Type Of Phobia Research Articles

The Discrimination of Children's Phobias Using the Revised Fear Survey Schedule for Children

The discriminant validity of children's and parents' ratings of the child's fear on the Revised Fear Survey Schedule for Children (FSSC-R; Ollendick, 1983) was examined using a clinic sample of children who met DSM criteria for phobic disorders (N = 120). Discriminant function analyses and item analyses were conducted to determine if children meeting diagnostic criteria for a primary disorder of social phobia, simple phobia of the dark/sleeping alone, simple phobia of animals, or a simple phobia of shots/doctors could be differentiated on the basis of FSSC-R subscale scores and items. Results of the discriminant function analyses indicated that the child-completed as well as the parent-completed FSSC-Rs were similarly useful in differentiating the specific types of phobias. Results of the item analyses indicated that child-completed FSSC-R items could discriminate among the different simple phobias but not social phobia and that parent-completed FSSC-R items could discriminate not only the different simple phobias but also social phobia. Results are discussed in terms of the utility of the FSSC-R in the assessment of clinically significant fears in children with phobic disorders and the relative utility of child and parent ratings in the assessment of childhood fears.

Effects of negative life experiences on phobia onset.

Conditioning theories, stress theories and social psychological theories each suggest that negative life experiences should influence phobia onset, though the patterns of effects suggested by each type of theory are different. Few previous studies have estimated the effects of a broad enough range of life experiences on onset of multiple types of phobia to evaluate patterns of effects. Retrospective data on life experiences and history of phobia from a representative sample of persons 15-54 years old from the US population (the National Comorbidity Survey) are analyzed using discrete-time event history methods. The effects of 12 negative life events and ten chronic childhood adversities on onset of agoraphobia, specific phobia, and social phobia are presented. Three discrete events have unique effects on agoraphobia onset: life threatening accidents, combat in war (for men), and a fire/flood or other natural disaster. Two chronic experiences during childhood have unique effects on specific phobia onset: violence at the hands of one or more adults, and verbal aggression between parents. Sexual assault by a relative and verbal aggression between parents have unique effects on social phobia onset. The effect of sexual assault by a relative on social phobia is confined to women, and to phobias beginning before age 12. Unpredictable and uncontrollable events that threaten or result in physical harm influence agoraphobia onset. Potentially predictable but difficult to control childhood experiences (e.g., chronic parental violence) influence specific phobia onset. Blame is a likely mediator of the effect of sexual abuse on social phobia. No data on perceptions of predictability and controllability of life experiences, or of blame, were available for analysis. These conclusions are therefore based on speculations about social psychological processes that have been supported by previous research and theory.

Dealing with the Fear of Mutilation in the Donation Discussion

Fear of mutilation is a significant barrier to organ and tissue donation. It constitutes an example of Mystical Thinking and may be seen as an exemplar of animal learning or, more specifically, as a representation of the “blood phobia.” As such the fear is not amenable to conventional public education efforts. Cognitive and behavioral techniques used in treating other types of phobias should be studied as a way to remove this barrier to donation.

Dealing with the fear of mutilation in the donation discussion.

Fear of mutilation is a significant barrier to organ and tissue donation. It constitutes an example of Mystical Thinking and may be seen as an exemplar of animal learning or, more specifically, as a representation of the "blood phobia." As such the fear is not amenable to conventional public education efforts. Cognitive and behavioral techniques used in treating other types of phobias should be studied as a way to remove this barrier to donation.

Blood–injury–injection phobia and dental phobia

The present study was carried out to explore the relation between BII phobia and dental phobia. An additional aim was to determine the fainting tendency of dental phobics and BII phobics during an invasive treatment procedure. Participants were 63 patients undergoing treatment in a dental fear clinic, and 173 patients undergoing dental surgery in a university hospital. They completed measures on fears of particular medical and dental stimuli, fainting history, general trait anxiety, dental anxiety, BII anxiety, BII avoidance, and a questionnaire aimed to define a phobia based on DSM-IV criteria. Immediately after treatment information was obtained on exposures to blood or injections, state anxiety, and feelings of faintness during treatment. The results did not indicate any significant relationship between measures of dental anxiety and BII anxiety or BII avoidance. However, 57% of the dental phobic patients could also be classified as BII phobic. The proportion of dental phobics who reported fainting episodes in their past was similar to that of the BII phobics (37%), but none of the participants fainted during treatment. It is concluded that, albeit the level of co-occurrence for both types of phobias is high, dental phobia should be considered as a specific phobia, independent of the BII subtype within DSM-IV. Further, the findings are inconsistent with the notion that individuals with BII phobia have a remarkably high tendency to faint in the presence of their phobic stimuli.

Subtypes of social phobia and comorbidity with depression and other anxiety disorders

Epidemiological studies have identified two subtypes of social phobia: speaking-only social phobia which is characterized by the fear of public speaking situations and complex social phobia which is characterized by the fear of multiple social situations. Speaking-only social phobia most closely corresponds to the DSM-IV's `nongeneralized social phobia' while complex social phobia resembles `generalized social phobia'. In contrast to the speaking-only social phobia, the complex form is usually more disabling, familial and longer-lasting. In addition, the complex form has a lower chance of spontaneous recovery and carries a higher risk of comorbidity and impairment. Overall, both types of social phobia tend to be underdiagnosed and under-treated. Effective treatments which can manage not only complex social phobia, but also its spectrum of comorbid conditions, are required.

Six-month prevalence of phobic symptoms in Iceland: an epidemiological postal survey.

An epidemiological questionnaire survey of the prevalence of the various types of phobias was undertaken among the Icelandic population. Out of 1,000 individuals surveyed, in accord with national census data held in Reykjavík, 775 questionnaires were returned. Results confirmed that among Icelanders, phobic symptoms overall are more prevalent among women than men. Prevalence rates were lower for individuals 45 years or older, suggesting that extinction may occur with ageing. Divorced or separated individuals were most at risk, as were women homemakers, disabled, or unemployed persons. Education was inversely related to the incidence of all types of phobias, with individuals with less than 10 years of education reporting the highest rates of phobia. Most respondents attributed the onset of their phobias to a specific terrifying experience, and in many cases, to observing another person displaying an intense fear reaction in a given situation. Factor analysis of the data indicated that social anxiety phobias accounted for the greatest proportion of variance.

Simple phobia as a comorbid anxiety disorder

This study sought to describe clinical and demographic characteristics differentiating patients with DSM-III-R simple phobias comorbid with one or more of five DSM-III-R index anxiety disorders as compared with those with the index diagnoses alone. From 711 subjects participating in a multicenter, longitudinal, naturalistic study of anxiety disorders, 115 subjects with comorbid simple phobias were compared with 596 subjects without simple phobias in terms of demographic data, comorbidity with other disorders, somatic and psychosocial treatment received, and quality of life. In addition, episode characteristics, types of simple phobias found, and course of illness were specified. Subjects with simple phobias had more additional comorbid anxiety disorders by history than did those without. Mean length of intake episode was 22.43 years and severity was typically moderate. Fears of heights and animals were the most commonly represented simple phobias. Subjects with uncomplicated panic disorder were less likely to have comorbid simple phobias than were subjects with other index diagnoses, and subjects with simple phobia were more likely to have comorbid posttraumatic stress disorder than were these without simple phobia. Subjects with and without simple phobias did not differ by somatic or psychosocial treatment received or in terms of quality of life. Simple phobia appeared in this study to be a chronic illness of moderate severity for which behavioral treatment methods of recognized efficacy were not being frequently utilized. Uncomplicated panic disorder may reflect some type of resistance to phobia development.

Simple phobia as a comorbid anxiety disorder

This study sought to describe clinical and demographic characteristics differentiating patients with DSM-III-R simple phobias comorbid with one or more of five DSM-III-R index anxiety disorders as compared with those with the index diagnoses alone. From 711 subjects participating in a multicenter, longitudinal, naturalistic study of anxiety disorders, 115 subjects with comorbid simple phobias were compared with 596 subjects without simple phobias in terms of demographic data, comorbidity with other disorders, somatic and psychosocial treatment received, and quality of life. In addition, episode characteristics, types of simple phobias found, and course of illness were specified. Subjects with simple phobias had more additional comorbid anxiety disorders by history than did those without. Mean length of intake episode was 22.43 years and severity was typically moderate. Fears of heights and animals were the most commonly represented simple phobias. Subjects with uncomplicated panic disorder were less likely to have comorbid simple phobias than were subjects with other index diagnoses, and subjects with simple phobia were more likely to have comorbid posttraumatic stress disorder than were those without simple phobia. Subjects with and without simple phobias did not differ by somatic or psychosocial treatment received or in terms of quality of life. Simple phobia appeared in this study to be a chronic illness of moderate severity for which behavioral treatment methods of recognized efficacy were not being frequently utilized. Uncomplicated panic disorder may reflect some type of resistance to phobia development. Depression and Anxiety 7:105–112, 1998. © 1998 Wiley-Liss, Inc.

A direct-interview family study of generalized social phobia.

The goal of this direct-interview family study was to replicate and extend an earlier finding of a familial liability for social phobia. The authors hypothesized that there would be higher rates of the generalized type of social phobia--but not the nongeneralized (or "discrete") type--among relatives of probands with generalized social phobia. They also hypothesized that rates of avoidant personality disorder, a frequent comorbid condition, would be higher in relatives of probands with generalized social phobia. The authors examined rates of three social phobia subtypes defined a priori--discrete, nongeneralized, and generalized--as well as rates of avoidant personality disorder by direct interview of 106 first-degree relatives of 23 patients with generalized social phobia and 74 first-degree relatives of 24 comparison subjects without social phobia. Relative risks for generalized social phobia and avoidant personality disorder were markedly higher (approximately 10-fold) among first-degree relatives of probands with generalized social phobia than among first-degree relatives of comparison probands. In contrast, relative risks for discrete social phobia and nongeneralized social phobia were not significantly different between the two groups of first-degree relatives. These results confirm earlier findings of a higher rate of social phobia among relatives of probands with generalized social phobia and extend these findings by specifically indicating that it is only the generalized type (and its probable axis II counterpart, avoidant personality disorder) that occurs more often among the families of probands with generalized social phobia. Implications for subsequent genetic studies are discussed.

Heterogeneity among specific phobia types in DSM-IV

Recently, it has been suggested that situational specific phobias (e.g., phobias of driving, flying, enclosed places) are more closely related to agorophobia than are other specific phobia types. The present study investigated this hypothesis by examining heterogeneity among the four main DSM-IV specific phobia types, particularly with respect to variables believed to be associated with agoraphobia. Using interviews and behavioral testing, 60 patients with specific phobias of animals, heights, blood/injections, or driving were compared with respect to etiology, age of onset, physiological response, predictability of panic attacks, and focus of apprehension. Fifteen patients suffering from panic disorder with agoraphobia served as a comparison group for some measures. Relative to the other specific phobias, driving phobias were most strongly associated with a later age of onset, similar to that of individuals with agoraphobia. Height phobias were also associated with a late age of onset as well as a more internal focus of apprehension, relative to other groups. Finally, individuals in the blood/injection phobia group reported a more internal focus of apprehension than those in other groups and were the only group to report a history of fainting in the phobic situation. Overall, the results did not support the hypothesis that situational phobias are a variant of agoraphobia. In fact, on several of the variables for which groups did differ, individuals with height phobias (a phobia from the natural environment type) showed a pattern most similar to individuals with agoraphobia. The implications of these results for the classification of specific phobias are discussed.

Heterogeneity among specific phobia types in DSM-IV

Heterogeneity among specific phobia types in DSM-IV

Response to hyperventilation and 5.5% CO2 inhalation of subjects with types of specific phobia, panic disorder, or no mental disorder.

This study tested the hypothesis that compared to other DSM-IV specific phobia types, situational specific phobias have more in common with panic disorder and agoraphobia. Responses to hyperventilation and CO2 inhalation were compared across groups of patients with the four main DSM-IV specific phobia types, a group with panic disorder, and a group of comparison subjects with no anxiety disorder (N = 15 per group). Although these challenges have been shown previously to distinguish patients with panic disorder from other groups, no groups differed significantly in their responses to hyperventilation. In addition, whereas the patients with panic disorder responded more to the CO2 challenge than did the normal subjects, the specific phobia groups did not differ from one another or from the other groups on most measures. For the few CO2 measures on which specific phobia groups differed, patients with situational and natural environment phobias showed the greatest response. Overall, these findings provided only limited support for the hypothesis that situational specific phobias are related to panic disorder.

Behavioural Analysis: Does It Matter?

Behavioural or, in more general terms, problem analysis is usually regarded as the prerequisite of behaviour therapy. In behaviour therapy research, however, problem analysis does not play a key role. Patients are usually assigned to treatment methods on the basis of clinical diagnosis. It could be assumed that the lack of attention to the patient's individual characteristics should lead to poorer therapy outcome results. However, empirical data of a project reviewed in this paper in fact showed that assigning patients to standard treatment merely on the basis of clinical diagnoses provides results equal to or even better than those of optimized individual therapy strategies. Two premises of problem analysis were therefore tested. It could be shown that therapists would diagnose different problem conditions not only for patients with different types of phobia, but also, as expected, for patients with identical diagnoses. However, this did not—as would be expected according to the second premise of problem analysis—result in choosing different individual therapy strategies. One reason for these findings could be that behaviour therapy research has been able to provide treatment programs that have been differentiated and gradually optimized for specific diagnostic groups. To decide on the application of these treatment programs, clinical diagnoses are necessary. It is suggested that clinical diagnosis and problem analysis should be complementary. An integrative model is suggested.

People who seek help for fear of flying: Typology of flying phobics

The objective of this study was to examine sociodemographic and clinical characteristics of 419 patients who were self-referred to a treatment agency because of fear of flying. With the use of homogeneity analyses to explore the association between flight-anxiety and different types of phobia, four specific subtypes of flying phobics were identified. The subtypes differed in terms of flight-anxiety level, age, sex, complaints like “fear of aircraft accidents, the need to have control over the situation, fear of losing control over themselves,” and phobias underlying their fear of flying, such as claustrophobia, acrophobia, social phobia, and symptoms of panic attacks. It is argued that the typology identified could have implications for the selection of treatment components.

Profile of a large sample of patients with social phobia: Comparison between generalized and specific social phobia

This study examines a large cohort of subjects with social phobia, as part of a larger naturalistic and longitudinal study of 711 subjects with anxiety disorders. We focused on 176 subjects who were in an episode of social phobia at intake. We were particularly interested in evaluating the diagnostic distinction between generalized and specific social phobia. We compared these two groups along demographic characteristics, comorbidities, psychosocial functioning (health, role functioning, social functioning, and emotional functioning) and global assessment scores. We found that generalized social phobics tended to have an earlier age of onset as compared to the specific group; however, this is not a statistically significant difference at this level of analysis. The two groups did not differ for the current comorbidities examined. We observed no differences in the treatment received by the two types of social phobia subjects, and the two groups functioned equally well in terms of health and fulfilling social roles. In addition, we examined adverse childhood events (i.e., death of a parent, childhood abuse) and found no evidence for any differential impact these events might have on the type of social phobia. Although we did observe significantly greater fear of public speaking among the specific compared to the generalized group, which may indicate a qualitative difference between the subtypes, our results suggest that for most parameters, generalized and specific social phobia represent a continuum of similar and overlapping entities. Depression and Anxiety 4:209–216, 1996/1997.© 1997 Wiley-Liss, Inc.

Profile of a large sample of patients with social phobia: comparison between generalized and specific social phobia.

This study examines a large cohort of subjects with social phobia, as part of a larger naturalistic and longitudinal study of 711 subjects with anxiety disorders. We focused on 176 subjects who were in an episode of social phobia at intake. We were particularly interested in evaluating the diagnostic distinction between generalized and specific social phobia. We compared these two groups along demographic characteristics, comorbidities, psychosocial functioning (health, role functioning, social functioning, and emotional functioning) and global assessment scores. We found that generalized social phobics tended to have an earlier age of onset as compared to the specific group; however, this is not a statistically significant difference at this level of analysis. The two groups did not differ for the current comorbidities examined. We observed no differences in the treatment received by the two types of social phobia subjects, and the two groups functioned equally well in terms of health and fulfilling social roles. In addition, we examined adverse childhood events (i.e., death of a parent, childhood abuse) and found no evidence for any differential impact these events might have on the type of social phobia. Although we did observe significantly greater fear of public speaking among the specific compared to the generalized group, which may indicate a qualitative difference between the subtypes, our results suggest that for most parameters, generalized and specific social phobia represent a continuum of similar and overlapping entities.

Exposure and Participant Modelling in a Case of Injection Phobia

From the literature it appears that there may be two types of injection phobia, (1) the 'vasovagal' type, and (2) the 'resistant' type. The first type is characterized by a diphasic cardiovascular response during or after injection and by a tendency to react in a passive, nonresisting way when injected. The second type is characterized by strong, sometimes violent resistance and no vasovagal reaction to an injection. Characteristics of blood injury phobia apply to the first type, but not to the second. The possibility is considered that exposure may be an effective treatment in the first type, and participant modelling in the second type. A single case study was carried out with a case of injection phobia of the second type in which exposure with modelling, followed by participant modelling of the injection, was applied. Measures of state anxiety (STAI) and heart rate were obtained. According to expectation, participant modelling of injections was effective in eliminating the fear of injections in a patient of the second type of injection phobia. The results of this study warrant further investigation of the model in a group design in which the differential treatment effects of exposure and participant modelling are tested.

Social sensitivity: a shared feature of all phobias.

The prominence of a variety of social fears among types of phobia was examined. Responses of 80 agoraphobics, 25 social phobics and 35 specific phobics to Wolpe's (1983) Fear Survey Schedule were factor-analysed. Factors of social sensitivity (accounting for 24 out of 50 per cent of the variance), agoraphobia (7 per cent), blood injuries (5 per cent) and five other small specific phobic factors were extracted. On social sensitivity, agora- and social phobics overlapped; specific phobics were significantly lower than social phobics. On agoraphobia scores, agoraphobics scored significantly higher than social and specific phobics. A regression analysis was performed to assess the relative contribution of the diagnostic groups to each factor. Social sensitivity may be a normal evolved mechanism that is protective in social interactions.

Specificity in familial aggregation of phobic disorders.

To investigate whether each of three DSM-III-R phobic disorders (simple phobia, social phobia, and agoraphobia with panic attacks) is familial and "breeds true." Rates of each phobic disorder were contrasted in first-degree relatives of four proband groups: simple phobia, social phobia, agoraphobia with panic attacks, and not ill controls. Phobia probands were patients who had one of the phobia diagnoses but no other lifetime anxiety comorbidity. We found moderate (two- to fourfold increased risk) but specific familial aggregation of each of the three DSM-III-R phobic disorders. These results support a specific familial contribution to each of the three phobia types. However, conclusions are limited to cases occurring without lifetime anxiety comorbidity and do not imply homogeneity within categories.