SEMINAR

ON

P R E S E N T E D B Y : S O N I A TA N A TA R A
ROLL NO : 32
BSCN 3RD YEAR
CONTENT
o INTRODUCTION
o DEFINITION
o EPIDEMIOLOGY
o CAUSES
- BEHAVIORAL FACTORS
- PSYCHOANALYTIC THEORIES
CONTD…
o TYPES OF PHOBIA
- SIMPLE PHOBIA
- SOCIAL PHOBIA
- AGORAPHOBIA
o SYMPTOMS OF PHOBIA
oDIAGNOSTIC CRITERIA
CONTD…
o MANAGEMENT
- PSYCHOTHERAPY
- PHARMACOTHERAPY
- BEHAVIOR THERAPY
o NURSING MANAGEMENT
oNURSING DIAGNOSIS
CONTD…
o SUMMARY
o BIBLIOGRAPHY
o JOURNAL REVIEW
o CONCLUSION
INTRODUCTION
Phobia develops when a person begins to organize
their life around avoiding the things they are afraid
of , whether it is an animal , object, place or
situations. Phobia usually do not result from past
negative experiences. In fact, the person may never
had contact with the object of the phobia.
DEFINITION
o Phobia is persistent avoidance behavior secondary
to irrational fear of a specific object, activity or
situations.
o A Phobia is an illogical , intense and persistent fear
of a specific object or a social situation that causes
extreme distress and interferes with normal
functioning.
CONTD…
o Phobia refers to the persistent , irrational ,
exaggerated and invariably pathological dread of a
specific stimulus or situation , results in a compelling
desire to avoid the feared stimulus.
EPIDEMIOLOGY
In the year 2020
•The 12 month prevalence of specific phobia is 7,000-9,000
per 100,ooo (7%-9%) of the overall population. An
American study by the national institute of mental health
(NIMH) found that between 8.7% and 18.1% of American
suffer from phobia. Broken down by age and gender , the
study found that phobias were the most common illness
among men older than 25.
Contd….
A Swedish study found that females have a higher member
of cases per year than males (26.5 percent for females and
12.4 percent for males). Among adults , 21.2 percent of
women and 10.9 percent of men have a single specific
phobia, while multiple phobias occur in 5.4 percent of
females and 1.5 percent of males. Women are nearly four
times as likely as men to have a fear of animals ( 12.1% in
women and 3.3% in men).
IN INDIA
Specific phobia has been identified as one of the most
common disorders in the school going age group , with the
prevalence of approx. 4.2%.
CAUSES
A. BEHAVIORAL FACTORS
I. Stimulus Response Model
- involves the traditional pavlovian stimulus response
model of the conditioned response to account for the
creation of phobia.
Contd…
II. OPERANT CONDITIONING THEORY
- In the classic stimulus response theory, the
conditioned stimulus gradually loses its potency to
arouse a response, if it is not reinforced by a periodic
repetition of the unconditioned stimulus.
- In the phobic symptoms, the attenuation of the
response to the phobic stimulus does not occur.
Contd…
B. PSYCHOANALYTIC THEORIES
- Sigmund Freud presented a formulation of phobic
neurosis.
- according to it, the major function of the anxiety is a
signal to the ego, that a forbidden unconscious drive is
pushing for conscious expression, thus altering the ego
to strengthen and marshal its defense mechanism.
Contd…
- In social and specific phobia, the conflict is
regarding sexual arousal, leading to castration
anxiety.
Defences are displacement, symbolization and
avoidance.
Contd…
- In agoraphobia, it is the separation anxiety playing a
central role.
TYPES OF PHOBIA
1. SPECIFIC PHOBIAS
- strong persisting fear of an object or stimulus or
situation .
- It is further subdivided into following categories:
> natural environmental
> blood-injection
Contd…
> situational
> animal
SIGNS AND SYMPTOMS
- Irrational and persistent fear of object or situation
- immediate anxiety on contact with feared stimulus
- loss of control, fainting or panic response.
- avoidance of activities involving feared stimulus
Contd…
- Anxiety when thinking about stimulus
- worry with anticipatory anxiety
- possible impaired social or work functioning.
COMMON SPECIFIC PHOBIA
FEAR OF
- close space: claustrophobia
- sight of blood: haemotophobia
- height : acrophobia
- dogs: cynophobia
- darkness: nyctophobia
2. SOCIAL PHOBIA
- strong, persisting fear of an interpersonal situation
in which embarrassment can occur.
- also called social anxiety disorder ( SAD ) i.e fear of
blushing in front of others.
SIGNS AND SYMPTOMS
• Hyperventilation
•Sweating, cold and clammy hands
•Blushing
•Palpitation
•Confusion
•Gastrointestinal symptoms
Contd…
•Trembling hands and voice
•Urinary urgency
•Muscle tension
•Anticipatory anxiety
•Fear of embarrassment or ridicule
3. AGORAPHOBIA
- It is characterized by an irrational fear of being in places
away from the familiar setting of home, in crowds or in
situation that the patient cannot leave easily .
- It is defined as the fear of being alone in public places,
particularly places from which a rapid exit would be difficult
in the course of panic attack.
SIGNS AND SYMPTOMS
•Overriding fear of open or public areas
•Confinement to home
RECAP
1. WHAT IS PHOBIA?
2. TYPES OF PHOBIA.
DIAGNOSIS
According to ICD-10, the diagnostic criteria is as follows:
• Psychological and autonomic symptoms which are the
primary manifestation
•Anxiety is restricted to the feared object, situation or place
•This phobic situation should be avoided whenever possible
MANAGEMENT
A. PSYCHOTHERAPY
- treatment of emotional and/or related bodily problems by
psychological means .
i. Insight oriented psychotherapy
- enables the patient to understand the origin of phobia,
phenomena of secondary gain and the role of resistance
and enables the patient to seek healthy ways of dealing.
Contd…
ii. Cognitive Behavior Therapy
-modification of thought pattern in order to handle the
phobia which is very closely associated with the thoughts.
While the cognitive part of therapy deals with the thought
pattern and the behavioral aspects deals with the
management of the behavior related to the phobia.
Various techniques of CBT
•Flooding
•Desensitization
•Exposure and response prevention
•Relaxation techniques
 B. PHARMACOTHERAPY
• Benzodiazepines
• Alprazolam
• Selective Serotonin reuptake inhibitor ( antidepressants)
•Others : diazepam, clonazepam
NURSING MANAGEMENT
•Assessment
•History and MSE
-observation of thought process, affect, communication,
psychomotor and physiological responses
-use directive questions
-Ask the patient about other somatic symptoms
NURSING MANAGEMENT
- Assess for communication pattern
- The Patient’s ability to perform and complete tasks.
NURSING DIAGNOSIS
1. Fear related to specific stimulus or causing
embarrassment to self in front of others, evidenced by
behavior directed towards avoidance of the feared object/
situation.
Intervention
- reassure the patient that he is safe.
- explore Patient’s perception of the threat to physical
integrity or threat to self concept.
- include patient in making decision related to selection of
alternative coping strategies.
- encourage patient to explore underlying feelings.
Contd…..
2. Social isolation related to fear of being in a place from
which one is unable to escape , evidenced by staying alone,
refusing to leave the room/ home.
Intevention
-convey an accepting attitude and unconditional positive
regard.
-make brief, frequent contacts.
-Be honest and keep all promises.
- attend group activities with the patient.
-administer antianxiety drugs as prescribed.
JOURNAL REVIEW
TOPIC : Association of specific Phobia and its subtypes with
Physical disease: an adult community study.

AUTHOR : Cornelia Witthauer, Vladeta Ajdacic-gross, Andrea

Hans Meyer, Peter Vollenweida, Gerard Walber, Martin
Preisig and Roselind Lieb
PUBLISHED ON : May 2016
BACKGROUND
Specific phobia is the most prevalent anxiety disorder in the
community and is associated with substantial impairment.
Comorbidity with physical disease is assumed and has
important implications for etiology, treatment or prevention
of the comorbid conditions.
METHODS
Data of the German Mental Health survey from 4181
subjects aged 18-65 years were used. Specific phobia was
diagnosed using M-CIDI/DIA-X interview, physical diseases
were assessed through a self report questionnaire and a
medical interview. Logistic Regression analyses adjusted for
sex were calculated.
RESULTS
Specific Phobia was associated with cardiac disease,
gastrointestinal diseases, respiratory diseases, arthritic
conditions, migraine and thyroid disease. Among the
subtypes , different patterns of associations with physical
disease were established.
CONCLUSION
Analyses show that subjects with specific phobias have an
increased probability for specific physical disease.
CONCLUSION
Fears are parts of life. Some fears help us, but most fears
pester us. Understanding the origin of a patient’s fear and
anxiety could help enhance patient management and care.
However, a lack of knowledge of the effects of
demographics, causal factors , ethnicity and treatment
modalities relative to the origin and pathways of fear in
dentistry.