Saturday, January 30, 2010


A phobia is a marked and persistent fear resulting in conscious avoidance of a specific feared object, activity or a situation. The patient avoids the phobic stimulus, and this avoidance usually impairs his occupational or social functioning. The affected individual is aware that the experienced fear is excessive and unreasonable to the given circumstances, but cannot help it.

Agoraphobia is the fear of public places; the patient tries his best to avoid such places or situations where escape may be difficult. The patient avoids crowds, public places, traveling away from home or alone. Agoraphobia is usually associated with panic disorder, but there exists a subgroup without panic disorder.

Social phobia is the specific fear of social or performance situations in which the individual is exposed to unfamiliar individuals or to possible examination and evaluation by others. This is different from agoraphobia where the patient is not bothered about the reaction of other people. Examples include having to converse at a party, use public restrooms, and meet strangers.

Simple phobias are specific phobias not covered by social phobia and agoraphobia. It is further sub-divided into five types: animals, aspects of natural environment, blood/ injection/ injury, situational and ‘other’. Common examples of simple phobia are fear of heights, fear of closed spaces (claustrophobia), fear of flying, fear of animals, fear of lightning and thunderstorm, fear of darkness, fear of blood, fear of crossing streets, etc.

Aetiology and Psychopathology:
Both genetic and environmental factors play a role in the aetiology.According to psychoanalysis school, phobias are the result of traumatic experiences in childhood such as separation anxiety (separation from mother) and unconscious conflict, which has been repressed and displaced into phobic symptoms. The unconscious anxiety is displaced to a neutral object or activity or situation.

Clinical Manifestations:
Onset is typically in childhood to early adulthood. The cardinal feature of phobic disorders is severe anxiety when the patient is exposed to specific object or situation or activity. Both mental and somatic symptoms of anxiety are present. To prevent the onset of anxiety, the patient avoids these objects or situations or activities. Most of the patients are able to live normal lives in spite of the phobic disorder because the phobic object or situation or activity is easily avoidable, but this avoidance usually impairs occupational or social functioning.
Panic attacks may be triggered by the phobic stimulus or may emerge spontaneously during the course of the illness. To get relief from anxiety, the patient may resort to abuse of alcohol or drugs. He may also develop features of depression.

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