Case 3 specific phobia
1. Dsm criteria specific phobia
-
2. Epidemiology
- 41% to 50% of the general population experience specific fears during their lifetime
- Situational phobias are the most common, followed by natural environment, animal,
and BII (blood-injection-injury) phobias
- fear of heights was the most common specific phobia
- specific phobias are more common among adolescents and less common among older
adult populations. Among adolescents, the lifetime prevalence varies from rates of 22,
18, and 18% at ages 13–14, 15–16, and 17–18. Among adults, lifetime prevalence
varies from 13, 14, and 14%, at ages 18–29, 30–44, and 45– 59, and rates of 9, 5, 4,
and 5% at ages 55–64, 65–74, 75–84, and greater than 84 years old.
- The rates of specific phobia are also higher among females compared to males
- Animal and BII phobias tend to onset earlier than natural environment and situational
phobias
- phobias tend to be chronic and rarely (16%) remit without intervention
- the natural course for the average specific phobia involves early onset, a chronic
course, and severity in the mild to moderate range. However, the age of onset and
chronicity vary as a function of subtype
- impairment
1
, o impairment significantly grows with the number of fears
o those with comorbid major depressive disorder (MDD) and specific phobia
reported impairments across multiple domains of quality of life as compared to
those with a singular diagnosis of MDD.
o all subtypes were associated with greater interference in daily and social
functioning relative to the general population
o situational phobias, in general, and the fear of being alone, specifically, were
associated with the most interference, the highest probability of seeking
professional help, and the highest use of medication.
o individuals with BII phobia are less likely to pursue some medical treatments
which may have a negative impact on their overall health
3. Comorbidity
- the likelihood of specific phobia appears to be greater given the presence of another
anxiety disorder. These data suggest that a phobia is more likely to be “secondary” to
other such disorders
- significant positive correlations between specific phobia and manic/hypomanic
episodes, oppositional defiant disorder, attention deficit hyperactivity disorder,
intermittent explosive disorder, and alcohol dependence.
- when the principal diagnosis was simple phobia in outpatients, the likelihood of any
personality disorder was 12%. among applicants to an inpatient unit specializing in
treatment of personality disorders, in those with a principal diagnosis of a personality
disorder the likelihood of simple phobia was 7%.
- diagnosed with borderline personality disorder, the co-occurrence of simple phobia
was 31.7%
- the presence of specific phobia does not increase the likelihood of personality disorder
over the base rate, with the exception of avoidant, dependent, and borderline disorders.
However, the findings of Zanarini and colleagues indicate the presence of borderline
disorder appears to increase the likelihood of specific phobia over the base rate. These
data make it difficult to judge whether specific phobia is a primary or secondary
disorder relative to personality disorder.
- as a whole 70% of patients with a specific phobia diagnosis had a comorbid anxiety or
mood disorder. The comorbidity rate, however, dropped to 33% among a subset of
patients for whom specific phobia was the principal diagnosis. In other words, whether
specific phobia is the principal (i.e., the most severe) disorder or not covaries strongly
with the level of functional impairment
-
2
1. Dsm criteria specific phobia
-
2. Epidemiology
- 41% to 50% of the general population experience specific fears during their lifetime
- Situational phobias are the most common, followed by natural environment, animal,
and BII (blood-injection-injury) phobias
- fear of heights was the most common specific phobia
- specific phobias are more common among adolescents and less common among older
adult populations. Among adolescents, the lifetime prevalence varies from rates of 22,
18, and 18% at ages 13–14, 15–16, and 17–18. Among adults, lifetime prevalence
varies from 13, 14, and 14%, at ages 18–29, 30–44, and 45– 59, and rates of 9, 5, 4,
and 5% at ages 55–64, 65–74, 75–84, and greater than 84 years old.
- The rates of specific phobia are also higher among females compared to males
- Animal and BII phobias tend to onset earlier than natural environment and situational
phobias
- phobias tend to be chronic and rarely (16%) remit without intervention
- the natural course for the average specific phobia involves early onset, a chronic
course, and severity in the mild to moderate range. However, the age of onset and
chronicity vary as a function of subtype
- impairment
1
, o impairment significantly grows with the number of fears
o those with comorbid major depressive disorder (MDD) and specific phobia
reported impairments across multiple domains of quality of life as compared to
those with a singular diagnosis of MDD.
o all subtypes were associated with greater interference in daily and social
functioning relative to the general population
o situational phobias, in general, and the fear of being alone, specifically, were
associated with the most interference, the highest probability of seeking
professional help, and the highest use of medication.
o individuals with BII phobia are less likely to pursue some medical treatments
which may have a negative impact on their overall health
3. Comorbidity
- the likelihood of specific phobia appears to be greater given the presence of another
anxiety disorder. These data suggest that a phobia is more likely to be “secondary” to
other such disorders
- significant positive correlations between specific phobia and manic/hypomanic
episodes, oppositional defiant disorder, attention deficit hyperactivity disorder,
intermittent explosive disorder, and alcohol dependence.
- when the principal diagnosis was simple phobia in outpatients, the likelihood of any
personality disorder was 12%. among applicants to an inpatient unit specializing in
treatment of personality disorders, in those with a principal diagnosis of a personality
disorder the likelihood of simple phobia was 7%.
- diagnosed with borderline personality disorder, the co-occurrence of simple phobia
was 31.7%
- the presence of specific phobia does not increase the likelihood of personality disorder
over the base rate, with the exception of avoidant, dependent, and borderline disorders.
However, the findings of Zanarini and colleagues indicate the presence of borderline
disorder appears to increase the likelihood of specific phobia over the base rate. These
data make it difficult to judge whether specific phobia is a primary or secondary
disorder relative to personality disorder.
- as a whole 70% of patients with a specific phobia diagnosis had a comorbid anxiety or
mood disorder. The comorbidity rate, however, dropped to 33% among a subset of
patients for whom specific phobia was the principal diagnosis. In other words, whether
specific phobia is the principal (i.e., the most severe) disorder or not covaries strongly
with the level of functional impairment
-
2
