Anxiety Disorders Part- II

Phobias

Phobos-  greek god for fear

Phobic disorders are a catagory of disorders where individual have specific and irrational fear towards an object, people or situation. Unlike people who have GAD, people with phobias know what exactly the are afraid of. Except for their specific fear, phobic person does not indulge in gross distortion of reality. Nothing physically wrong with them, but their fears are out of propotion with reality,inexplicable, and beyond voluntary control.

                             The stimuli that evokes fear are not random. Mostly its animals, objects or events that presented real dangers ib earlier stage of human development. They dont need actual presentation of phobic stimuli, but thought of it even invokes physiological reactions.some are daily life aspects- cats, dogs, stairs and few are not- snakes, death, height. Phobias tend to grow broader over time. In milder terms, more prevailant than GAD .

Double the rate in females. Typically have onset in childhood or young adulthood. Mean duration- 24-31 yrs. No institutionalisation. Phobias grouped into three-

Specific Phobia-

          Specific phobias are marked, persistant and irrational fears. Eg.

(a)  Acrophobia- fear of heights

(b)  Claustrophobia- Fear of closed places

(c)  Xenophobia- Fear of strangers.

Most common type of phobia. 11% of population meeting the criteria in there lifetime. The degree of distress varies with prevalance of the avoided situation.

Clinical Feature:

1.    Marked and persistant fear that is excessive

2.    Person suffering recognizes that the fear is unreasonable but continues to avoid the frightening situation.

3.    The avoidance of, anxious anticipation of and distress caused by the feared situation cause problem in the areas of social relationships, work and carrying of normal routine.

Therapeutic Approch-

1.    Systematic DeSensatisation.

2.    Cognitive therapy

 

Social Phobias

     They are phobias characterized by fear and embarrassment in dealing with others. Often the individuals fear is that the signs of anxiety such as intense blushing, tremors of hand, and quavering of voice will be detected by the people whom he or she comes with contact.

Fear of public speaking and of eating in public are frequent complaints. Problems begin in late childhood, and may cristallized into phobia in late adolescents. Its different from shyness. Personal life is bleak. No friends or social life.

Clinical features-

1.    Marked and persistant fear of one or more social or performance situation, which usually involve unfamiliar people, or scrutiny or evaluation by others, and phobic reaction include intense concern over being humiliated or embarrassed.

2.    The person recognizes the fear to be excessive and unreasonable

3.    The avoidance of, anxious anticipation of and distress caused by the feared situation cause problem in the areas of social relationships, work and carrying of normal routine.

Agoraphobia-

     Fear of entering certain fear evoking or unfamiliar situation, which often accompanies panic attacks. To outsider, a person with agoraphobia may look no different from one with social phobia. Both stay away from party an prefer home. But the reason is different. Socially phobic person opt out as they are embarrassed in dealing with others, whereas agoraphobic person is afraid he might get a panic attack and loose control in crowd. These people has an irrational fear of leaving familiar setting of home.

Often begins in late teens, though its seen in older people too. They may come without panic attacks too. It waxes and wanes, also object of fear changes. Half of the people with panic attack develops agarophobia if not treated properly.

Graduated Exposure therapy, Coginitive and Behavioral techniques.

Obsessive Compulsive Disorder-

       

   The defining charecteristic of obsesssive compulsive disorder is reccurent obsession or compulsion that are sever enough to be time consuming. (take more than 1 hour a day). Or cause marked distress or significant impairment. 

Obsessive behavior- unable to get an idea out of their mind. Obsession involve doubt, fear of contamination, or fear of one’s own aggression.

Compulsive behavior- Feel compellled to perform a purticular act or series of act over an over again. Most common include counting, checking, washing.

Checking- if everything proper, cleaning- avoiding public materials and extreme self hygene, slowness- i am very slow, Doubting- feeling it wasn’t quite right.

25% just have Obsessive thought. Others compulsion too. Compulsion else is rare. 

Under treated condition as people often secretive about symptoms due to embarrassement. Obsessive thought are often distasteful or shameful. Compulsive rituals may turn elaborate patterns to daily routine and is a protection against anxiety, as they feel safe as long as they follow it. They are not counted psychotic as they are aware of irrationality.

Heredity- family history of psychiatric difficulties are seen.

Biological factors- brain imaging shows brain structure and functions of OCDs are different.

Past traumatic experiences can also be a factor.

OCDs are guilty about their behavior, but they continue as they believe its the safest option. Onset 20-29. More common in upper income and intelligent. Male and female equal. 50% remain unmarried as they are aware of their behavior. 

Common features-

1.    Obsession or compulsion intrudes insistently and persistently into individuals awareness.

2.    A feeling of anxious dread occure if the thought or act is prevented for some reason.

3.    Individual recognizes the adsurdity and irrationality for the obsession or compulsion.

4.    Individual feels a need to resist it.

Symptoms increase when stress increases. Eg, new job.

Cognitive behavioral Therapy works if patient is motivated.

Post Traumatic Stress Disorder (PTSD)-

          PTSD is charecterized by feeling of extreme fear and apprehension as a result of an extreme experience, such as war, natural catastrophe, physical assault, or serious accident.  Trauma range from one that’s directly experienced to those that are witnessed. Even start after a silent phase (3-6 months-delayed PTSD, Chances of recovery lesser). More in women than men.

Combination of vulnerablity factors and exposure earlier in life increases the likelihood of PTSD. More in people with anxiety and depression.

DSM IV TR Criteria-

1.                            Exposure to traumatic event that involved actual or threatened death or serious injury

2.    A response to event that include intense fear, helplessness or horror.

3.    Persistent re experiencing of the traumatic event in form of recurring and distressing thoughts or dreams, feeling or behaving as traumatic event has actually happened again, intense psychological or physiological reactivity when exposed to cues that resemble event.

4.    Persistant avoidance of stimuli avoided with trauma

5.    Persistant symptoms of increased arousal- Hypervigilance, irritablity, sleep difficulties, difficulty in concentration etc- not present before trauma.

6.    Symptoms more than 1 month duration, causing significant imparement in various spheres of life.

Three essential charecteristics- hyper arousal, avoidance, and re experience.