Phobias
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Introduction
Excessive dear of a specific object or situation
can have anxiety
Social phobia is a "marked and persistent fear of one or more social or performance situations with exposure to unfamiliar people or scrutiny of others".
It is the most common anxiety disorder of adults, with about 13%. Its onset is usually in med adolesence, with a prevalence of 2-8%.
Social phobia is underrecognized and treated by family doctors.
- can have generalized or performance type
- must interfere with daily function
- present for more than 6 months
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Pathophysiology
Social phobia can lead to significant co-morbidities, including depresison, other anxiety disorders, alcohol and substance abuse, and eating disorders.
learning
Signs and Symptoms
- history
- physical exam
History
- fear of unfamiliar people or situations
- person recognizes situation is unreasonable or excessive
Commonly feared situations include:
- public speaking
- eating, drinking, or writing in front of others
- using public restrooms
- speaking on the telephone and at social gatherings
Avoidance, anticipation, and distress significantly interferes with social/occupational/academic functioning.
Somatic complaints can include:
- insomnia or fatigue
- palpitations, chest pain, shortness of breath
- dizziness, trembling hands
- sweating, blushing
- GI complaints
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
- Medications
- Psychosocial Therapy
Medications
MAOIs, anxiolytics, and SSRIs can be used. SSRIs are becoming the drug of choice due to effectiveness and lack of side effects.
Psychosocial Therapy
A behavioural approach is the best for specific phobia. Exposure therapy, cognitive restructuring, and social skills training to decrease anxiety and avoidance.
CBT looks at how thoughts, feelings, and actions are connected, and focuses on changing thoughts and actions through 'homework'. For anxiety, key tasks include explosing oneself to the feared situation or thought.
Teaching the patient to accept uncertainty is another key concept.
Psychoeducation
Consequences and Course
Resources and References
Topic Development
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