Specific Phobia - Anatomy of Psych

What is specific phobia?

Specific phobia is an anxiety disorder characterized by intense fear or anxiety in the presence of a particular situation or object (phobic stimulus). There are four main categories of fears: animal, natural environments, medical, and situations. The yearly prevalence of specific phobia is 7-9%. Women are twice as likely than men to be affected. Specific phobia can develop after an individual experiences a traumatic event or witnesses another individual experiencing a traumatic event, but most indivduals with specific phobia are unable to recall a specific triggering event.

Agoraphobia and social phobia (social anxiety disorder) are considered to be complex phobias as they are more debilitating to the individual on a daily basis.

What does specific phobia look like?

Signs & Symptoms

An immediate feeling of intense fear, anxiety and panic when exposed to or even thinking about the source of your fear
Awareness that your fears are unreasonable or exaggerated but feeling powerless to control them
Worsening anxiety as the situation or object gets closer to you in time or physical proximity
Doing everything possible to avoid the object or situation or enduring it with intense anxiety or fear
Difficulty functioning normally because of your fear
Physical reactions and sensations, including sweating, rapid heartbeat, tight chest, or difficulty breathing
Feeling nauseated, dizzy, or fainting around blood or injuries
For children: tantrums, clinging, crying, or refusing to leave a parent's side or to approach their fear

DSM-5 Criteria

Criterion A. Marked fear or anxiety about a specific object or situation (e.g. flying, heights, animals, receiving an injection, seeing blood – the specific object or situation is called a phobic stimulus).

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.

Criterion B. The phobic object or situation almost always provokes immediate fear or anxiety.

Criterion C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.

Criterion 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.

Criterion E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

Criterion F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion 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 (agoraphobia)
Objects or situations related to obsessions (obsessive-compulsive disorder)
Reminders of traumatic events (post-traumatic stress disorder)
Separation from home or attachment figures (separation anxiety disorder)
Social situations (social anxiety disorder)

Specifiers

Specifiers:

Specify based on the phobia:
- Animal (e.g. spiders, insects, dogs)
- Natural environment (e.g. heights, storms, water)
- Blood-injection-injury (e.g. needles, invasive medical procedures)
- Situational (e.g. airplanes, elevators, enclosed places)
- Other (e.g. situations that may lead to choking or vomiting; in children, e.g. loud sounds or costumed characters)
Panic attacks
- Recurrent unexpected panic attacks. An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time at least 4 of the following symptoms occur (Note: The abrupt surge can occur from a calm state or an anxious state):
  - Sweating
  - Trembling or shaking
  - Unsteady, dizziness, light-headed, or feeling faint
  - Derealization (feelings of unreality) or depersonalization (being detached from one self)
  - Excessive/accelerated heart rate, palpitations, or pounding heart
  - Nausea or abdominal distress
  - Tingling, numbness, parathesesias
  - Shortness of breath
  - Fear of losing control or “going crazy”
  - Fear of dying
  - Choking feelings
  - Chest pain or discomfort
  - Chills or heat sensations

Risk Factors

First-degree relative with specific phobia
Adverse childhood experiences
Overprotective parenting
Parental loss or separation

Examples of Animal Phobias

Ailurophobia (fear of cats)
Arachnophobia (fear of spiders)
Cynophobia (fear of dogs)
Equinophobia (fear of horses)
Herpetophobia (fear of lizards/reptiles)
Murophobia (fear of mice)
Ophidiophobia (fear of snakes)
Scoleciphobia (fear of worms)
Zoophobia (fear of animals)

Examples of Environment Phobias

Acrophobia (fear of heights)
Astraphobia (fear of lightning)
Brontophobia (fear of thunder)
Nyctophobia (fear of darkness)
Pyrophobia (fear of fire)

Examples of Medical Phobias

Algophobia (fear of pain)
Belonephobia (fear of needles)
Mysophobia (fear of dirt/germs/contamination)
Thanatophobia (fear of death)

Examples of Situational Phobias

Claustrophobia (fear of closed spaces)
Ochophobia (fear of riding in a car)
Siderodromophobia (fear of railroads or train travel)
Taphophobia (fear of being buried alive)

Differential Diagnosis

Agoraphobia
Social anxiety disorder
Separation anxiety disorder
Panic disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder
Eating disorders
Schizophrenia spectrum and other psychotic disorders

How is specific phobia investigated?

Screening/Scale	Rater	Description
Phobia Questionnaire (PHQ)	Client	15-item questionnaire to measure avoidance to a particular object or situation as a factor of fear
Specific Phobia Questionnaire (SPQ)	Client	45-item questionnaire to assess the extent of fear and interference for a broad range of objects and situations
Fear Questionnaire (FQ)	Client	24-item scale to assess the degree of avoidance for phobias

How is specific phobia treated?

Exposure therapy

Nursing Management

Fear

Causes & Behaviors:

Phobic stimulus
Physiological symptoms - mental or cognitive behaviors indicative of panic
Behavior directed toward avoidance of a feared object or situation

Interventions:

Provide reassurance that the client is safe
Explore client’s perception of threat to physical integrity or threat to self-concept to help build an understanding of the the client's own condition so that they can work toward desensitization
Encourage the client to explore underlying feelings that may be contributing to irrational fears. Help client to understand that facing these feelings, rather than suppressing them, can result in more adaptive coping abilities
Discuss the process of thinking about the feared object/situation before it occurs, as anticipation of a future phobic reaction allows client to be prepared to deal with the physical manifestations of fear
Encourage the client to use relaxation techniques

References

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[3] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.