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FEARS AND PHOBIAS : ARE THEY NORMAL OR ABNORMAL ?
HS Dhavale*, Meenal SohaniI**
*Prof. and Head; **Ex. Lecturer; Department of Psychiatry, BYL Nair Hospital, Mumbai.
Phobias are one of the commonest psychiatric condition in the community, and among the commonest diagnosis in females. However, there is a paucity of cases in clinical practice. This study attempts to find the occurrence of specific phobia - animal type in the adult population. 250 people in the community were surveyed with a structured proforma. 50.2% had fear of one or more animals or insects. Female outnumbered males, onset was invariably in childhood and family history was present in 38.8% cases. But only 8% cases fulfilled the criteria for phobic disorder.
INTRODUCTION
A common incidence in our daily lives is, a blood curling scream emanating from some corner of the house, upon hearing which we rush to the room, anticipating the worst, only to find the young female family member standing on top of the chair, table or bed, petrified, tremulous or simply immobilized and pointing to a small harmless creature - a cockroach or a lizard. The creature is probably trying to save its own life by crawling into a crevice or shedding its tail rather trying to harm the lady. What the animal is showing a fear response and the lady is exhibiting a phobic response, that is out of proportion to its danger. The fourth edition of the diagnostic and statistic manual of mental disorders (DSM IV) includes three types of phobic disorders - agoraphobia, specific phobia and social phobia. Specific phobias are divided into four, animal type, natural environmental type, blood injection type and other types. In DSMIIIR, this was known as simple phobia, but as the name simple does not allow the occurrence of panic attack, which are common in these patients, the name was changed to specific phobia.
We decided to study specific phobias because as compared to agoraphobia and social phobia, which have been widely studied in the last decade, there are comparatively fewer studies on specific phobias. This may be due to a paucity of such cases in clinical practice, as phobic situations and objects can be easily avoided and do not interfere with daily routine. Yet, epidemiological studies have shown that phobias are one of the commonest conditions in the community and among the commonest diagnosis in females - six months prevalence of specific phobias being 5-10%. Amongst specific phobias animal phobias are commonest animal phobias are isolated fears of animal or insects. Such phobias involve fear and avoidance of animals in their own right rather than a fear of contamination by them. They are supposed to be uncommon in an adult that’s why we decided to study animal phobias in adults.
MATERIAL AND METHODS
A questionnaire was prepared to collect socio-demographic data and details of fears and phobias pertaining to animals and insects. A random sample of 250 people over the age of 18 were administered the questionnaire and the data was analyzed. The mental status examination was done to rule out other psychiatric disorders.
RESULTS
126 (50.4%) reported being fearful of one or more animal or insect. Multiple fears was reported by 50 (20%). Out of 95 males 25 (26.3%) and out of 155 females 101 (65.16%) gave positive history of fear.
Onset of fear started in childhood in 118 (94.4%) and 3 (2.38%) in adulthood. 32 people exactly remembered the triggering incidence. Family history of similar fear was present in 49 (38.9%) and absent in 77 (61.11%).
Lizard was the most commonly feared in 74 (58.75%) followed by cockroaches in 64 (50.79%) and rats in 34 (26.98%). Other animals or insects reported with lesser frequency were cats, spiders, butterflies, snakes, etc. Response to fear varied from screaming to immobilization. Screaming was present in 110 (87.3%), avoidance in 63 (50.7%), help seeking in 61 (48.41%), panic reaction in 34 (26.9%) and others like immobilization in 3 (2.38%). 70 out of 250 that is 28% felt the fear was excessive or unreasonable, 28 (11.2%) felt that fear was interfered in their daily routine and 20 (8%) realized both the fear as excessive and unreasonable and interfered with daily routine. So 8% fulfilled the criteria for phobic disorders. None of the patient had co-morbid psychiatric illness.
DISCUSSION
Nearly half the population studied reported being fearful of at least one animal or insect. Multiple animal / insect fear was present in 20% and 46% had other fears besides fear of animals e.g. fear of heights, closed places etc. fears and phobias appears to be commonly occurring phenomena. Hence the question - Are they normal or abnormal? The abnormality lies in the fact that although fear has survival values, what purpose does fear of a small or harmless creature serve? Any response which is purposeless is usually discarded as shown by evolutionary studies. Why then do phobic responses defy classical conditioning in becoming generalized and not getting extinct even on avoidance? The Freudian model to centering around oedipal conflict appears inadequate or inapplicable in most cases. Hence it appears that phobia arise only when factors interact on inherently present biological vulnerability.
TABLE 1
Fear of animals and insectsMales Female Total Present 25 (26.3%) 101 (65.16%) Absent 70 (73.7%) 54 (34.84%) Total 95 155 250
TABLE 2
Onset of phobiaNumber Percentage Childhood 118 94.4% Adulthood 3 2.38% Don’t remember 5 3.22%
TABLE 3
Family history of phobiasNumber Percentage Present 49 38.9% Absent 77 61.1%
Incidence of fear was much more in females as compared to males which is in agreement with most of the studies. According to Kaplan female to male ratio is about 2 to 1 and according to Ashok Singhal females suffering twice as compared to males. Singal case reports nearly all concern women and the 23 Maudsley cases included only one man. Although in young children animal phobias are common in both sexes, by age 10 to 11 they are already much rarer in boys. (Rutter et al). In ECA survey phobias were found in 100% females.
118 (94.4%) traced their fear to childhood. Specific phobias have an earlier age of onset compared to other phobias and among the subtypes, animal phobia is acquired the earliest. According to Marks, cases presenting for treatment as adults the animal phobia usually begins in early childhood before age eight and persisted fairly continuously thereafter. 25.39% remembered the exact triggering event for development of their fear, similarly Marks also found only 23% of a series ascribed the onset to a frightening encounter with the animal.
At least one other family member had a fear of insect or animal in 49 (38.8%), majority was mother or sibling. Most studies have shown that upto 73% of families of a proband have at least one relative with specific phobia, while persons with animal phobias are likely to have first degree relatives with animal phobia, though not of the same animal.
According to Marks mild fears of snakes, spiders, mice, dogs and other species are extremely common in general population of UK and variation in the species feared in different countries. In our study fear of lizard was maximum followed by cockroach, hence commonly found animals and insects in that geographical region appear to be objects of phobia.
Commonest responses were screaming followed by avoidance and help seeking, whereas smaller number responded by being immobilized till the animal was removed. Majority showed multiple responses. 70 out of 250 (28%) felt their fear excessive and unreasonable. 28 (11.2%) felt that fear interfered with their normal routine and only 20 (8%) felt both, fear being excessive or unreasonable, as well as interfering with their daily routine, hence qualifying for the diagnosis of specific phobia - animal type as per DSM IV. None of the patient had any co-morbid psychiatry illness.
According to Chapman TF the patient seeking treatment help are often different from untreated groups. The treated individuals report more phobias involving dogs and cats, elevators, and transportation, most have multiple phobias and many experience panic attacks in the context of their phobic stimulus. The untreated individuals typically report only one phobia, which is often related to blood injury and is seldom complicated by panic symptoms. In our study, 8% were suffering from phobic disorder and another 8% felt that they would benefit from treatment but neither group had sought professional help. This finding highlight the fact that there is a lack of awareness among the general population about phobic disorder and availability of effective treatment. Hence efforts towards increasing public awareness of this condition should be made.
REFERENCES
1.Singhal Ashok. Phobic disorders. Text book of Post graduate psychiatry. JN Vyas and Niraj Ahuja 2nd edition. Jaypee Brothers Medical Publishers Pvt. Ltd. New Delhi. 1999; 275-279.
2.Chapman TF, et al. Compassion of treated and untreated simple phobia. Am J Psychiatry 1993; 150 : 816-8.
3.Neurosis Part II. Oxford Textbook of Psychiatry Michael Gelder, Dennis Gath, Richard Mayou Oxford University Press. 150-185
4.Phobias and Obsessive Compulsive Phenomena : Classification, Prevalence, and relationship to other problems. Fears, phobias and rituals. Panic, anxiety and their disorders Issac M Marks. 1987; Oxford University Press. 1987; 281-322.
5.Social and specific phobias Fears, phobias and ritualspanic, anxiety and their disorders Issac M Marks. Oxford University Press. 1987; 362-400.
6.Specific phobias and social phobias. Synopsis of psychiatry behavioral sciences / clinical psychiatry Harold Kaplan and Benjamin Sadock. 8th edition. BI Waverly Pvt. Ltd. New Delhi. 1998; 603-609.
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