3. Introduction
• Phobia: excessive fear of a specific object, circumstance or situation
• Specific Phobias are fears of specific objects or situations, such as spiders or
blood, that go beyond the true threat of the stimulus and cause avoidance and
functional impairment
4. History
• Term phobia Greek god,
Phobos
• First in medical literature-
hydrophobia
• 19th century – to describe morbid
fears
• Psychiatric use of term phobia by
Westphal in 1871- agoraphobia
5.
6. Epidemiology
• 5-10 percent in general
population in the US
• 6% lifetime prevalence
• Females > males
• Mean age of onset 13-16yrs
8. Etiopathogenesis
Behavioral factors:
• Little Albert
• Hobart Mowrer two
factor theory of avoidance
learning
• combined the learning
principles of classical and
operant conditioning
9. • Specific phobia
• due to pairing of a specific object or situation with the emotion of
fear and panic
• Modeling is another mechanism
10. • Genetic factors
• Runs in families
• meta-analysis of twin studies on fears and specific phobia
showed that highest mean heritability among fear
subtypes was animal fear (45percent), and among
specific phobias, the highest mean heritability was blood-
injury-injection phobia (33 percent)
11. Neuroimaging
• Region that were consistently activated to phobic stimuli
included the left insula, amygdala, and globus pallidus
• Compared to healthy controls, phobic subjects had
increased activation in response to phobic stimuli in the
left amygdala/globus pallidus, left insula, right thalamus
(pulvinar), and cerebellum
14. Some common phobias…
Acrophobia- fear of heights
Aerophobia- fear of flying
Arachnophobia- fear of spiders
Astraphobia- fear of thunder and lightning
Autophobia- fear of being alone
Claustrophobia- fear of confined or
crowded spaces
Hemophobia- fear of blood
Hydrophobia- fear of water
Ophidiophobia- fear of snakes
Zoophobia-fear of animals
Triskaidekophobia- fear of 13
16. Diagnostic criteria- ICD 10
• All the following should be fulfilled for a definite diagnosis:
a) The psychological or autonomic symptoms must be
primary manifestation of anxiety and not secondary to
other symptoms such as delusion or obsessional
thoughts
b) The anxiety must be restricted to the presence of the
particular phobic object or situation
c) The phobic situation is avoided whenever possible
17. Differential diagnosis
Agoraphobia
Social anxiety disorder and separation anxiety disorder
panic disorder
OCD
Trauma and stressor related disorder
Eating disorder
Schizophrenia spectrum and other psychotic disorder
19. Treatment –Psychological
• Behavior therapy
• Success of the therapy determined
by
1. Patients commitment
2. Clearly identified problems and
objectives
3. Available alternative strategies
for coping with the feelings
20. Treatment
EXPOSURE THERAPY
• Systematic desensitization
• Based on behavioral principal of counter
conditioning
• Patient is exposed serially to a
predetermined list of anxiety provoking
stimuli
• 3 steps
1. Relaxation training
2. Hierarchy construction
3. Desensitization of stimulus
21. • In vivo exposure:
• In vivo exposure involves helping patients directly confront
feared objects, activities, and situations.
• It is usually conducted in a graduated fashion according to a
mutually agreed-on hierarchy
22. Imaginal exposure
• Imaginal exposure typically
involves having the patient
close their eyes and imagine
feared stimuli as vividly as
possible.
• Imaginal flooding : worst
scenario repeatedly
• Helps to process fear
emotionally and cognitively
23. • Insight-oriented psychotherapy
• Despite of uncovering unconscious conflicts, patients failed to lose phobic
symptoms
• Virtual therapy
• Patients are exposed to or interact with phobic stimulus on the
computer screen
24. Treatment- Pharmacological
• The benefit of pharmacotherapy has not
been well studied
• SSRIs (escitalopram and paroxetine)
may be useful as second-line
treatments if patients do not respond to
psychotherapy.
• BZDs have not been found to be
beneficial
• Comorbid depression or other anxiety
disorders if present can be treated with
first line therapeutic drugs
25. Coronaphobia???
• Fear of contracting COVID-
19
• Avoidance of public places
• Frequent request for testing
for infection or refusing tests
27. References
• Kaplan and Sadock’s Synopsis of Psychiatry 11th edition
• Kaplan and Sadock's Comprehensive textbook of
Psychiatry
• American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.)
• Meta-analysis of functional brain imaging in specific
phobia Jonathan C. Ipser, PhD, 1 * Leesha Singh, MD1,2
and Dan J. Stein, MD, PhD1
• Reddy YJ, Manjula M, Arumugham SS, NarayanswamyJC
Clinical practice guidelines for cognitive behavioral
therapies in anxiety disorders and obsessive compulsive
and related disorders. Indian J Psychiatry 2020;62:S230-
50
Following exposure-based therapy widespread deactivation was observed in the right frontal cortex, limbic cortex, basal ganglia and cerebellum, with increased activation detected in the thalamus. Exposure to phobia-specific stimuli elicits brain activation that is consistent with current understandings of the neuroanatomy of fear conditioning and extinction. A meta-analysis suggested that exposure therapy for specific phobias was associated with reduced activation in the frontal cortex, limbic regions, and cerebellum A longitudinal study of patients with spider phobia who underwent a single 2-hour exposure therapy session found that patients showed increased amygdala, insula, and ACC activation to phobic versus neutral stimuli prior to treatment.
