Anxiety Disorders 289
- Neurological factors that give rise to social phobia include an
amygdala that is more easily activated in response to social
stimuli, too little dopamine in the basal ganglia, too little sero-
tonin, and a genetic predisposition toward a shy temperament
(behavioral inhibition). - Psychological factors that give rise to social phobia include
cognitive distortions and hypervigilance for social threats—
particularly about being (negatively) evaluated. Classical
conditioning of a fear response in social situations may contrib-
ute to social phobia; avoiding feared social situations is then
negatively reinforced (operant conditioning). - Social factors that give rise to social phobia include parents’ model-
ing or encouraging a child to avoid anxiety-inducing social interac-
tions. Moreover, people in different cultures may express their social
fears somewhat differently (e.g., taijin kyofusho). The rate of social
phobia appears to be increasing in more recent birth cohorts.- Medication is the treatment that targets neurological factors,
specifically, beta-blockers for periodic performance anxiety,
and SSRIs or SNRIs for more generalized social phobia. The
treatment that targets psychological factors is CBT, specifi cally,
exposure and cognitive restructuring. Treatments that target
social factors include group CBT and exposure to feared social
stimuli.
- Medication is the treatment that targets neurological factors,
Making a Diagnosis
- Reread Case 7.4 about Rachel, and determine whether or not
her symptoms meet the criteria for social phobia. Specifi cally,
list which criteria apply and which do not. If you would like more
information to determine her diagnosis, what information—
specifically—would you want, and in what ways would the
information infl uence your decision?
Specifi c Phobias
During Hughes’s convalescence after a near fatal plane crash at the age of 40, he grew
concerned that he’d become afraid of fl ying. Before the crash, Hughes had loved to
fl y. But he knew that a number of his relatives had developed some extreme fears. For
instance, his mother “had an intense fear of animals and was known to faint when
one came near” (Barlett & Steeele, 1979, p. 30). Hughes’s paternal grandmother
“had developed a phobia about bugs, refusing to allow closets to be built in her new
home for fear insects would nest in them” (Barlett & Steele, 1979, p. 45).
His mother also was extremely anxious about Hughes’s health—she “watchedfor the slightest change in his physical condition. If she detected any abnormality in
his feet, teeth, digestion, or bowels, she whisked him off to a doctor for an examina-
tion. During outbreaks of infectious diseases, the two of them often left Houston
for some distant, uncontaminated place” (Barlett & Steele, 1979, p. 38). Hughes
himself was afraid that he’d develop an illness: “Raised to believe in his own deli-
cate nature and in the grave danger of being exposed to germs, he became obsessed
about his health.... He began to take pills and resort to all sorts of precautions to
insulate himself from disease and illness” (Barlett & Steele, 1979, p. 52). Mental
health clinicians would probably consider Hughes’s mother and grandmother—and
likely Hughes himself—each to have had a specifi c phobia.
What Is Specifi c Phobia?
What distinguishes normal fear and avoidance of an object or situation from its “ab-
normal” counterpart? DSM-IV-TR describes the central element of a specifi c phobia
as an excessive or unreasonable anxiety or fear related to a specifi c situation or ob-
ject (American Psychiatric Association, 2000). People with a specifi c phobia know
that their fear is excessive or unreasonable (see Table 7.10). (In contrast, a rational
fear of being mugged in a large city park late at night and avoiding parks after dark
would not be considered to be a specifi c phobia.) A person with a specifi c phobia
works hard to avoid the feared stimulus, often signifi cantly restricting his or her ac-
tivity in the process (see Case 7.5). A person with an elevator phobia, for example,
will choose to walk up many fl ights of stairs rather than take the elevator. Specifi c
phobias you might recognize include claustrophobia (fear of small spaces), arach-
nophobia (spiders), and acrophobia (heights). DSM-IV-TR lists five types or
categories of specifi c phobias: animal,natural environment,blood-injection-injury,
situational, and “other” (American Psychiatric Association, 2000).
Specifi c phobia
The anxiety disorder characterized by
excessive or unreasonable anxiety or fear
related to a specifi c situation or object.