DOES ANYONE HAVE ANY PHOBIAS?

CLINICAL PSYCHOLOGY
Anxiety disorders and
fear-related disorders

Diagnostic criteria
→ diagnostic criteria (ICD-11) of anxiety disorders and fear-related disorders:
– generalised anxiety disorder
– agoraphobia
SYLLABUS – specific phobia (blood-injection-injury).
CONTENT → measures of anxiety and fear-related disorders:
– Generalised Anxiety Disorder assessment (GAD-7).
– the blood injection phobia inventory (BIPI)
including a study, e.g. Mas et al. (2010).
 Diagnostic criteria of anxiety disorders and fear related disorders
– generalised anxiety disorder
– agoraphobia
– specific phobia (blood-injection-injury).

Psychological
terminology
Starter
anxiety
fear
Any real life / media sympathetic branch of
experiences of anxiety or autonomic nervous system
insomnia
phobias? GAD-7
BIPI
 Anxiety: a general feeling of dread or
apprehension accompanied by physical
reactions “Fear and anxiety are
closely related phenomena;
fear represents a reaction to
perceived imminent threat in
Fear: an emotional response to an the present, whereas anxiety
is more future-oriented,
immediate threat and is associated with a referring to perceived

fight or flight reaction anticipated threat.” ICD-11

Anxiety can be adaptive, but not if it is intense and persistent

 Autonomic
nervous system:
A control system
that acts largely
unconsciously and
regulates bodily
functions.
e.g. breathing, heart rate,
digestion, threat response

Part of the peripheral

nervous system (PNS)
which connects the central
nervous system (CNS)
[brain and spinal cord] to
the rest of the body
Anxiety disorders: characterised by a pattern of
frequent, persistent, excessive worry and apprehension
about a perceived threat in the environment
Fear and reactive behaviours are out of proportion to situation or irrational
Anxiety causes significant distress or impairment in functioning (personal, social, occupational, etc)
May be triggered by a specific stimuli or a broader range of stimuli

Types of anxiety or fear- Most common

related disorders mental disorders
affecting 30% of
● Generalized Anxiety Disorder adults at some
● Panic Disorder point in their
● Agoraphobia
● Specific Phobia lives.
● Social Anxiety Disorder In some cultures,
● Separation Anxiety Disorder symptoms may be
● Selective Mutism video somatic instead of
● Other Specified Anxiety or cognitive.
https://psychcentral.com/anxiety/
Fear-Related Disorders somatic-anxiety
https://www.youtube.com/watch?v=_Cr7IomSy8s
types of anxiety disorders and fear-
related disorders
generalised anxiety disorder
agoraphobia
specific phobia (blood-
injection-injury).
ICD-11 Generalised anxiety disorder
Intense, persistent and unreasonable anxiety about a wide
range of situations and issues, rather than one specific event.
May not be able to identify the causes of anxiety.

General apprehension [“free-floating anxiety”] about many

situations and excessive worries about negative events
occurring

Symptoms persist for several months, for more days than not.

Symptoms vary between patient, but can include:

physical (muscle aches, palpitations, insomnia, digestive issues)
behavioural (restlessness, irritability)
affective (nervousness)
or cognitive (inability to concentrate)

Can be mild, moderate or severe.

Other information:
- patients tend to have good insight into their condition. Aware of irrationality but
cannot control thoughts.
- impact on ability to function varies between individuals.
Prevalence
2-5% of the population.

Almost twice as common in

women than men
Spitzer et al (2006) Missouri, USA
- 9% in women, 4% in men.

Typical onset is early to mid-

30s.
Lessens with age - after 50,
GAD becomes rare
 Phobias
An intense fear of certain situations or objects.

Sufferers spend a lot of time avoiding their

phobic situation or object.

Three categories of phobia:

specific phobia, agoraphobia, social phobia
ICD-11 Agoraphobia From the Greek:
Fear response triggered by multiple situations in which
‘escape may be difficult / help may not be available’ agora = marketplace
e.g. in crowds, waiting in line, having hair cut, flying
phobos = fear
Patient actively avoids these situations - or only enters
them under special circumstances, e.g. friend present.

Consistent anxiety about these situations, and fear of

specific negative outcomes, e.g. having a panic attack

Persists for at least several months and result in significant

distress / impairment (social, personal, family, occupational,
etc)

Other information:
- Common to have a history of panic attacks.
- May be so severe that patient is housebound.
- Different fears / situations at different ages.
Prevalence
Onset typically between late
adolescence and age 35.

Almost twice as common in

women.
Age of onset younger in
women.
• Kimya has been afraid of birds for as long
as she can remember. She has no idea
what caused her extreme fear towards
them.
• Kimya cannot even bear to look at a
photograph of birds; she finds the sound of
birds flapping their wings particularly
upsetting. The thought of looking at or
having to touch feathers makes her feel
sick.
• Kimya avoids places where she might be
exposed to birds, such as town centers,
beaches, or woodlands, which limits her
social life.
ICD-11 Specific phobia (blood-injection-
injury)
Marked or excessive fear or anxiety that consistently occurs
upon exposure (or anticipation of exposure) to one or more
specific objects or situations.

Reaction is out of proportion to actual danger.

Symptoms persist for several months and result in significant
distress / impairment.
Phobic object is avoided or endured with intense fear / anxiety.

Other information:
- Phobic objects are heterogeneous and broad, most commonly
being animals, heights, enclosed spaces, sight of blood or
injury.
- Reactions can include disgust or revulsion, anticipation of
danger or harm, or physical symptoms, such as fainting.
Prevalence
May occur after a specific negative
experience, or be due to social
learning.

Most common onset in early

childhood (7-10 years of age)

Almost twice as common in

females. (especially for animal and
natural environment phobias).
 The sight of blood or activities linked to blood
Blood Phobia (haemophobia)
Often combined into blood-injection-injury phobia.
Cause increased heart rate + decreased blood pressure
vasovagal response This can lead to fainting.
Activities linked to use of needles
Injections / Medical Needles (trypanophobia)
Mas et al (2010)
72% have phobia since childhood
46% have a first-degree relative with the same phobia.
86% say it causes significant impairment in daily functioning, and fainting
is a common response.
 Animal Phobia
Irrational fear of a type / species of
animal – commonly snakes, rats,
other rodents

Leads to
avoidance of
An irrational and the animal
persistent fear of
buttons

Sufferers tend to
avoid clothes with
buttons

Button Phobia
 Core symptom of panic disorder is recurrent panic Panic Disorder
attacks, an overwhelming combination of physical
and psychological distress.

Sudden episodes of intense dread, strikes suddenly

wreaks havoc, then disappears.

Heart palpitations, shortness of breath, choking,

dizziness, feelings of choking, chills.
Misinterpreted as heart attack

Panic Attacks
• Symptoms, last minutes or hours, frightening,
• Restlessness, muscle tension, ‘on edge’, difficulty concentration,
preoccupation, tired, irritable,
• Sleep disturbance – getting to sleep or staying asleep difficult
Social Phobia
a.k.a Social Anxiety Disorder

Intense fear of social situations. Sufferers may have

overwhelming worry and self-consciousness in these
situations, worrying that others may judge them or they’ll
embarrass themselves.
 Arachibutyropho
Acrophobia Agoraphobia Ailurophobia Anuptaphobia
bia

Arachnophobia Astraphobia Aviophobia Bambakophobia Bananaphobia

Blood-injury-
Claustrophobia Clinophobia Cynophobia Coulrophobia
injection phobia

Kakorrhaphioph
Emetophobia Ephebiophobia Haemophobia Hippophobia
obia

Koumpounophob Lunaediesophob
Monophobia Mysophobia Naviphobia
ia ia

Nomophobia Ophidiophobia Pteronophobia Social Phobia Thalassophobia

Link to answer ppt

 Diagnostic criteria of anxiety disorders and fear related disorders
measures of anxiety and fear-related disorders:
– Generalised Anxiety Disorder assessment (GAD-7).
– the blood injection phobia inventory (BIPI)
including a study, e.g. Mas et al. (2010).

Psychological
Starter terminology

anxiety
What is the difference fear
sympathetic branch of
between generalised autonomic nervous system
anxiety disorder and a insomnia
specific phobia? GAD-7
BIPI
Measures

Two psychometric tests that measure symptoms of anxiety disorders:

Generalised Anxiety Disorder assessment (GAD-7).

the blood injection phobia inventory (BIPI)

including a study, e.g. Mas et al. (2010)
Generalised Anxiety Disorder Assessment (GAD-7)
A seven-item questionnaire that measures
severity of anxiety-related symptoms in the last
two weeks.
(Can be used as a structured interview.)
(Used to have 13 items)
Used by doctors to screen patients’ symptoms.

A score out of 21 is generated (on 0-3 scales/4-

point scales)
5+ indicates mild GAD
10+ indicates moderate GAD
15+ indicates severe GAD
(GAD patient average score 14.4 (control 4.9) Spitzer et al, 2006) .

e.g: Not being able to stop or control worrying choose from (0–3 scale)
0 Not at all 1 Several
days
Evaluating the GAD-7:
Psychometric tests – reliable, standardised,
valid instruments for testing each disorder. Results could be swayed by recent
events - only in the previous two
Has concurrent validity compared to weeks, so need to repeat measure to
different measures of the same symptoms. get an idea of symptoms over time.

Has test-retest reliability (Spitzer et al,

Self-report measure: risk of social
2006)
desirability / demand characteristics
Collects quantitative data – easy to
compare scores during treatment and to Subjective scales and interpretations -
other patients / for objective diagnosis. asks for how people would respond

Minimises risk of researcher bias

Cultural bias: developed in Western
Quick and easy assessment to complete - countries, might lack generalisability
questionnaire frees up psychiatrist time.
Past Paper Question - Paper 4
a. Outline how answers are scored on the GAD-7 scale. [2]

b. Suggest how the validity of the GAD-7 could be tested. [2]

c. Explain one strength and one weakness of the GAD-7 scale. [4]
Past Paper Question - Paper 4
a. Outline how answers are scored on the GAD-7 scale. [2]

Award 2 marks for a detailed outline.

Award 1 mark for a partial outline.

Definitive answer:
• the ‘GAD score’ is calculated by assigning scores of 0 (not at all), 1 (several
days), 2 (more than half the days), and 3 nearly every day, to all 7 questions (hence
GAD-7).
• a GAD-7 total score for the seven items ranges from 0 to 21. Scores represent: 0–
5 mild anxiety, 6–10 moderate anxiety, 11–15 moderately severe anxiety and 15–21
severe anxiety.
Example: the GAD-7 has a four-point scale (1 mark) ranging from 0 not at all to 3
nearly every day (2 marks).
Past Paper Question - Paper 4
b. Suggest how the validity of the GAD-7 could be tested. [2]
Marks: Award 2 marks for an appropriate suggestion and applied to study with detail /
elaboration / example.
Award 1 mark for an appropriate suggestion identified but not applied. Answers may include
(other appropriate responses to be credited).
NB: the study itself states ‘it has good criterion, construct, factorial and procedural validity’ and there are
detailed paragraphs on each of these. This detail is NOT expected in the answer; this is a ‘suggest’ question
and the ‘GAD-7 doesn’t even have a study to be included.
NB does not need to use the terms criterion validity or construct validity.

• criterion validity by comparing the GAD-7 to other measures of generalised anxiety (1 mark)
and if the two scores have a strong correlation the GAD-7 could be said to be valid (2 marks)
• construct validity by seeing if seeing if the GAD-7 matches up with theoretical ideas about
what it is supposed to be measuring (1 mark) and if it does the GAD-7 could be said to be valid
(2 marks).
• ecological validity: does the scale apply to real life (1 mark) do the questions (on paper)
reflect real life experiences of people (2 marks)
• temporal validity: test the GAD-7 over time (1 mark) to see if the person shows any
improvement (2 marks)
Past Paper Question - Paper 4
c. Explain one strength and one weakness of the GAD-7 scale. [4]
Marks: Up to 2 marks for each strength and up to 2 marks for each weakness: Award 2
marks for an appropriate strength/weakness stated and applied as required by the
question with detail / elaboration / example.
Award 1 mark for an appropriate strength/weakness stated but not applied.

Answers may include (other appropriate responses to be credited):

Strengths: • the scale is easy to use / is not complex (1 mark) as there are only 7
questions and the same scoring is used for each item (2 marks)
• the scale can apply to any form of disorder involving anxiety or anyone with feelings
of anxiety (1 mark) because of the nature of the questions such as ‘trouble relaxing’ are
deliberately general (2 marks)
Weaknesses: • the time frame is ambiguous (1 mark) the scale only applies to the last
two weeks, when there might have been an improvement from previously (2 marks)
• the wording of the scale is ambiguous (1 mark) use of the term ‘several days’ for
example (2 marks)
 Blood-Injury Phobia Inventory (BIPI)

18-items/scenarios relating to blood, 32 situations related to blood, injections and the

dentist
injections, injuries involving yourself or 5 situations related to animal blood
others. 4 situations related to the colour red

5 situations about agoraphobia

Patient has to rate how often they 4 situations about social anxiety
experience 27 phobic responses (categorised Both of these used to see if they create a similar
as either cognitive, physiological, or behavioural) phobic response

The frequency of each symptom is rated from 0 to 3

(0 = Never, 1 = Sometimes, 2 = Almost always, 3 = Always)

Measures both ‘situational anxiety’ [how

you would think/feel/behave during the
event] and ‘anticipatory anxiety’ [how
would feel in the lead up to the event].
Sample situations:
● When I see an injured person after an accident, bleeding in the road or on the
television,
● When I think about a pool of blood on the floor.
● When I think I have to accompany a relative to have a blood test or to treat an
open wound.
Sample phobic responses:
Evaluating the BIPI:
Psychometric tests – reliable, standardised,
valid instruments for testing each disorder.
Results could be swayed by recent
Valid evidence of phobic symptoms from a interactions with phobia objects /
Spanish speaking culture (Mas et al, 2010) situations.
Has concurrent validity compared to
different measures of the same symptoms, Self-report measure: risk of social
e.g. Fear Questionnaire (blood subscale) desirability / demand characteristics

Collects quantitative data Subjective scales and interpretations -

asks for how people would respond
Huge range of phobic objects/situations

Minimises risk of researcher bias Cultural bias: developed in Western

countries, might lack generalisability
Quick and easy assessment to complete -
questionnaire frees up psychiatrist time.
Mas et al, 2010 → Blood-injection Phobia Inventory
(BIPI): Development, reliability and validity
Aim: To develop a reliable measure of blood anxiety / blood Sample: 39 diagnosed
phobia symptoms for first language Spanish speakers. blood phobia patients
and 135 matched
controls.
Procedure: Questionnaire - All
participants rated 50-items From Andalucia, Spain.
Av age 24.
relating to agoraphobia, social
phobia and blood-injection-injury Researchers removed items where there were
phobia on cognitive, biological no significant differences between the groups,
and behavioural 4-point Likert and then identified the 18 items that best
scales. identified patients with blood anxiety / phobia.

Positive correlation between BIPI scores and

Phobic group also completed an blood sub-section of FQ.
interview and the Fear
Questionnaire (FQ). Scale found to be reliable and valid measure
for Spanish speakers.
Evaluating Mas et al (2010):
Results could be swayed by recent
Has concurrent validity compared to interactions with phobia objects /
different measures of the same symptoms, situations.
e.g. Fear Questionnaire (blood subscale)
Self-report measure: risk of social
Collects quantitative data desirability / demand characteristics

Used ‘factor analysis’ to choose the final 18 Subjective scales and interpretations -
( a rigorous statistical test). asks for how people would respond

Quick and easy assessment to complete - More females than males in the sample
questionnaire frees up psychiatrist time. F: 30, M: 9.
May be better at predicting B-I-I phobia
in females.
Issues and Debates
What are the applications to everyday life?

Relevant issues and debates and methodology for this topic

include:
• questionnaires
• psychometrics
• subjective and objective data
• validity
• reliability.
Write a Paper 3 Section A
question on this module and
force the person sitting next
to you to complete it.