Theoretical Explanations

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The many theories which attempt to explain how phobias develop can be grouped under three general headings: those which stress unconscious emotional conflicts, those which explain phobias based on the principles of learning, and those which consider biological factors. For Sigmund Freud, phobias represented the external manifestation of unconscious internal emotional conflicts which had their origin in early childhood. These conflicts typically involved the inhibition of primitive sexual feelings.

Learning-theory explanations of phobias are based on Pavlovian conditioning, instrumental conditioning, and social learning theory. According to a Pavlovian conditioning model, phobias result when a neutral stimu-lus—a dog, for example—is paired with an unconditioned stimulus (US), for example, a painful bite to the leg. After this event, the sight of the dog has become a conditioned stimulus (CS) which elicits a conditioned response (CR), fear; thus, a dog phobia has been learned. Instrumental conditioning (the modification of behavior as a result of its consequences) has been combined with Pavlovian conditioning in the two-factor model ofpho-bias. After the establishment of the phobia by Pavlovian conditioning, as above, a person will attempt to escape from or avoid the phobic object or situation whenever it is encountered. When this is successful, the fear subsides. The reduction in fear is a desirable consequence which increases the likelihood of escape/avoidance behavior in the future (that is, the escape/avoidance behavior is reinforced). The two-factor model thus accounts for both the development and maintenance of phobias. Social learning theory suggests that human learning is based primarily on the observation and imitation of others; thus, fears and phobias would be acquired by observing others who show fearful behavior toward certain objects or situations. This learning occurs primarily during childhood, when children learn many behaviors and attitudes by modeling those of others.

Two theories suggest that inherited biological factors contribute to the development of phobias. The preparedness theory suggests that those stimuli which are most easily conditioned are objects or situations which may have posed a particular threat to humans' early ancestors, such as spiders, heights, small spaces, thunder, and strangers. Thus, people are genetically prepared to acquire fear of them quickly. Similarly, people vary in susceptibility to phobias, and this is also thought to be based at least partly on an inherited predisposition. A phobia-prone person may be physiologically highly arousable; thus, many more events would reach a threshold of fear necessary for conditioning.

Stressful life situations, including extreme conflict or frustration, may also predispose a person to develop a phobia or exacerbate an existing phobia. Further, a sense of powerlessness or lack of control over one's situation

DSM-IV-TR Criteria for Phobias

Specific Phobia (DSM code 300.29)

Marked and persistent fear that is excessive or unreasonable and cued by presence or anticipation of specific object or situation (flying, heights, animals, receiving an injection, seeing blood)

Exposure to phobic stimulus almost invariably provokes immediate anxiety response, which may take the form of situationally bound or situationally predisposed panic attack; in children, anxiety may be expressed by crying, tantrums, freezing, or clinging

Person recognizes fear as excessive or unreasonable; in children, this feature may be absent

Phobic situation(s) avoided or endured with intense anxiety or distress

Avoidance, anxious anticipation, or distress in feared situation(s) interferes significantly with normal routines, occupational (or academic) functioning, or social activities or relationships, or marked distress about phobia present

In individuals under age eighteen, duration of at least six months

Anxiety, panic attacks, or phobic avoidance associated with specific object or situation not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder, Post-traumatic Stress Disorder, Separation Anxiety Disorder, Social Phobia, Panic Disorder with Agoraphobia, or Agoraphobia Without History of Panic Disorder

Specify:

• Natural Environment Type (such as heights, storms, water)

• Blood-Injection-Injury Type

• Situational Type (such as airplanes, elevators, enclosed places)

• Other Type (such as phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds or costumed characters)

may increase susceptibility; this may partly explain why phobias are more common in women than in men, as these feelings are reported more often by women than by men. Once initiated, phobias tend to persist and even worsen over time, and the fear may spread to other, similar objects or situations. Even phobias which have been successfully treated may recur if the person is exposed to the original US, or even to another US which produces extreme anxiety. Thus, many factors—unconscious, learned, and biological—may be involved in the onset and maintenance of phobias. As every person is unique in terms of biology and life experience, each phobia is also unique and represents a particular interaction of the factors above and possibly other, unknown factors.

Social Phobia (DSM code 300.23)

Marked and persistent fear of one or more social or performance situations involving exposure to unfamiliar people or to possible scrutiny by others; individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing

In children, evidence requires the capacity for age-appropriate social relationships with familiar people and anxiety must occur in peer settings, not just in interactions with adults

Exposure to feared social situation almost invariably provokes anxiety, which may take the form of situationally bound or situationally predisposed panic attack; in children, anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people

Person recognizes fear as excessive or unreasonable; in children, this feature may be absent

Feared social or performance situations avoided or endured with intense anxiety or distress

Avoidance, anxious anticipation, or distress in feared social or performance situation(s) interferes significantly with normal routines, occupational (academic) functioning, or social activities or relationships, or marked distress about phobia present

In individuals under age eighteen, duration of at least six months Fear or avoidance not due to direct physiological effects of a substance or general medical condition

Not better accounted for by another mental disorder such as Panic Disorder with or Without Agoraphobia, Separation Anxiety Disorder, Body Dys-morphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder

If general medical condition or another mental disorder present, fear unrelated to it

Specify if Generalized (fears include most social situations)

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