Phobic Disorders

Phobia's are a type of anxiety disorder which occur when anxiety is associated with a particular situation or stimulus. They're identified by: persistant fear that is excessive or unreasonable; exposure to phobic stimulus/situation provokes an immediate anxiety response; recognition that the fear is unreasonable; phobic situation/stimulus is avoided or endured with intense anxiety/distress; avoidance, anticipation or distress impacts on daily life; present for at least 6 months in under 18s; anxiety isn't better accounted for by another mental disorder. (DSM-IV-TR)

Different types of phobia include:

• specific phobia (of a object/situation)
• social phobia (of social/public gatherings)
• agoraphobia (of leaving the house)

A clinical diagnosis is only made if there is no other physiological cause (e.g. substance abuse) or if the symptoms cannot be explained by another disorder. The fact that the individual recognises that their fear is unreasonable is important as it distinguishes between a phobia and a delusional mental illness (e.g. schizophrenia) where the individual is not aware of the unreasonableness of their behaviour.

• Skyre et al (1991) found high reliability when diagnosing phobias using Clinical Structred Interviews, this may be due to the extensive training required to administer the interview.
• Hiller et al (1990) reported satisfactory ot excellent diagnostic agreement in a test-retest study using the Munich Diagnostic Checklist (a shorter, structered, self administered scale).
• Kendler et al (1999) found a mean agreement of +.46 using face to face and telephone interviews (very low reliability). Kendler suggests this may be due to patients poor recall of their fears or the difference between clinicians judgement of whether symptoms meet the clinical threshold of a phobia.

The diathesis-stress model argues that people have a biological vulnerability to develp certain disorders and then cognitive or environmental factors trigger it.

Behavioual: through classical conditioning an initially neutral stimuli becomes associated with a fear response (unconditioned response), the neutral stimulus then becomes the conditioned stimulus and the fear response becomes the conditioned response (Little Albert). Mowrer proposed that classical conditioning was only the first stage of the development of a phobia; the second stage is operant conditioning. The avoidance of the phobic stimulus removes the fear/anxiety and so the phobia is negatively reinforced.  Social learning suggests that phobias are learned through modelling others.

Cognitive: phobias may develop due to irrational thinking. Beck proposed that phobias occur because people become afraid of situations where a fear may occur. He also said that phobics ten to overestimate their fears, incrasing the likelihood of phobias.

Behavioural:

• Sue et al - people with phobias do often recall a specific event when their phobia appeared But not everyone does. Ost suggests that traumatic events did happen but have since been forgotten.
• Di Nardo et al - not everyone bitten by a dog bevelops a phobia. Could be explained by the diathesis-stress model.
• Bregman - failed to condition 8-16mnth y/o's to be phobic of wooden blocks. Could be explained by diathesis-stress model OR ancient fears.
• Bandura and Rosenthal - observer who watched a model apparently experiencing pain every time a buzzer sounded, later demonstrated an emotional reaction to the sound.
• Sue et al - different phobias may be the result of different proccesses, e.g. agoraphobics were most likely to explain their disorder in terms of a specific incident, whereas arachnophobics were most likely to cite modelling.
  

Cognitive:

• Gournay - phobics more likely to overestimate risks.
• CBT has been effective at treating phobias.