Anxiety: Specific phobia

Question 1

Define

Answer 1

ICD-10: phobias restricted to highly specific situations such as proximity to slugs or snails

Consistently occurs when exposed to ≥ 1 specific objects (e.g. proximity to certain animals, flying, heights, closed spaces, sight of blood or injury) and that is out of proportion of actual danger - it cannot be reasoned away and is beyond voluntary control

Question 2

Epidemiology

Answer 2

Specific Phobia: often develop in childhood

Question 3

Symptoms

Answer 3

• Sometimes develops later, after a frightening experience
• Avoidance, fear and disability (in severe cases)
• Contact can evoke panic (e.g. barricading bedroom, screaming at housemates)
• May have a FHx of phobia (indicating a negative reinforcement as a child or classical conditioning)
• Most phobias lead to tachycardia, but blood or injury phobia cause an initial tachycardia followed by vasovagal bradycardia and hypotension -> may cause nausea and fainting

Question 4

Management

Answer 4

Education, reassurance and self-help

Exposure Response Prevention (ERP)
- Flooding = exposing someone to maximal fear until the fear becomes extinct – all at once

-Relaxation therapy and breathing techniques

• Short-term BDZ for certain specific phobias (i.e. dental injections) – NEVER LONG-TERM

Question 5

Investigations

Answer 5

Cardiorespiratory examination

Rule out: ECG, TFTs, LFTs, U&Es, glucose, urine drug screen, urine VMAs

SPIN questionnaire for social phobia

Hospital Anxiety and Depression Scale

Collateral history

Social and occupational assessments for effect on QoL