Phobic anxiety disorders

Etiology and Epidemiology in general

 * generally w > m (2:1 ratio)
 * in general very common ranging up to 10% of the population
 * Fear → exaggerated + irrational against a thing or situation
 * multifactorial: genetic, neurobiological factors (serotonin system, GABAergic transmission), environmental and developmental factors (stress, smoking, trauma)
 * secondary to medical conditions (hyperthyroidism, CHF, asthma...)

Specific phobia (F40.2)

 * examples: heights (acrophobia), needles (blenophobia), situations (flying), spiders (arachnophobia), dogs (cynophobia) snakes, clowns... (arachn
 * Tx: CBT- Flooding, desensitization, alternatively: SSRIs or Benzos

Social anxiety (social phobia) (F40.1)

 * Fear: Of other people, their criticism (and embarrassment), their perception, social situations → public speaking, going to a party, eating in public → can cause blushing, hand tremor, nausea, urgency
 * Two types: Performance-only SAD and Social anxiety disorder (everything)
 * typical: female, low self-esteem, does not want to look in the eye
 * Tx: SSRIs/SNRIs or clonazepam (long acting benzo, if no response to SSRIs)

Agoraphobia (F40.0)

 * Fear of situations, where it seems difficult to escape from or get help (Agora means market place, phobia is fear)
 * Clinical features
 * ≥ 6 months, in ≥ 2 of the following 5 situations
 * Using public transportation
 * Being in open spaces
 * Being in enclosed places
 * Standing in line or being in a crowd
 * Being outside of the home alone → those places are actively avoided
 * Therapy:
 * CBT, SSRIs
 * associated with panic disorder, social phobia

General anxiety disorder (F41.1, belongs to the group of other anxiety disorders)

 * Fear: unspecific fear, not focused on a single specific fear -> e.g. a woman in middle age lying in bed worrying about everything and anything ("I hope my children, will not become like me", "Oh I have to give a presentation tomorrow", "Oh no did I really lock the door?". "I hope John will like his birthday present")
 * Time: ≥ 6 months (i.e. prolonged, on most days)
 * Causes significant distress, exclusion of medications and substances
 * Restlessness and irritability, sleep disturbances and difficulty concentrating
 * Tx: CBT, SSRIs

F41 is other anxiety disorders, which includes panic disorder, GAD, mixed anxiety and depressive disorder