Diagnosis Of Phobia Research Articles

Publicly Available Online Educational Videos Regarding Pediatric Needle Pain

The objectives of this scoping review were to: (1) identify publicly available educational videos on needle pain management; and (2) evaluate the content of these videos. Reviewers screened publicly available educational videos on pediatric needle pain management available on YouTube and Google using a broad-based search strategy. Videos were categorized using the CRAAP Test: Current, Relevant, from a trustworthy source (Authority), Accurate and evidence-based, and for what Purpose does the source exist. Twenty-five relevant, educational videos were identified. The intended audience for most videos was parents (n=16, 64%), followed by clinicians (n=6, 24%) and children (n=3, 12%). Common examples of needle pain included immunizations or IV insertion, with interventions appropriate for infants through school-aged children. The most frequently described techniques were parent-guided distraction and behavioral factors such as comfort holds and parent demeanor. Most videos were Current (96%), Relevant (100%), created by a trustworthy source: Authority (76%), and all were Accurate, with Purpose relating to needle pain management. None of the videos addressed the unique needs of children with a preexisting diagnosis of needle phobia. Publicly available educational videos offer clinicians, parents, and children evidence-based techniques to manage pediatric needle pain. Further evaluation is needed to determine whether this form of education meets the needs of target audiences and whether this type of content can lead to improved management of pediatric needle pain.

Treating nighttime fears in young children with bibliotherapy: Evaluating anxiety symptoms and monitoring behavior change

ObjectiveChildren's nighttime fears are a normal part of child development and are transient for most children, but result in considerable distress for others. The present study evaluated a 4-week bibliotherapy intervention designed to treat young children with persistent and interfering nighttime fears utilizing a multiple baseline design. MethodNine children between 5 and 7 years of age with specific phobia diagnoses were randomized into one of three baseline control conditions (1, 2, or 3 weeks). The treatment protocol involved parents reading Uncle Lightfoot, Flip that Switch: Overcoming Fear of the Dark, Academic Version (Coffman, 2012) with their children over 4 weeks while engaging in activities prescribed in the book. Assessments took place at baseline, post treatment, and 1 month following treatment. Daily and weekly tracking of nighttime behaviors was also obtained. ResultsPre-post group analyses revealed that eight of the nine children demonstrated clinically significant change in anxiety severity. In addition, decreases in child-reported nighttime fears were observed, as were parent-reported decreases in separation anxiety and increases in the number of nights children slept in their own bed. ConclusionsThe present study provides initial support for the use of bibliotherapy in the treatment of nighttime fears. Further replication and evaluation are needed to determine appropriate length of treatment and long-term effects. Implications of the findings are discussed.

The Efficacy of Self-Report Measures in Predicting Social Phobia in African American Adults

Empirical literature pertaining to anxiety in African Americans has been relatively sparse. More recent studies indicate that the construct of social fear is different in African Americans than in non-Hispanic Whites. Although some of these studies have examined factor structure utilizing self-report measures of anxiety in African American samples, none to date have examined the clinical utility of these measures in predicting anxiety diagnoses, particularly social phobia. A total of sixty-five African American adults from the community completed the Fear Survey Schedule-Second Edition (FSS-II), Social Anxiety Interaction Scale (SIAS), Social Phobia Scale (SPS), and Albany Panic and Phobia Questionnaire (APPQ). The Anxiety Disorder Interview Schedule-Fourth Edition (ADIS-IV) was administered to all participants to specify differential diagnoses of anxiety and related disorders. Twenty-three African American adults were diagnosed with social phobia leaving 42 diagnostic controls. Results suggest that the social anxiety factors were highly predictive of a social phobia diagnosis (AUC=.84 to .90; CI .73-.98, p<.01) and sensitivity and specificity rates revealed optimal cutoff scores for each measure. The optimal cutoff scores reveal the clinical utility of the social fear factor from these measures in screening for social phobia in African Americans. Future direction and implications are discussed. Publication indicesPsychinfo, PubMed, Medline

Delaying in vivo exposure to a tarantula with very brief exposure to phobic stimuli

Background and objectivesResearch has documented the very brief exposure (VBE) effect: the reduction of phobic fear by continuous presentation of masked phobic pictures. In prior studies, phobic participants approached a live tarantula immediately after the masked stimuli were presented. This study tested the hypothesis that VBE would reduce phobic avoidance of the tarantula 24 h later. Method86 spider-phobic participants were identified with a fear questionnaire and Behavioral Avoidance Test (BAT) with a live tarantula indicative of a DSM-IV diagnosis of Specific Phobia. One week later, they were randomly assigned in double-blind fashion to presentation of a continuous series of 25 trials of masked images of either spiders or flowers (33-ms each), i.e., to VBE or control exposure. The participants gave subjective distress ratings just before and after these exposures. Then they engaged in the BAT again either immediately thereafter or 24 h later to measure changes in avoidance of the tarantula. ResultsMasked images of spiders reduced avoidance of the tarantula both immediately after exposure and 24 h later without causing subjective distress. The effect sizes at these two time points did not significantly differ from each other. LimitationsWe did not manipulate awareness of the spider images by presenting them unmasked to a third group. Conclusions about the effect of awareness of the stimuli cannot be drawn. ConclusionsVBE induces a process of fear reduction before phobic individuals engage in in vivo exposure, which is more distressing. Thus, VBE may help phobic-resistant individuals start treatment more gradually.

Clinical implications of panic symptoms in dental phobia

The occurrence of panic symptoms in various anxiety disorders has been associated with more severely impaired and difficult-to-treat cases, but this has not been investigated in dental phobia. We examined the clinical implications of panic symptoms related to sub-clinical and clinically significant dental phobia. The sample consisted of 61 patients at a university dental clinic who endorsed symptoms of dental phobia, 25 of whom met criteria for a formal diagnosis of dental phobia. Participants with dental phobia endorsed more panic symptoms than did those with sub-clinical dental phobia. In the total sample, greater endorsement of panic symptoms was associated with higher dental anxiety, more avoidance of dental procedures, and poorer oral health-related quality of life. Among those with dental phobia, certain panic symptoms exhibited associations with specific anxiety-eliciting dental procedures. Panic symptoms may serve as indicators of clinically significant dental phobia and the need for augmented treatment.

Effects of corrective surgery on social phobia, psychological distress, disease-related disability and quality of life in adult strabismus patients

BackgroundCorrective surgery is done for ocular alignment and disrupted facial expression in some cases of adult strabismus patients. The effects of corrective surgery on the presence of social phobia (SP)...

Psychometric properties of the Social Phobia and Anxiety Inventory-Child version in a Swedish clinical sample

The Social Phobia and Anxiety Inventory for Children (SPAI-C) is a 26 item, empirically derived self-report instrument developed for assessing social phobic fears in children. Evidence for satisfactory psychometric properties of the SPAI-C has been found in multiple community studies. Since its development, however, no study has presented an extensive psychometric evaluation of SPAI-C in a sample of carefully diagnosed children with social phobia. The present study sought to replicate and expand previous studies by administrating the SPAI-C to a sample of 59 children that fulfilled DSM-IV criteria for social phobia, and 49 children with no social phobia diagnosis. An exploratory factor analysis resulted in a three factor solution reflecting: (1) fear of social interactions, (2) fear of public performance situations, and (3) physical and cognitive symptoms connected with social phobia. These factors appear to parallel domains of social phobia also evident in adults. The SPAI-C total scale and each factor was found to possess good internal consistency, good test–retest reliability and was generally strongly correlated with both self-report and clinician measures of anxiety and fears. The discriminative properties of the total scale were satisfactory.

Cognitive behavioral therapy for youth with social anxiety: Differential short and long-term treatment outcomes

This study examined social anxiety symptoms and/or diagnosis as a predictor of differential short- and long-term cognitive-behavioral treatment (CBT) outcomes. Ninety-one anxiety-disordered youth participated in a randomized clinical trial of CBT. Semi-structured interviews provided dimensional clinical severity ratings (CSRs) for children's principal anxiety disorder at pretreatment, posttreatment, 1-year and 7.4-year follow-up assessments for youth with versus without pretreatment social anxiety. Thirty-nine youth presented with either principal (n=17), secondary (n=11), or tertiary social phobia diagnoses (n=7) or subclinical social anxiety symptoms (n=4). Hierarchal linear modeling (HLM) indicated that youth made similar gains from pretreatment to posttreatment and 1-year follow-up regardless of their social anxiety symptoms or diagnosis; however, youth with social anxiety symptoms or diagnosis were significantly less improved at 7.4-year follow-up. This pattern was distinct from that of youth with the most severe (CSR=4) principal anxiety disorders at pretreatment. Though initially responsive to CBT, children who present with social anxiety diagnoses or symptoms may require an enhanced or extended treatment to maintain their gains into young adulthood whether or not social anxiety is considered their principal childhood difficulty.

Internet-Delivered CBT for Children with Specific Phobia: A Pilot Study

Background: Cognitive behavior therapy (CBT) has been shown to be an effective treatment for specific phobia in youth, but not all affected seek or receive treatment. Internet-delivered CBT could be a way to increase the availability of empirically supported treatments. Aims: An open trial was conducted to evaluate Internet-delivered CBT for children with specific phobia. Method: Children (N = 30) aged 8–12, and their parents, with a principal diagnosis of specific phobia were recruited through media advertisement. Participants received six weeks of Internet-delivered CBT with therapist support. The treatment was aimed for the parents and the children, with the first part being only for the parents. The primary outcome measure was the Clinician Severity Rating (CSR), and secondary measures included clinician-rated global functioning and child- and parent-reported anxiety and quality of life. All assessments were made at pretreatment, posttreatment, and three-month follow-up. Results: At posttreatment, there were significant reductions on the CSR, with a large within-group effect size (Cohen's d = 1.0) and 35% of children no longer meeting criteria for specific phobia. Self-report measures from parents and children showed significant effects on anxiety, with small to moderate effect sizes. Effects were maintained at three-month follow-up. Conclusions: Results show that Internet-delivered CBT with therapist support for children with specific phobia has the potential to reduce symptom severity. Randomized controlled trials are needed to further evaluate this treatment format.

Are male and female responses to social phobia diagnostic criteria comparable?

Females typically report higher social phobia levels than males in community samples, and this may be due to sex bias in assessment measures. This study aims to establish whether patterns of responding to social phobia diagnostic criteria in the Composite International Diagnostic Interview (CIDI) are comparable across males and females. A subsample of participants in the Australian National Survey of Mental Health and Wellbeing (1997) reporting at least one social fear were selected (n = 1755). Analyses were conducted using a series of multi-group confirmatory factor analyses for categorical data, with unique steps to model invariance of residual variances. Partial, but not full, invariance was established, as males and females differed in their responses to items assessing physical anxiety symptoms at low levels of social fear. Whilst these differences were statistically significant, they are likely not to affect clinical practice or rates of social phobia diagnosis. This supports differences on this measure being interpreted as genuine, and strengthens findings females are more vulnerable to social phobia than males.

A Screening Tool for Social Anxiety Disorder in Primary Care

There is little research from low- and middle-income countries examining the psychometric properties of a screening tool for social anxiety disorder. The sensitivity and specificity of the Social Anxiety Screening Questionnaire against the Mini-International Neuropsychiatric Interview as a gold standard in social phobia diagnosis were investigated using analyses of receiver operating characteristics. The "best subsets" selection procedure was conducted to determine the best three to five questions. Three questions on the screening questionnaire that best discriminate between a positive and negative diagnosis of social anxiety disorder on the MINI module were identified. Answering yes to all three of these questions gives a false-positive rate of 0.44 and a false negative rate of 0.11. For this combination, the sensitivity was 0.84, and specificity was 0.67. Additional work is needed to develop a more accurate scale that could help increase the percentage of people who receive appropriate treatment of this debilitating disorder.

Adaptation and psychometric properties of the Spanish version of the Index of Dental Anxiety and Fear (IDAF-4C+).

The Index of Dental Anxiety and Fear (IDAF-4C+) constitutes a theory-grounded, reliable and valid instrument, which, due to its modular structure, allows different uses such as assessing dental anxiety levels, establishing preliminary dental phobia diagnoses and identifying feared stimuli. This study aimed to develop a Spanish version of the original IDAF-4C+ and evaluate its psychometric properties. A sample of 231 Spanish undergraduate students (70.6% female; mean age 21.4 years) completed a questionnaire comprising the Spanish version of the IDAF-4C+ and other measures related to dental anxiety. The structure, reliability and validity of the adapted IDAF-4C+ were analysed. The adapted IDAF-4C fear module yielded a single-factor structure and demonstrated good internal consistency (Cronbach's alpha) and test-retest reliability. It shared a greater amount of variance with phobia diagnoses than the Modified Dental Anxiety Scale (MDAS) and a single-item measure of dental fear (SIDF). Moreover, the IDAF-4C was moderately to highly correlated with the MDAS and the SIDF measure, as well as with variables connected with dental anxiety such as negative dental thoughts, having had a negative dental experience and negative affect. The frequency of dental visits was also linked to IDAF-4C scores, and IDAF-stimulus items involving cognitive vulnerability, interpersonal and cost concerns were associated with dental attendance. The Spanish version of IDAF-4C+ presents similar psychometric properties to the original version which, considering the advantages of this instrument, qualifies the adapted one for its use in different research and applied contexts.

The impact of comorbid cannabis use disorders on the clinical presentation of social anxiety disorder

Previous research has examined the relationship between social anxiety disorder (SAD) and substance use disorders. Cannabis use disorders (CUDs) are becoming increasingly problematic within the population of individuals with SAD, yet the nature of this comorbidity remains largely unexamined. The aim of the current study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine differences between outpatients with SAD with versus without comorbid CUDs. The current study included 873 outpatients with a current diagnosis of SAD. Patients with SAD and comorbid CUDs (n = 173) were then compared to those with SAD without CUDs (n = 700) on demographic and clinical characteristics. Compared to patients without the comorbidity, patients with comorbid SAD and CUDs were more likely to have a lifetime diagnosis of PTSD and specific phobia and lifetime substance use disorders (including alcohol). SAD patients with comorbid CUDs were also more likely to report better physical health, and fewer limitations related to their physical health. These analyses remained significant after controlling for gender, the presence of other substance use disorders, mood disorders, and other anxiety disorders. Findings of this study suggest that there may be a unique relationship between SAD and CUDs that can potentially impact the clinical presentation of individuals with SAD. Future research is needed to examine the impact of this comorbidity in other patient populations.

High social phobia frequency and related disability in patients with acne vulgaris

Acne is an easily recognizable abnormality which may cause some adverse psychosocial consequences. We aimed to determine the social phobia frequency, social anxiety level, and disease related disability in a group of acne vulgaris patients. One-hundred and forty acne vulgaris patients and 98 healthy control subjects were included in the study. Acne severity was determined by the Global Acne Grading System (GAGS). A psychiatrist interviewed each participant and the Liebowitz Social Anxiety Scale (LSAS) was administered to all participants, who also completed the Hospital Anxiety and Depression Scale (HADS) and Sheehan Disability Scale (SDS). Social phobia was diagnosed in 45.7% of acne vulgaris patients and in 18.4% of control subjects. Acne vulgaris patients demonstrated higher performance avoidance and total avoidance scores in LSAS than controls. Acne vulgaris patients without social phobia had higher scores in HADS and LSAS than the acne vulgaris patients with social phobia. They were more disabled in their occupational, social, and familial lives. Social phobia diagnosis predicted disability at work, whereas education level predicted the disability in family life of acne vulgaris patients. Social phobia seems to be a common psychiatric comorbidity which may give rise to some additional disability among acne vulgaris patients.

The epidemiology of specific phobia and subthreshold fear subtypes in a community-based sample of older adults

Specific phobias have received little attention among older adults. This study is aimed at determining the 12-month prevalence rates of fear subtypes in older adults with a full or subthreshold DSM diagnosis of specific phobia as well as to examine differences among these conditions according to health and health behavior characteristics potentially associated with the severity of anxious symptoms. Data came from a representative sample of community-dwelling older adults aged 65 years and older (N = 2784). Diagnoses were established by in-home semi-structured interviews. DSM-IV criteria for specific phobia were slightly modified in line with recommendations for DSM-V. The 12-month prevalence rates of specific phobias and subthreshold fears were, respectively, 2.0 and 8.7%. More than half of the respondents with a specific phobia did not recognize the "excessiveness" of their fears. Situational and natural environment fears were the most frequent subtypes. Compared to respondents with no symptoms of anxiety, older adults with a full- or subthreshold-specific phobia reported more chronic physical health problems, more comorbid depressive disorders and a higher use of benzodiazepines. However, older adults with specific phobia reported more comorbid anxiety disorders than respondents with subthreshold fears. The present study provides evidence for the fact that subthreshold fears have a high prevalence among older adults. Since several older people with specific phobia do not recognize the "excessiveness" of their fears, it is recommended that DSM-V criteria allow clinicians to rely on their own judgment to assess whether the perceived danger is out of proportion.

The structure of genetic and environmental risk factors for phobias in women

To explore the genetic and environmental factors underlying the co-occurrence of lifetime diagnoses of DSM-IV phobia. Female twins (n=1430) from the population-based Norwegian Institute of Public Health Twin Panel were assessed at personal interview for DSM-IV lifetime specific phobia, social phobia and agoraphobia. Comorbidity between the phobias were assessed by odds ratios (ORs) and polychoric correlations and multivariate twin models were fitted in Mx. Phenotypic correlations of lifetime phobia diagnoses ranged from 0.55 (agoraphobia and social phobia, OR 10.95) to 0.06 (animal phobia and social phobia, OR 1.21). In the best fitting twin model, which did not include shared environmental factors, heritability estimates for the phobias ranged from 0.43 to 0.63. Comorbidity between the phobias was accounted for by two common liability factors. The first loaded principally on animal phobia and did not influence the complex phobias (agoraphobia and social phobia). The second liability factor strongly influenced the complex phobias, but also loaded weak to moderate on all the other phobias. Blood phobia was mainly influenced by a specific genetic factor, which accounted for 51% of the total and 81% of the genetic variance. Phobias are highly co-morbid and heritable. Our results suggest that the co-morbidity between phobias is best explained by two distinct liability factors rather than a single factor, as has been assumed in most previous multivariate twin analyses. One of these factors was specific to the simple phobias, while the other was more general. Blood phobia was mainly influenced by disorder specific genetic factors.

Psychiatric diagnoses in patients who screen positive on the Mood Disorder Questionnaire: Implications for using the scale as a case-finding instrument for bipolar disorder

Bipolar disorder is prone to being overlooked because its diagnosis is more often based on retrospective report than cross-sectional assessment. Recommendations for improving the detection of bipolar disorder include the use of screening questionnaires. The Mood Disorder Questionnaire (MDQ) is the most widely studied self-report screening scale that has been developed to improve the detection of bipolar disorder. Although developed as a screening scale, the MDQ has also been used as a case-finding measure. However, studies of the MDQ in psychiatric patients have found high false positive rates, though no study has determined the psychiatric diagnoses associated with false positive results on the MDQ. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to identify the psychiatric disorders associated with increased false positive rates on the MDQ. Four hundred eighty psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) and completed the MDQ. After excluding the 52 patients diagnosed with a lifetime history of bipolar disorder we compared diagnostic frequencies in patients who did and did not screen positive on the MDQ. Based on the Hirschfeld et al. scoring guidelines of the MDQ, 15.2% ( n = 65) of the 428 nonbipolar patients screened positive on MDQ. Compared to patients who screened negative, the patients who screened positive were significantly more likely have a current and lifetime diagnosis of specific phobia, posttraumatic stress disorder, alcohol and drug use disorders, any eating disorder, any impulse control disorder, and attention deficit disorder. Results were similar using a less restrictive threshold to identify MDQ cases. That is, MDQ caseness was associated with significantly elevated rates of anxiety, impulse control, substance use, and attention deficit disorders. Studies using the MDQ as a stand-alone proxy for the diagnosis of bipolar disorder should consider whether the presence of these other forms of psychopathology could be responsible for differences between individuals who screen positive and negative on the scale.

Recognition of irrationality of fear and the diagnosis of social anxiety disorder and specific phobia in adults: Implications for criteria revision in DSM-5

In DSM-IV, the diagnosis of social anxiety disorder (SAD) and specific phobia in adults requires that the person recognize that his or her fear of the phobic situation is excessive or unreasonable (criterion C). The DSM-5 Anxiety Disorders Work Group has proposed replacing this criterion because some patients with clinically significant phobic fears do not recognize the irrationality of their fears. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project we determined the number of individuals who were not diagnosed with SAD and specific phobia because they did not recognize the excessiveness or irrationality of their fear. We interviewed 3,000 psychiatric outpatients and 1,800 candidates for bariatric surgery with a modified version of the Structured Clinical Interview for DSM-IV. In the SAD and specific phobia modules we suspended the skip-out that curtails the modules if criterion C is not met. Patients who met all DSM-IV criteria for SAD or specific phobia except criterion C were considered to have "modified" SAD or specific phobia. The lifetime rates of DSM-IV SAD and specific phobia were 30.5 and 11.8% in psychiatric patients and 11.7 and 10.2% in bariatric surgery candidates, respectively. Less than 1% of the patients in both samples were diagnosed with modified SAD or specific phobia. Few patients were excluded from a phobia diagnosis because of criterion C. We suggest that in DSM-5 this criterion be eliminated from the SAD and specific phobia criteria sets.

Specific phobias in older adults: characteristics and differential diagnosis

Differential diagnosis implies identifying shared and divergent characteristics between clinical states. Clinical work with older adults demands not only the knowledge of nosological features associated with differential diagnosis, but also recognition of idiosyncratic factors associated with this population. Several factors can interfere with an accurate diagnosis of specific phobia in older cohorts. The goal of this paper is to review criteria for specific phobia and its differential diagnosis with panic disorder, agoraphobia, post-traumatic stress disorder and obsessive compulsive disorder, while stressing the specific factors associated with aging. A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used. Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia. First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.

Measuring Anxiety in Youth with Learning Disabilities: Reliability and Validity of the Multidimensional Anxiety Scale for Children (MASC)

Youth with learning disabilities (LD) are at an increased risk for anxiety disorders and valid measures of anxiety are necessary for assessing this population. We investigated the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC; March in Multidimensional anxiety scale for children. Multi-Health Systems, North Tonawanda, 1998) in 41 adolescents (ages 11– 17 years) with LD. Youth and parents completed the MASC and were administered the semi-structured Anxiety Disorders Interview Schedule: Child and Parent Versions (ADIS: C/P; Silverman and Albano in The Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent Versions. Psychological Corporation, San Antonio, 1996). Results found that child and parent reports of Social Anxiety on the MASC closely corresponded with ADIS-generated social phobia diagnoses, and parent total scores discriminated well among youth with and without any anxiety disorder. A multi-method multi-trait matrix provided evidence of the construct validity of the MASC total score for both parent and child reports. Our findings provide empirical evidence that parent and child versions of the MASC are useful for assessing anxiety in youth with LD.