Related Subjects:
|Psychiatric Emergencies
|Depression
|Mania
|Schizophrenia
|Suicide
|Acute Psychosis
|Delusions
|General Anxiety Disorder
|Obsessive-Compulsive disorder
|Wernicke Korsakoff Syndrome
|Medically Unexplained symptoms
|Postpartum/Postnatal Depression
|Postpartum / Postnatal Psychosis
|Eating disorders in Children
|Anorexia Nervosa
|Phobic disorders
💡 About
- Phobias are a subset of anxiety disorders, defined as intense, irrational, and disproportionate fears of objects, situations, or phenomena.
- They cause significant avoidance behaviour and distress, impacting daily life and functioning.
📖 Definition
- Triggered by an object 🕷️ (e.g., spiders)
- Triggered by a situation ✈️ (e.g., flying, crowded places)
- Triggered by a phenomenon 🌩️ (e.g., thunder, lightning)
🔎 Types of Phobias
- Simple (Specific) Phobia:
Fear of a specific object/situation (e.g., animals, heights, injections). Often underreported, usually limited to one trigger.
- Social Phobia (Social Anxiety Disorder):
Fear of being judged or negatively evaluated by others.
👉 Symptoms: blushing, trembling, sweating, stammering.
👉 Some use alcohol for "Dutch courage."
👉 Equal prevalence in men and women.
👉 Treatment: CBT, graded exposure, SSRIs; MAOIs may help in resistant cases.
- Agoraphobia:
Fear of leaving a "safe space" → avoidance of public places, often housebound.
👉 May trigger panic attacks.
👉 More common in women.
👉 Often chronic and disabling.
👉 Treatment: relaxation, antidepressants, structured graded exposure programs.
🧬 Aetiology
- Genetic predisposition (family clustering).
- Learned behaviours (classical conditioning, observation of others).
- Overactive amygdala and sympathetic nervous system response.
🩺 Clinical Features
- Severe anxiety upon thinking about/encountering the trigger.
- Somatic symptoms of anxiety: palpitations, sweating, tremor, dyspnoea.
- Panic attacks in severe cases.
- Avoidance behaviour to reduce distress (can be very disabling).
🔬 Investigations
- Usually clinical diagnosis – no formal tests required.
- Screen for co-morbidities (depression, other anxiety disorders, substance misuse).
💊 Management
- CBT (Gold Standard): Corrects maladaptive thoughts & behaviours, combined with graded exposure therapy.
- Exposure Therapy (Systematic Desensitisation): Stepwise exposure to trigger → from imagery to real-life situations.
- Relaxation & Mindfulness: Breathing control, progressive muscle relaxation.
- Medication (adjunct only):
- SSRIs (esp. in social anxiety disorder, agoraphobia).
- Benzodiazepines – short-term use in unavoidable acute settings (e.g., fear of flying).
- Beta-blockers (e.g., propranolol) – reduce somatic symptoms like palpitations.
📋 Exam Tips
✅ Phobias are common in OSCE psychiatry stations – always ask about avoidance, functional impairment, and coping mechanisms.
✅ Management = CBT + exposure first line.
✅ Drugs are adjuncts, not curative.
✅ Social phobia often confused with shyness → key differentiator is functional impairment.
