Specific and Social Phobias OCD
Specific and Social Phobias OCD
Specific and Social Phobias OCD
Phobia
an irrational fear that leads to avoidance of the feared object or situation
Specific phobia
a strong, exaggerated fear of a specific object or situation
Social phobia
also called social anxiety disorder a fear of social situations in which embarrassment can occur
EPIDEMIOLOGY
Phobias are the most common mental disorders in the United States.
At least 5 to 10% of the population is afflicted with a phobic disorder, and some studies report as high as 25% of the population.
Women are 2x as likely to have specific phobia as men Social phobia: men = women
ETIOLOGY
The cause of phobias is most likely multifactorial, with the following components playing important parts: Genetic
Fear of seeing blood often runs in families and may be associated with an inherited, exaggerated vasovagal response. First-degree relatives of patients with social phobia are three times more likely to develop the disorder.
Behavioral
Phobias may develop through association with traumatic events. For example, people who were in a car accident may develop a specific phobia for driving.
Neurochemical
An overproduction of adrenergic neurotransmitters may contribute to anxiety symptoms. This has led to the successful treatment of some phobias. (Most notably, performance anxiety is often successfully treated with beta blockers).
If necessary, a short course of benzodiazepines or beta blockers may be used during desensitization to help control autonomic symptoms.
Compulsion
a conscious repetitive behavior linked to an obsession that, when performed, functions to relieves anxiety caused by the obsession
Patients are generally aware of their problems and realize that their thoughts and behaviors are irrational (they have insight). The symptoms cause significant distress in their lives, and patients wish they could get rid of them (i.e., their obsessions and compulsions are ego-dystonic).
Compulsions
Repetitive behaviors that the person feels driven to perform in response to an obsession The behaviors are aimed at reducing distress, but there is no realistic link between the behavior and the distress.
2. The person is aware that the obsessions and compulsions are unreasonable and excessive. 3. The obsessions cause marked distress, are time consuming, or significantly interfere with daily functioning.
EPIDEMIOLOGY
Lifetime population prevalence: 2 to 3% Onset is usually in early adulthood Men = women Associated with:
major depressive disorder eating disorders other anxiety disorders obsessivecompulsive personality disorder
The rate of OCD is higher in patients with firstdegree relatives who have Tourettes disorder.
ETIOLOGY
Neurochemical
OCD is associated with abnormal regulation of serotonin.
Genetic
Rates of OCD are higher in first-degree relatives and monozygotic twins than in the general population.
Psychosocial
The onset of OCD is triggered by a stressful life event in approximately 60% of patients.
TREATMENT
Pharmacologic
SSRIs are the first line of treatment, but higherthan-normal doses may be required to be effective. Tricyclic antidepressants (TCAs) (clomipramine) are also effective.
TREATMENT
Behavioral Therapy
as effective as pharmacotherapy in the treatment of OCD best outcomes are often achieved when both are used simultaneously
Relaxation techniques are employed to help the patient manage the anxiety that occurs when the compulsion is prevented.
TREATMENT
Last Resort
In severe, treatment-resistant cases, electroconvulsive therapy (ECT) or surgery (cingulotomy) may be effective.