phobic anxiety disorder
Introduction
Introduction to Terrorist Anxiety Disorder Terrorist anxiety disorder is called phobia. It is characterized by strong, persistent and irrational fears caused by a particular thing or situation, often accompanied by avoidance behavior, and the prevalence of phobia is lacking in exact statistics. According to the foreign data, the prevalence rate is about 6, which is more common in adolescents. Social phobia is equal to men and women. Square phobia and special phobia are more common in women. basic knowledge The proportion of illness: 0.19% Susceptible people: more common in teenagers Mode of infection: non-infectious Complications: depression
Cause
Causes of phobic anxiety disorder
(1) Causes of the disease
The cause of phobia is not yet clear, and current research is related to genetic, biochemical and special conditioning.
Square phobia (30%):
It is the most common type of phobia. The cause may be: square phobia often begins with a spontaneous panic attack, and then produces expected anxiety and avoidance behavior; suggesting the formation of conditionalization. Some clinical studies have shown that people with square phobia often have panic attacks at the same time.
Social phobia (25%):
The cause of social phobia is unknown. It is a kind of terrorist obstacle that is characterized by fear of being in contact with people or speaking in public, worrying about being ugly or embarrassing in front of others.
Object phobia (20%):
Also known as simple phobia or single phobia, special phobia. The cause is that some harmless things or situations overlap with fearful stimuli multiple times, forming a conditioned reflex, thus obtaining the nature of causing anxiety and becoming the object of patient terror. This anxiety is an unpleasant emotional experience that prompts the patient to take some action to avoid it. If the avoidance behavior reduces or eliminates the patient's anxiety, it becomes a strengthening factor, and the behavior itself is fixed and sustained by operational conditioning.
(two) pathogenesis
1. Genetic factors family and twin surveys suggest that place phobia may be related to heredity. Some surveys show that 60 cases of phobia probands and siblings 12.5% of the same place phobia, 13 pairs of monozygotic twins 4 For the same disease, and 16 pairs of twin-oval twins have no sickness.
2. Conditional Reflex Theory The phobia is caused by the occurrence of certain harmless things or situations and fearful stimuli, forming conditioned reflexes, becoming the target of fear of the patient, and causing anxiety, which can prompt the patient to take certain actions. Avoidance, if the avoidance behavior reduces the patient's anxiety, it becomes a strengthening factor, and this behavior is fixed by operational conditional reflex. For example, the recurrence of the symptoms of the place phobia makes the anxiety condition conditional, and the avoidance behavior hinders Conditional regression; plus fear, fainting and public outrage will be more anxious, horrible symptoms are formed and fixed.
3. Biochemical changes in social phobia patients may have 5-HT system (may be related to their emotional response) and NE dysfunction, social phobia patients may have a sharp rise in plasma adrenaline concentration when feared, may be related to the patient's cognitive process The panic attack of anxiety disorder does not have this phenomenon, and intravenous lactate can cause panic attacks in patients with anxiety, but does not cause panic in patients with phobia, suggesting that the biochemical mechanisms of the two disorders are different.
Prevention
Terrorist anxiety disorder prevention
At present, the causes of many mental illnesses are not detailed. Over the years, professional workers have continuously and carefully observed many mental diseases according to their living and working practices, and have formed some simple concepts, recognizing that many mental diseases are human individuals and The anomalous results of social or natural environment interactions, in quite a few cases, although the external conditions are similar, but the disease can be completely different, suggesting that individual characteristics play an important role in the occurrence of disease, therefore, people are preventing This type of disease advocates improving the mental health of people so that they can withstand the harmful effects of the outside world. This is:
1Cultivate the whole body, including the development of brain function, and support it to be in a healthy state, so that the body is strong and full of spirit.
2 Cultivate the healthy development of personality and strengthen exercise so that it can be adapted to the social environment.
When the treatment of exposure is implemented, the principle of treatment should be explained to the patient. The patient should be fully cooperated. There should be no intention to avoid the intention when exposing. Generally, it should be practiced from a project that is easy to be successful. The doctor should promptly affirm the progress of the patient, praise the family in the interim period. Homework, encourage patients to practice, and encourage relatives of patients to help patients with exposure exercises as "synergy therapists."
Complication
Complications of phobic anxiety disorder Complications depression
In view of the fact that depression is often accompanied by phobia, patients with all phobias should be carefully examined for the possibility of depression.
Symptom
Symptoms of Terrorist Anxiety Disorders Common Symptoms Panic attacks anxiety urinary tract insect bites or... Syphilis horror social fear depression trembling nervous dizziness
Common feature
(1) There is a strong fear of certain objects or situations. The degree of fear is not commensurate with the actual danger. Knowing that others do not feel dangerous or threatening in the same situation, but can not alleviate their fearful experience and anxiety.
(2) The episode is accompanied by autonomic symptoms such as dizziness, fainting, palpitation, trembling, sweating, etc.
(3) There is a strong evasive behavior against the object of fear.
(4) Know that fear is excessive, unreasonable, unnecessary, but uncontrollable.
(5) There is no symptom without touching a specific object or environment, but the patient feels nervous (expected anxiety) as long as he or she envisages entering a terrible situation.
2. Type
(1) Location phobia: also known as square fear, often originated from spontaneous panic attacks, and gradually produce expectant anxiety and avoidance behavior in corresponding occasions. Some scholars believe that square fear is a form of panic disorder, but other scholars It is believed that the disease is an independent disease from a panic attack, but both scholars believe that the generalization of symptoms and persistent patients are more and more related to the conditioned reflexes of anxiety, and that the behavior of avoidance Inhibition of de-reflective effects and fearful thoughts (such as fear of fainting or embarrassment when socializing) lead to the persistence of symptoms (the above disagreements are reflected in the classification system of the disease, and the US DSM-IV attributes the fear and panic of the square to panic disorder) In the middle, the international classification ICD-10 is classified as a single category. The square fears are more common in the early and middle 20s, and there is also a small peak in the middle of the 30s (and simple fears are more common in childhood, social fears At the end of the teens, the annual prevalence rate of the square fear is about 3%, and the female is twice as many as the male. If not treated, the square phobia can develop into a chronic Sexual diseases, avoidance will have a significant impact on the patient's work and social function, there are reports suggesting that people who are afraid of gait instability or fall in an open place are mostly after 40 years of age, and the course of disease tends to be chronic, most of them Patients can be cured by cognitive behavioral therapy, and some patients take the drug effectively.
Square fear is the most common type of phobia, accounting for about 60% of all cases. Square phobia is an anxiety in an unavoidable situation, or fear of panic attacks when it is difficult to get help in such a situation. Panic-like symptoms are often associated with panic disorder. Anxiety often leads patients to avoid many fearful situations. The horror objects are mainly specific environments, such as open spaces, crowded places, closed rooms, dark places, Elevators, public transport (crowded cabins, cars, train cars, airplanes and other confined spaces), etc., patients often appear to be afraid of leaving home, afraid of being alone, afraid of being unable to leave the home after leaving home or unable to leave the occasion immediately; fear Riding cars, planes, trains; afraid to go to theaters, restaurants, markets, afraid to wait in line, afraid to go far and away from home, afraid to go home after going out; fear of being alone, when the patient is accompanied, the horror can be significantly reduced, based on Clinical observations have the following two situations.
1 Square phobia without panic attacks: These patients have no panic attacks before and during the horror symptoms of the plaza. The main manifestations are as follows:
A. Fear of crowded places: such as venues, theaters, restaurants, vegetable markets, department stores, etc., or waiting in line.
B. Fear of using public transport: such as taking a car, train, subway, plane, etc.
C. I am afraid to leave home alone or stay alone at home.
D. Fear of empty places: such as wilderness, empty parks.
When a patient enters such a place or is in such a state, he feels nervous, uneasy, and has obvious autonomic nervous reactions such as dizziness, palpitations, chest tightness, and sweating; in severe cases, personality disintegration experience or syncope may occur, because the patient has strong fear Insecure or painful experience, often with avoidance behavior, if the patient avoids the fearful situation, the anxiety will decrease, the frequency of panic disorder will decrease, or even not occur, however, there is one or more similar After the experience, because of the expected fear of panic, often expecting anxiety, so even if panic attacks or panic-like symptoms disappear, square phobia will often continue to occur, whenever the patient encounters the above situation, they will feel anxious, Try to avoid or refuse to enter such places. When someone is accompanying, the patient's fear can be alleviated or disappeared. Usually, after the patient has experienced panic attacks or panic-like symptoms, the fear of the square gradually develops. However, once the square phobia develops, it is terrified. Symptoms can continue to occur or stop.
2 Square phobia has panic attacks: there are 3 kinds of performances:
A. Square phobia has no panic attacks before onset, no panic attacks in fearful places, extreme fear when experiencing fearful places or situations, reaching the diagnostic criteria for panic attacks, avoiding fearful places or situations, or horror Symptoms are effectively controlled, and panic attacks will stop. In this case, the phobia is the primary disease, and the panic attack is a secondary reaction.
B. Square phobia experienced one or more panic attacks before onset, fearing to go out alone or staying at home alone, fearing that no relatives and friends will be there when there is a panic attack; if someone is accompanying, you can eliminate fear and panic disorder After effective treatment, the horror of the square will gradually disappear. The primary disease of this type of case is panic disorder, and the horror of the square is a secondary symptom.
C. Square horror and panic attacks are seen in the same patient. Patients are nervous and nervous when they are crowded. In general, there are panic attacks. This situation often requires appropriate treatment, and the two types of symptoms will disappear. For both comorbidity.
(2) Social phobia (social anxiety phobia): The main feature of social phobia is fear of being examined or denied by others, fearing that you will do something embarrassing, or that some performance may be humiliating (including showing obvious Anxiety symptoms), this concern can be limited to specific occasions, but also can be involved in most social situations, social phobia symptoms can occur in the late teens - most concerned with the period of leaving impressions to others, or suddenly in normal people Usually, for the first time, a serious anxiety attack induced by stress events, because of fear of others paying attention to and criticizing their anxiety, the symptoms are often sustainable after the first episode, and the terrorist objects are social occasions and interpersonal contact, which is manifested as fear of being in full view. On occasion, everyone looks at themselves, or fears that they are ugly in public, making themselves in an embarrassing or bail-out situation. Therefore, they are afraid to eat in public places, go to the toilet, make public speeches or perform, and when they are writing, they cant control their hands and tremble. In a social setting, you cant answer, you can also be afraid to see people blush and be seen by others. Seeing uneasy or consciously blushing, (red face phobia, erythrophobia), afraid to look at others, or think that the eye's afterglow is peeping at others, and therefore fearful (seeing phobia), afraid to meet strangers in public places People or people familiar with (human phobia, anthropophobia), fear of meeting with the opposite sex (heterosexual phobia).
Most people with social phobia are only afraid of one or several social interactions or public performances. They are called special social phobia. Under normal circumstances, they can be completely asymptomatic. Their anxiety symptoms are only fear of encountering fear. Social occasions (expected anxiety) or have entered a fearful situation, when the patient feels varying degrees of tension, anxiety and fear, often accompanied by autonomic symptoms such as blushing, sweating and dry mouth; especially shy blushing The most prominent manifestation of social horror, cognitive aspects pay special attention to their expressions and behaviors when meeting people, and their social performance is too low, serious social horror, can cause panic attacks when extremely nervous, afraid of socializing A very wide range of cases, called generalized social phobia, such patients are often afraid to go out, do not dare to interact with people, even long-term social life, can not work, and some patients can be accompanied by avoidance personality disorder (avoidant personality disorder), in leaving these environments, there can be no symptoms at all, just worrying about In the fear of social occasions (expected anxiety), it is often manifested as not courage to interact with people, or even long-term separation from public social life, serious people can not work, there is no obvious incentive for the incidence, most patients (especially those with higher education level) ) The effect is better with proper treatment.
Social phobia is fear of being negatively evaluated. It is often because people don't like to talk about their fears and is not recognized by people. It can also be confused with shyness by doctors or considered to be secondary to depression or material dependence. Identification, social phobia is not uncommon. When someone says "I see people nervous," you should consider whether there is social phobia.
(3) Object phobia: also known as simple phobia or monophobia, special phobia, the main object of fear is certain specific objects or situations, the situation of triggering is very simple, very specific, this A syndrome also contains three components: anticipatory anxiety, anxiety caused by fearful stimulation, and avoidance behaviors to alleviate anxiety. These patients are often afraid of not being in contact with these objects, but are worried that the contact will have dire consequences. For example, patients do not dare to touch sharp objects, fear that they will use such items to hurt others, do not dare to cross the bridge, fear that the bridge will collapse, fall into the water, fear that all kinds of small animals will bite themselves, etc. Most patients recognize these Fear is excessive and unreasonable. Actually, there is nothing terrible, but it is impossible to control one's fear. Even if you guarantee to the patient, you can't alleviate their fear. According to the characteristics of the patient's fear, they can be divided into the following types. Type: Animal Horror: Fear of spiders, insects, mice, etc., natural environment horror: fear of lightning, ascending, water, darkness, etc. Fear of entering closed spaces such as cars, elevators, airplanes, blood-injury-injection horror: fear of seeing bleeding, exposed wounds and receiving injections, sharp and sharp objects such as knives, scissors, axes, etc.; other causes suffocation, vomiting or disease a place; a patient or scene that is afraid of being exposed to a specific disease; eating something; going out to find a toilet, worrying about putting the feces on the body, etc. The above various phobias may appear alone or in combination, although the patient can recognize These fears are excessive, unreasonable, but uncontrollable, and even if they are assured to the patient, they cannot alleviate their fears, and the degree of functional impairment depends on how easily the patient avoids the fear situation, usually in childhood or early adulthood. It appears that if left untreated, it can last for decades. It has been reported that animal phobia often begins in childhood and can relieve itself with age.
There are other phobias and specific phobias. The specific phobia is characterized by persistent, unreasonable fear and avoidance of a thing or situation. The scope of the situational object causing a particular phobia is very small. Young mammals have had some protective functions. There are two sets of situations: one is high, the confined space, falling in calm water, suffocating and drowning, and the other is from poisonous insects, snakes and carnivores. Everyone will be wary of these situations, but certain phobia patients will have an expectation of anxiety in these situations. Their fears are not commensurate with the dangers of the situation. The fear of blood and damage is a special case, with a protective function, for flight. The fears are various and need to be focused on what the ultimate danger is. The fear of flying may be due to fear of high altitude or confined space, may be a manifestation of phobia or social phobia, or Unexpected conditioned reflex fear, the ultimate risk or reason for fear of patients with each disease is completely different, the weight of treatment What depending on the ultimate fear why.
When a particular phobia is faced with a fearful situation, there may be a panic attack, or a high heart rate or a strong heartbeat, tremors, collapse or dizziness, difficulty breathing, and sweating.
Depending on the nature and location of the fear situation, the severity of anxiety is usually different (eg, the size of the animal, whether the animal is active, and the distance from the animal).
Usually, certain phobia patients always try to avoid the fear situation as much as possible. The degree of fear and avoidance hinders their life or causes obvious distress. When they don't touch or don't want to go to the fear situation, there is no anxiety. Usually the patient thinks Fear is unreasonable or excessive.
Examine
Examination of horrible anxiety disorder
There is no specific laboratory test index for this disease.
Neurological examination, exclusion of nerves, organ organic lesions, for patients with a tendency to depression, to do ZUNG's Depression Scale score, the scale is as follows:
ZUNG Depression Scale
Please rate according to your feelings in the past week. The order of numbers is from no, sometimes, often, continuous.
1, I feel depressed, depressed 1234
2, I feel the best mood in the morning 4321
3, I want to cry or want to cry 1234
4, I sleep bad at night 1234
5, I eat as much as usual, 4321
6, my sexual function is normal 4321
7, I feel weight loss 1234
8, I am troubled by constipation 1234
9, my heartbeat is faster than usual 1234
10, I feel tired for no reason 1234
11, my mind is as clear as usual 4321
12, I do things as usual, do not feel difficult 4321
13, I am restless, it is difficult to maintain calm 1234
14. I feel hope for the future 4321
15. I am more likely to irritate 1234 than usual.
16, I think it is easy to decide what is 4321
17. I feel that I am a useful and indispensable person 4321
18, my life is very meaningful 4321
19, if I die, others will live better 1234
20, I still love my favorite car West 4321
Analysis of results: The indicator is the total score. The scores of the 20 items are added together, that is, the rough score is obtained. The standard score is equal to the integer part of the coarse division multiplied by 1.25, and the normal upper limit of the total coarse division is 41 points. 53 points, for reference only.
This rating scale can not only help diagnose the symptoms of depression, but also determine the severity of depression. Therefore, it can be used as a tool to assist diagnosis and on the other hand to observe changes in depression during treatment. It is used as a judgment indicator for curative effect. However, this rating scale cannot be used to judge the nature of depression, so it is not the cause of depression and the classification of disease diagnosis.
Diagnosis
Diagnosis and identification of terror anxiety disorder
diagnosis
This disease is based on terror as the main symptom. According to clinical manifestations and characteristics, it is generally not difficult to diagnose, specific environment, specific objects or interactions, etc., resulting in strong fear or nervousness, so it is strongly avoided.
1. Square phobia diagnosis is a fear of being alone away from home, to a crowded place, accompanied by anticipatory anxiety and avoidance behavior, with or without panic attacks, such as fear of limited places In social places, patients are mainly worried that their expressions and behaviors will be diagnosed as social phobias when they are given bad evaluations. If the feared place is limited to a specific situation, then the diagnosis of simple phobia should be considered, fear of being contaminated. Avoiding certain objects or places, those who are obsessed with obsessive-compulsive attitudes should be diagnosed with obsessive-compulsive disorder, and those who are concerned with previous severe trauma should consider post-traumatic stress disorder. If children are afraid of leaving the family or relatives in childhood, they should consider parting anxiety. Separation anxiety disorders; refusal to attend school is school phobia, according to ICD-10, diagnostic criteria for phobia:
(1) Anxiety occurs mainly in (or only in) at least two situations: noisy and crowded places, public places, leaving home, going out alone.
(2) Obviously avoiding the situation of fear.
2. Social phobia diagnosis According to ICD-10, social phobia can be diagnosed when the following characteristics are met.
(1) Significantly and persistently in one or more social or operational situations that are afraid of being looked upon, that is, fearing that they will be embarrassed or humiliating (including showing symptoms of anxiety).
(2) Exposure to a fearful situation can cause anxiety and can lead to panic attacks.
(3) Knowing that this fear is unreasonable and excessive.
(4) This fear leads to obvious pain when exposed to social situations or leads to avoiding social situations.
3. Object phobia diagnosis According to ICD-10, the diagnosis of a specific phobia must meet the following characteristics.
(1) There are persistent and unreasonable concerns about a thing or situation (excluding fear caused by panic disorder, social phobia, square phobia, obsessive-compulsive disorder, and post-traumatic stress disorder).
(2) When you are exposed to a fearful situation, you have an immediate anxiety reaction.
(3) Avoiding the terrorist situation or experiencing extreme anxiety in this situation.
(4) Fear, avoidance or suffering hinders normal life and social activities.
(5) I think this kind of worry is unreasonable or excessive.
The phobia needs to be identified with the following diseases:
1. Anxiety disorders should pay special attention to the identification of anxiety disorders. There is no obvious cause of acute anxiety disorder (panic disorder), no relevant objective and dangerous environment, the episode is not easy to predict, and there is anxiety in the intermittent period that is afraid of recurrence. This is related to phobia. The predictability is different; generalized anxiety is a constant or persistent fear of no clear object and specific content. This is different from the fear of the object or environment in the phobia. The anxiety of phobia is caused by a specific object, and Relieving anxiety can take evasive behavior. Anxiety anxiety is not a response to a specific subject, and there is no obvious fear and avoidance behavior, but it should be noted that some patients have both phobia and anxiety symptoms. Symptoms can make two types of diagnoses at the same time.
2. Obsessive-compulsive disorder is characterized by obsessive-compulsive symptoms. The obsessive-compulsive symptoms stem from certain thoughts or concepts in the patient's heart. They are not fears of external things, and there are few avoidance behaviors.
3. The suspected illness is the main clinical phase with the suspected symptoms. The object of horror is not external, but its own disease or deformity, such as fear of illness (disease of disease) or fear of deformation (deformation and horror), all should be suspected A condition is classified as phobia if it is fearful of the disease and is repeatedly caused by possible exposure to the source of the infection or source of contamination, or simply fear of medical operations or medical institutions.
4. Schizophrenia This disease can have transient phobia symptoms, but the presence of characteristic symptoms of schizophrenia can be identified.
5. Square phobia differential diagnosis
(1) Generalized anxiety disorder: These patients also experience anxiety in public, but the anxiety is only part of the anxiety of many occasions, and there is no characteristic avoidance behavior of square fear. In the case of difficulty in identification, Ask the patient if the early onset of the disease is situational or extensive.
(2) Social fear: Many feared patients in the square are afraid of social occasions, and some socially feared patients will avoid crowded stations and shops, and carefully ask about their avoidance behavior and early performance of the disease to identify, that is, serious social phobia patients He is afraid of going out or going to the public because he is afraid of being looked at by others, and in the phobia of the square he is afraid of panic attacks.
(3) Depressive disorder: Depressed patients can avoid shops and people due to low mood, but careful mental examination can reveal their depressive symptoms. It is worth noting that depression can occur on the basis of long-term square fear disorder.
(4) Schizophrenia: Sometimes patients with paranoia may have some avoidance behaviors like square fear. If the patient hides his or her delusions, the diagnosis may be difficult, but repeated mental examinations can finally confirm the diagnosis, that is, the patients with delusions are People who believe in the street want to hurt their imaginative beliefs and avoid public places.
(5) Obsessive-compulsive disorder: Some obsessive-compulsive patients avoid public transportation because of forced fear, and the avoidance of square phobia patients is not the result of forced thinking.
6. Social phobia differential diagnosis
(1) Most people have normal social anxiety or avoidance experiences, such as fear of speaking in public places. Such fears should not be diagnosed as social phobia if they do not interfere with their social or professional functions.
(2) Avoidance personality disorder, usually with social anxiety and avoidance. The difference between this disorder and social phobia may be quite difficult. The two obstacles may overlap each other. For details of avoidant personality disorder, please refer to the personality problem. Chapter.
(3) Square phobia can have an avoidance of social situations, but this avoidance is often followed by fear of panic attacks in public places. This is not a fear of the social situation itself, but a fear of panic in such a situation. The attack cannot escape or get help.
(4) A specific phobia refers to the fear of a particular stimuli. However, such stimuli are usually not social, but insects or animals, usually fearing the stimuli themselves rather than fearing embarrassment or shame in public places.
(5) Schizophrenia may have the illusion of being noticed or examined by others. However, a careful diagnosis can be made by careful medical history and mental examination. Social phobia has no symptoms of typical schizophrenia such as mental disorder or apathy.
(6) Some social fear beliefs may be very firm. If you think that your body odor or a certain part of your body is deformed or ugly, it may cause others to look at or negatively evaluate. If there is such a delusion (that is, regardless of the opposite and objective facts, false beliefs) Very firm), then you can attach a diagnosis of delusional disorder.
The situation that social phobia patients are afraid of is limited to the occasion of dealing with people, meeting people, worrying about being in an embarrassing situation when speaking or performing in public, and avoiding, and fearing that people are crowded with square phobia, worrying about the inner heart that cannot escape. The experience is inconsistent, and the motivation for obsessive-compulsive disorder is different from that of obsessive-compulsive disorder.
7. Object phobia differential diagnosis The object of fear of simple phobia patients is often limited to one or a few special objects, situations or activities, rarely generalized, and the motivation for avoiding behavior is to worry about serious consequences, not fear of panic attacks. People help or get out of trouble, some people can not alleviate fear, can be identified with square horror or social horror, obsessive-compulsive patients are afraid of dirty origins from the obsessive concept of fear of pollution, different from simple terror, afraid of their own incurable disease, Such as cancer, AIDS, or infectious diseases, such as hepatitis, syphilis, leprosy, etc., seeking medical treatment everywhere, called disease phobia, should be classified as suspected diseases.
(1) Patients with panic disorder have a sudden panic attack experience, but this panic attack is unpredictable and does not always respond to specific fear situations.
(2) The avoidance of certain situations and activities by social phobia patients is due to fear of losing face or being negatively evaluated by others, and not limited to fear of social occasions themselves, but only fear of the consequences in such situations.
(3) Obsessive-compulsive patients fear and evade specific activities or things to avoid the consequences of fear (such as avoiding the use of chemicals is afraid of being contaminated, or avoiding the use of sharp knives to prevent the urge to stab wounds).
(4) Similarly, patients with post-traumatic stress disorder avoid specific situations or things related to traumatic events to prevent re-experience of traumatic events.
If any of the above differential diagnoses is met, it should not be diagnosed as a specific phobia.
