Phobic Disorders - Introduction
The DSM IV( diagnostics and statistical manual) - contains a list of all mental disorders and a description of the signs and symptoms of the disorders.
It is used by psychiatrists to diagnose patients with mental disorders and decide what treatment is best to use.
A classification system is valid it the symptoms described are actually symptopms of the illness. A system can be reliable but not valid, but a classification can only be relaibe if it is valid.
Diagnosis of Phobias , is ususally clear and unambiguos. It will include
- persistent fear or a specifis situation which is out of proportion to the real danger.
- they have a sense that something catastrophic will happen
- a compllling desire to avoid and escape the situation
- recogntion that the fear is unreasonable and they are aware that they have a problem but feel unabel to control thier behaviiour
The DSM IV identifeies 3 diffrent catagores of phobias
- Social Phobia
- Specific Phobia
Classification of Phobias
Fear of open spaces.People with agoraphobia are anxious when not at home, in crowd or in a situation they can not easily leave .
An intense and exessive fear of being in a social situation.An individual experiences innaproriate anxiety in social situations
Fear of a particular object or specific situation. Types of Specific phobia include :
- Animal type
- Natural environment
Symptopms of Fear
- expectation of impending harm . we worry about what will happen and often anticipate dire consequenses
- not being able to move or running away or avioidance behaviour
- Feelings of dread terror panic e.t.c
- experiencing these feeilings for a long time can lead to fealling drained and overwhelmed
- the bodys emergency reaction to danger.
- the sympathetic nervous systemis activated( fight or flight response)
- involuntary physiological responses such as dry mouth, palpitations , tense muscles and sweating
Issues of Classification and Diagnosis of Phobic D
There is more than one classification system:
- Chapter 10 if the International Classification of Diseases (ICD-10) produced by the worl health organisation
- The Diagnostics Statistical Manual of Mental disorders ( DSM - IV ) produced by the American Psychatric Association
- there is reasonablly good agreement between the two manuals. however the DSM classifies agoraphobia as a panic dosorder when panic attacks are present
The Myth of Mental Illness
- Thomas Szasz argued that Md's such as phobias arr a myth
- phobias are simply prblems of living
- over medicalising the problem makes it worse and takes power away from the person to deal with the issue
- he believed that we see mental disorders such as phobias as mental illnesses when they are actualy just symptoms of the problem of living
diagnosis can produce benifits in terms of ra[id and effective tratmetn but can also have negative effects in therms of labelling.
someone with a phobia may suffer adverse consequences and can be treated differently bu socoiety .
Doctors may interprit all medical thing wihich happen to them in terms of thier phobis.
Reliability and Validity
Reliability means Consistency - a system is said to be valid if people using it consistently arrive at the same diagnosis
Inter- Rater reliablity- testing the reliability by seeing weather two clinicans agree on the same diagnosis
Test Retest: this is when the patient is assesed two or more times to see if the same results are given consistently
Consturuct validity : this is the extent to which a categorie of mental disorder really exists
Issues in the diagnosis of phobic disorders
- Phobias have a distinct set of easily recognisabel symptoms so would expect thier diagnosis to have good reliablilty
Issues Pt 2
Many People with diagnosed with one anxiety disorder also show signs of another anxiety disorder and this raised issues about validity of some categores and distinct symptoms. This draws attention to the issue of Muttally exclusicity. Categories of mental disorders shoudl not overlap. An ideal diagnostics system shoudl not allow 2 categories of mental disorders to contain the same signs and symptoms.
Phobias can co-occur making it difficult to identify which should be treated. This is important as establishing the primary disorder influenses the treatment offered.
- People with socal Phobias can oftern suffer from agoraphobia and or panic disorder. Some mental disorders precede others.for example social phobia can actually be a good predictor of depression but also increases the severty of sympotms. If a social phobia can be accurately diagnosed at an early stage, it might prevent the onset of depression
- there are many similarites between social phobia and avoidant personality disorder. Many people demonstrate characteristcs that meet the criteria for both diagnosis which again threatens the validity of the DSM
- the implication of this assumption of seprate categories is that a person is either normal or abnormal
- Particular phobias are recognised in some cultures but not in others