4%• Children ~ 5% 13-17 year olds 16%• Older individuals 3-5%• Females > males, 2:1 (varies across phobic
stimulus)
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Comorbidity
• Unlikely to only present SP without other psychopathology
• Frequently associated with range of disorders• Increased risk for developing other anxiety
disorders, depression, bipolar, substance related disorders, somatic symptom and related disorders, and personality disorders (dependent personality disorder)
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Course of SP• SP can occur: after experiencing or observing a
traumatic event, informational transmission, unexpected panic reaction in presence of soon to be phobic stimulus
• Many individuals are unable to recall the reason for onset of SP
• Onset usually in early childhood, majority of cases develop before age 10, (type of SP varies onset)
• Early onset is usually associated with a wax and wane pattern
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Risk and Prognostic Factors• Temperamental: Negative affectivity (neuroticism), behavioral
inhibition • Environmental: Parental over protectiveness, parental loss &
separation, physical/sexual abuse, negative or traumatic event• Genetic/Physiological: First degree relative with SP,
significantly more likely to have SAME SP, individuals with blood-injection-injury show unique propensity to fainting in presence of phobic stimulus
• Culture: Asians and Latinos report significantly lower rates of SP/ countries outside of US show differences in disorder
• Suicide: 60% more likely to make suicide attempt w/ SP diagnosis
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Differential Diagnosis• Agoraphobia: If individual fears only ONE of the
agoraphobia situations- Specific Phobia-Situational • Social Anxiety Disorder: If situations are feared
because of negative evaluation – SAD not SP• Separation Anxiety Disorder: If situations are feared
because of separation from a primary caregiver or attachment figure- Separation Anxiety Disorder
• Panic Disorder: If the panic attacks only occur in response to the specific phobia stimulus- Specific Phobia
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Differential Diagnosis• OCD: If fear or anxiety is result of obsessions and other
diagnostic criteria are met- OCD• Trauma- and stressor-related disorder: If phobia
develops after traumatic event, consider PTSD, only assign SP if ALL PTSD criteria are not met
• Eating disorders: If avoidance behavior is exclusively limited to avoidance of food and food-related cues, anorexia nervosa or bulimia considered
• Schizophrenia spectrum and other psychotic disorders: When fear/avoidance are due to delusional thinking- SP NOT WARRANTED
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DSM-V ModelExperience or observation of traumatic event/information
transmission/ situation
Genetic predisposition: First degree relative risk/
amygdala and related structures
Parental environment: protectiveness, separation,
loss, physical or sexual abuse/ neglect
Temperamental: Negative affectivity
Behavioral Inhibition
Phobia Stimulus: Specific object or
situation
Specific phobia
Suicide
Comorbidity
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Fears are Normal• Mild fears are fairly common among children (Craske,
1997)• Infancy: children become fearful of stimuli in their
immediate environment (Muris, Merckelbach, de Jong & Ollendick, 2002)
• As child develops, fears start to incorporate anticipatory events and stimuli of an imaginary or abstract nature (Muris et al., 2002)
• This developmental pattern is assumed to reflect everyday experiences and mediated by cognitive capacities (Muris et al., 2002)
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Descriptives on SP (Essau, Conradt, & Petermann, 2000)
• Examined the frequency, comorbidity, & psychosocial impairment of SP and specific fears
• First wave of the Bremen Adolescent Study (BJS) (northern Germany)
• How frequent in 12-17 yr olds• Distribution according to sex and age• Comorbidity of other disorders• Level of impairment
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