CHILD PHOBIAS DEFINITION
A phobia is an overwhelming and unreasonable fear of an object or situation that poses little real danger but provokes anxiety and avoidance. Unlike the brief anxiety most people feel when they give a speech or take a test, a phobia is long lasting, causes intense physical and psychological reactions, and can affect your ability to function normally at work or in social settings.
Several types of phobias exist. Some people fear large, open spaces. Others are unable to tolerate certain social situations. And still others have a specific phobia, such as a fear of snakes, elevators or flying.
Not all phobias need treatment. But if a phobia affects your daily life, several therapies are available that can help you overcome your fears — often permanently.
CHILD PHOBIAS CAUSES
A phobia is an irrational fear, a kind of anxiety disorder in which the sufferer has a relentless dread of a situation, living creature, place or thing.
Individuals with a phobia go to great lengths to avoid a perceived danger which is much greater in their minds than in real life. If confronted with the source of their phobia, the person will suffer enormous distress, which can interfere with their normal function; it can sometimes lead to total panic. For some people, even thinking about their phobia is immensely distressing.
A phobia starts when a person begins organizing their lives around avoiding the object of their fear. A phobia is much more serious than a simple fear. Sufferers have an overpowering need to steer clear of anything which triggers their anxiety.
If the phobia is of something the phobic person very rarely comes into contact with, such as snakes, their daily lives will not be affected. However, some complex phobias are impossible to avoid, such as agoraphobia (fear of leaving home or public places) or social phobia (fear of being among groups of people).
Non-psychological phobias – photophobia means sensitivity to light. For example, if you have conjunctivitis or a migraine your eyes may be particularly sensitive to light. This does not mean the person is afraid of light. One of the symptoms of rabies is hydrophobia, which is the inability to drink water.
CHILD PHOBIAS PATHOPHYSIOLOGY
Several biologic theories are postulated for the pathogenesis of phobic disorders, most focusing on the dysregulation of endogenous biogenic amines. Sympathetic nervous system activation is common in phobic disorders, resulting in elevations in heart rate and blood pressure, as well as symptoms such as tremor, palpitations, sweating, dyspnea, dizziness, and paresthesias.
Psychological theories range from explaining anxiety as a displacement of an intrapsychic conflict (psychodynamic models) to conditioning (learned) paradigms (cognitive-behavior models). Many of these theories capture portions of the disorder.
A psychoanalyst would likely conceptualize social anxiety as a symptom of a deeper conflict—for instance, low self-esteem or unresolved conflicts with internal objects. The treatment uses exploration with the goal of understanding the underlying conflict.
A behaviorist would see phobia as a learned, conditioned response resulting from a past association with a situation that had negative emotional valence at the time of association (eg, social situations are avoided because intense anxiety was originally experienced in that setting). Even if no danger is posed in most social encounters, an avoidance response has been linked to these situations. Treatment from this perspective aims to weaken and eventually separate the specific response from the stimulus.
Genetic factors seem to play a role in both social anxiety disorder (social phobia) and specific phobia. On the basis of family and twin studies, the risks for specific phobia and social anxiety disorder appear to be moderately heritable.
Preliminary neuroimaging evidence indicates that while different patterns of brain activation might be associated with the different phobias, there is an overall increased activation in the prefrontal and orbitofrontal cortex, anterior cingulate cortex, insula, and amygdala in phobic patients exposed to phobia-related triggers compared with healthy controls.
CHILD PHOBIAS SYMPTOMS
Phobias are divided into three main categories:
- Specific phobias. A specific phobia involves an irrational, persistent fear of a specific object or situation that’s out of proportion to the actual risk. This includes a fear of situations (such as airplanes or enclosed spaces); nature (such as thunderstorms or heights); animals or insects (such as dogs or spiders); blood, injection or injury (such as knives or medical procedures); or other phobias (such as loud noises or clowns). There are many other types of specific phobias. It’s not unusual to experience phobias about more than one object or situation.
- Social phobia. More than just shyness, social phobia involves a combination of excessive self-consciousness and a fear of public scrutiny or humiliation in common social situations. In social situations, the person fears being rejected or negatively evaluated or fears offending others.
- Fear of open spaces (agoraphobia). This is a fear of an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line or being in a crowd, or being outside the home alone. The anxiety is caused by fearing no easy means of escape or help if intense anxiety develops. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to fear another attack and avoid the place where it occurred. For some people, agoraphobia may be so severe that they’re unable to leave home.
No matter what type of phobia you have, it’s likely to produce the following reactions:
- A feeling of uncontrollable panic, terror or dread when you’re exposed to the source of your fear
- The feeling that you must do everything possible to avoid what you fear
- The inability to function normally because of your anxiety
- Physical as well as psychological reactions, including sweating, rapid heartbeat, difficulty breathing, a feeling of panic and intense anxiety
- Often, the knowledge that your fears are unreasonable or exaggerated but feeling powerless to control them
- In some cases, anxiety just thinking about what you fear
- In children, possibly tantrums, clinging or crying
CHILD PHOBIAS DIAGNOSIS
There is no diagnostic laboratory test for phobias. Diagnosis is based on the patient’s account of their experiences. The American Psychiatric Association provides criteria for the diagnoses of agoraphobia, social phobia, and specific phobia in the Diagnostic and Statistical Manual of Mental Disorders.
- Diagnostic Criteria For Agoraphobia
o The person experiences anxiety about being trapped in places or situations that might be difficult or embarrassing or that might trigger a panic attack.
o Situations are avoided or endured with great distress or anxiety about having a panic attack.
o Avoidance is not caused by another disorder such as social phobia, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, or separation anxiety.
- DIAGNOSTIC CRITERIA FOR SOCIAL PHOBIA
o The person fears or is anxious about experiencing public embarrassment or humiliation in social or performance situations.
o Being in such situations creates intense anxiety and possibly a panic attack.
o The person knows that the fear is excessive and irrational.
o Social or performance situations are avoided or endured with great distress.
o The condition disrupts their ability to function at work or school and causes them to withdraw from social activities and/or relationships, or the fact that they have the phobia causes them distress.
o The condition persists for at least 6 months in people over the age of 18.
o Fear and avoidance are not caused by other mental disorders, a medical condition, or the effects of a drug.
- Diagnostic Criteria For Specific Phobia
o The person experiences excessive or irrational fear of a specific object or situation.
o Exposure to the object or situation causes an immediate anxiety response or a panic attack.
o The person knows that the fear is excessive and irrational.
o The object or situation is endured with distress or avoided.
o Avoidance, anticipatory anxiety, or distress during exposure to the feared object or situation interferes with the person’s ability to function in normal daily activities. The person may have distress about having the phobia.
CHILD PHOBIAS TREATMENT
Your doctor or a mental health provider may suggest medications or behavior therapy or both to treat phobias. Most adults don’t get better on their own and may require some type of treatment. The goal of phobia treatment is to reduce your anxiety and fear and to help you better manage your reactions to the object or situation that causes them.
Medications can help control the anxiety and panic from thinking about or being exposed to the object or situation you fear.
- Beta blockers. These medications work by blocking the stimulating effects of adrenaline on your body, such as increased heart rate, elevated blood pressure, pounding heart, and shaking voice and limbs that are caused by anxiety. Short-term use of beta blockers can be effective in decreasing symptoms when taken before an anticipated event, for example, before a performance for people who have severe stage fright.
- Antidepressants. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are commonly used in the treatment of phobias. These medications act on the chemical serotonin, a neurotransmitter in your brain that’s believed to influence mood. As an alternative, your doctor may prescribe another type of antidepressant, depending on your situation.
- Sedatives. Medications called benzodiazepines help you relax by reducing the amount of anxiety you feel. Sedatives need to be used with caution because they can be addictive and should be avoided if you have a history of alcohol or drug dependence.
Talking with a trained mental health professional can help you deal with your phobias.Several types of psychotherapy, also called talk therapy, may be effective.
- Desensitization or exposure therapy focuses on changing your response to the object or situation that you fear and may be helpful for phobias. Gradual, repeated exposure to the cause of your phobia may help you learn to conquer your anxiety. For example, if you’re afraid of elevators, your therapy may progress from simply thinking about getting into an elevator, to looking at pictures of elevators, to going near an elevator, to stepping into an elevator. Next, you may take a one-floor ride, then ride several floors and then ride in a crowded elevator.
- Cognitive behavioral therapy involves exposure combined with other techniques to learn ways to view and cope with the feared object or situation differently.You learn alternative beliefs about your fears and the impact they have on your life. There’s special emphasis on learning to develop a sense of mastery and control of your thoughts and feelings.
Treatment depends on the type of phobia you have:
- Specific phobias usually are treated with exposure therapy.
- Social phobias may be treated with exposure therapy or with antidepressants or beta blockers.
- Agoraphobia, especially when it’s accompanied by a panic disorder, is usually treated with exposure therapy or with SSRIs.