Blood-injury-injection phobia and dental phobia

The present study was carried out to explore the relation between BII phobia and dental phobia. An additional aim was to determine the fainting tendency of dental phobics and BII phobics during an invasive treatment procedure. Participants were 63 patients undergoing treatment in a dental fear clinic, and 173 patients undergoing dental surgery in a university hospital. They completed measures on fears of particular medical and dental stimuli, fainting history, general trait anxiety, dental anxiety, BII anxiety, BII avoidance, and a questionnaire aimed to define a phobia based on DSM-IV criteria. Immediately after treatment information was obtained on exposures to blood or injections, state anxiety, and feelings of faintness during treatment. The results did not indicate any significant relationship between measures of dental anxiety and BII anxiety or BII avoidance. However, 57% of the dental phobic patients could also be classified as BII phobic. The proportion of dental phobics who reported fainting episodes in their past was similar to that of the BII phobics (37%), but none of the participants fainted during treatment. It is concluded that, albeit the level of co-occurrence for both types of phobias is high, dental phobia should be considered as a specific phobia, independent for the BII subtype within DSM-IV. Further, the findings are inconsistent with the notion that individuals with BII phobia have a remarkably high tendency to faint in the presence of their phobic stimuli.     

Managing the anxious and phobic dental patient

This article discusses dental anxiety and phobia. The author presents background information, including incidence and etiology. A discussion of evaluative techniques for assessing anxiety levels follows. Examination and treatment planning are considered in relation to this patient's special needs. The article stresses behavioral treatment modalities that eliminate the debilitating phobia. In closing, the author presents practical information regarding prevention of dental phobia and the merits of incorporating this type of patient into a dental practice.     

Stressful life events and personality styles: relation to impairment and treatment outcome in patients with social phobia

Forty-five patients with social phobia and 15 individuals with no mental disorder were compared on number and type of life events experienced. Social phobia patients were further examined to evaluate the effect of negative life events and of the interaction between personality style and life events on severity of impairment and reactions to cognitive-behavioral group therapy. Patients with social phobia reported more negative life events than participants with no mental disorder. Among patients with social phobia, more frequent negative life events were associated with higher scores on measures of depression and general anxiety. Patients high on autonomy who reported more negative autonomous (i.e., achievement-oriented) life events also scored higher on measures of social anxiety and general anxiety. There were no significant interactions between sociotropy and the frequency of reported socially oriented negative life events. However, patients high on sociotropy scored higher on measures of social anxiety, depression, and general anxiety. Patients who had experienced more negative life events improved more after treatment on measures of social anxiety than did those who had experienced fewer negative life events. Implications of these findings and recommendations for future research are discussed.     

Age of onset in different phobias.

The age of onset, other background data, and measures from behavioral avoidance tests were studied in 370 phobic patients. They belonged to six different categories: agoraphobia (n?=?100), social phobia (n?=?80), claustrophobia (n?=?40), animal phobia (n?=?50), blood phobia (n?=?40), and dental phobia (n?=?60). Results showed that animal phobia had the earliest onset age (7 years), followed by blood phobia (9 years), dental phobia (12 years), social phobia (16 years), claustrophobia (20 years), and agoraphobia (28 years). The groups also differed in marital and occupational status, heart rate, anxiety experiences during the behavioral test, and general fearfulness. On the whole, agoraphobia and animal phobia stood out as the extremes on many measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The formation and persistence of a dental treatment phobia

The anxiety which accompanies dental care may in some cases represent a disabling handicap. The authors have outlined the characteristics of this type of dental anxiety and describe the typical pattern with which "odontophobia" is formed and persists over time. This enables them to understand the "attempted solutions" used to overcome this phobia, opening the way to the study of psychological interventions which may prove efficacious and effective.     

Development and psychometric evaluation of the Index of Dental Anxiety and Fear (IDAF-4C+).

The measurement of dental fear is important due to its high prevalence and appreciable individual, clinical, and public health consequences. However, existing measures of dental anxiety and fear (DAF) have theoretical or practical limitations. This study describes the development and subsequent assessment of the reliability and validity of test scores of a new DAF scale for adults. The Index of Dental Anxiety and Fear (IDAF-4C+) contains 3 modules that measure DAF, dental phobia, and feared dental stimuli. The final 8-item DAF module (IDAF-4C) assesses emotional, behavioral, physiological, and cognitive components of the anxiety and fear response. The proposed scale dimensionality received support from exploratory factor analysis. IDAF-4C items showed good internal consistency (Cronbach's α = .94) and test–retest reliability at 4 months (r = .82), and the scale was strongly associated with other dental fear scales as well as with dental visiting patterns, avoidance of the dentist, and dental phobia diagnosis. The convergent and predictive validity of the IDAF-4C compared positively to Corah's (1969; Corah, Gale, & Illig, 1978) Dental Anxiety Scale and a single-item measure of dental fear, and the scale predicted future dental visiting and visit perceptions. Both phobia and stimulus modules showed strong and statistically significant associations with DAF ratings. In all, sufficient evidence is provided to demonstrate that the new scale would be a useful tool to assess DAF in an adult population. The IDAF-4C+ is based on strong theoretical underpinnings, yet the scale is practical enough for application across a variety of potential uses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality traits in social phobia, II: Changes during drug treatment

BACKGROUND: Patients with social phobia often describe personality traits characterized by avoidant social behavior and more general depressive-anxious features. There is only sparse knowledge about the effects of drug treatment on these traits. METHOD: Fifty-seven patients with social phobia completed a 12-week double-blind, placebo-controlled trial with the reversible and selective monoamine oxidase A inhibitor brofaromine 150 mg/day. The Clinical Global Impressions-Improvement scale, Liebowitz Social Anxiety Scale, a questionnaire with 140 items regarding personality traits, and ratings on the presence or absence of diagnostic criteria for the DSM-III-R avoidant and dependent personality disorders were used for assessments at baseline and endpoint. Comparisons were made with a group of 58 healthy controls. RESULTS: Before treatment, there were no significant differences between the brofaromine and placebo groups in their ratings on situationally bound social anxiety or on personality traits that differed significantly from those of the controls. At endpoint, a marked normalization was noted in the brofaromine group. The changes that had occurred differed significantly from those in the placebo group. The normalization of traits seemed more marked than the normalization of anxiety in more specific social phobic situations. The number of brofaromine patients who fulfilled the criteria for avoidant personality disorder had diminished from 15 (60%) to 5 (20%). CONCLUSION: The results support the conclusion that the maladaptive personality traits characteristic of social phobia are at least as responsive to the monoamine oxidase inhibitor brofaromine as are the more circumscribed social anxiety responses.     

An evaluation of the iatrosedative process for treating dental fear

The iatrosedative process is an interpersonal-cognitive technique by which fearful patients are calmed by the behavior, attitude, and communicative stance of the dentist. The process consists of an iatrosedative interview and a clinical encounter. In our study, 58 fearful dental patients were assigned to 1 of 3 treatment groups. The Corah Dental Anxiety Scale was administered at admission to the clinic, immediately after the iatrosedative interview or standard interview, and again after the first and second clinical encounters. Participants who received the iatrosedative interview had a significantly greater reduction in dental anxiety after the interview than those who received the standard interview. After the two clinical encounters, however, the difference in anxiety reduction between the two groups was not significant. In addition, there was no significant difference in anxiety reduction between iatrosedative participants who had the same dentist for both the interview and the clinical encounter and participants who had different dentists for each part of the study. It is concluded that an iatrosedative interview is more effective than a standard dental interview in decreasing anxiety.     

Processing threatening information in posttraumatic stress disorder.

The authors used a modified Stroop task to study how people with posttraumatic stress disorder (PTSD) process threatening information. Participants were motor vehicle accident (MVA) survivors with either PTSD (n?=?15), simple phobia of driving (n?=?15), or low anxiety (n?=?15). Participants named colors of 4 types of words: strong threat words (MVA related), mild threat words (MVA related), positive words, and neutral words. Participants with PTSD demonstrated greater interference on strong threat words than those with simple phobia or low anxiety. Contrary to expectation, participants with simple phobia did not display an interference effect. Findings suggest that individuals with PTSD and simple phobia may process threatening information differently. The nature of attentional bias in different anxiety conditions following trauma is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Social Thoughts and Beliefs Scale: A New Inventory for Assessing Cognitions in Social Phobia.

Development and initial psychometric features of a new inventory to assess cognitions associated with social phobia are described. The Social Thoughts and Beliefs Scale (STABS) is designed to assess cognitions in individuals with social phobia. In the 1st study, an initial pool of 45 items was reduced to 21. In the 2nd study, psychometric features of the scale were examined in a sample of individuals with social phobia, other anxiety disorders, and no psychiatric disorder. Total scores and two factor scores significantly differentiated individuals with social phobia from those in the other groups and were found to have adequate test-retest reliability and internal consistency. Potential usefulness of the STABS for assessing cognitions associated with social phobia is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral treatment of childhood social phobia.

Sixty-seven children (ages 8 and 12) with social phobia were randomized to either a behavioral treatment program designed to enhance social skills and decrease social anxiety (Social Effectiveness Therapy for Children, SET-C) or an active, but nonspecific intervention (Testbusters). Children treated with SET-C were significantly more improved across multiple dimensions, including enhanced social skill, reduced social fear and anxiety, decreased associated psychopathology, and increased social interaction. Furthermore, 67% of the SET-C group participants did not meet diagnostic criteria for social phobia at posttreatment compared with 5% of those in the Testbusters group. Treatment gains were maintained at 6-month follow-up. The results are discussed in terms of treatment of preadolescent children with social phobia and the durability of treatment effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tumor antigen presentation: changing the rules

The relationship between dental status and dental anxiety was analysed in 165 patients. To assess the dental status, D3.4 MFS-index and Bleeding-on-Probing-Index (BOP) were applied. Dental anxiety was assessed using dental anxiety rating, whereas aspects of state and trait anxiety were analysed by the State-Trait-Anxiety Inventory. The hypothesis was: higher levels of dental anxiety lead to avoiding check-ups and necessary treatment, the consequence of which is a deterioration of the dental status. No significant correlation was found between dental anxiety and dental status. A significant difference was found when comparing patients with high or low dental anxiety in respect of the D3.4 MFS-index, whereas a different trend was found on comparing these groups for BOP-index. In addition, a significant correlation was found between dental anxiety and trait anxiety. These results suggest that dental anxiety is a rather non-specific phenomenon, since it is an aspect of proneness to anxiety. In addition, in patients who display considerably high dental anxiety, this may lead to anxiety denial and abnormal behaviour (e.g. avoidance of dental hygiene or care) thus contributing to further deterioration of oral health.     

Social phobia: long-term treatment outcome and prediction of response--a moclobemide study

In this open, prospective, structured, naturalistic study of the efficacy of long-term treatment in social phobia 93 consecutive outpatients suffering from severe generalized or circumscribed social phobia (median Liebowitz Social Anxiety Scale score 83) and a high degree of concomitant psychiatric disease were administered treatment with moclobemide (712 +/- 75 mg/day at steady state). Fifty-nine patients who responded (Clinical Global Impression for Change: very much/much improved) completed 2 years of treatment. Patients then entered a drug-free period of at least 1 month during which 88% of the patients deteriorated. In a further 2-year treatment period with moclobemide those patients who had deteriorated became responders again. Symptoms recurred in a substantial number of the patients at the end of the study when the dose was reduced and then discontinued. Post-study follow up at 6-24 months after study completion found that 63.2% of patients were almost asymptomatic or had only mild symptoms, 15.8% were off all treatment, 28.1% were back on moclobemide, 10.6% were taking another psychotropic drug and 8.8% were in psychotherapy. All previous non-responders to moclobemide and mostly alcohol abusers (36.9%), had moderate or severe social phobia and were off all treatment (13.3%), on psychotherapy (15.9%) or on another psychotropic drug (8.8%). Discriminant analysis correctly predicted outcome in 93.5% of all patients. Alcohol abuse was by far the strongest predictor of negative outcome. Coexisting generalized anxiety disorder and dysthymia were less potent in this regard, whereas high baseline Hamilton anxiety or depression scale scores, circumscribed social phobia, or social phobia unassociated with avoidant personality disorder were predictors of a positive outcome. In conclusion, severe social phobia can be successfully treated in the long-term but many patients may need medication or psychotherapy for many years. Treatment should start as early as possible because complications such as alcohol abuse make treatment difficult.     

Validity of the distinction between generalized social phobia and avoidant personality disorder.

Disorders of pervasive social anxiety and inhibition are divided into 2 categories: generalized social phobia (GSP) and avoidant personality disorder (APD). The authors explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 Ss showed high comorbidity of the 2 diagnoses: All Ss who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. The authors also investigated a proposed social phobia subtyping scheme. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The validity of the DSM-III posttraumatic stress disorder classification as applied to adolescents.

Examined the validity of the posttraumatic stress disorder (PTSD) classification as it applies to adolescents of both sexes. 24 adolescents (mean age 13.81 yrs) who met Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for Axis 1 PTSD, 24 Ss (mean age 13.67 yrs) who met DSM-III criteria for simple phobia, and 24 controls (mean age 13.28 yrs) were compared using a children's PTSD inventory, a children's manifest anxiety scale, the Children's Depression Inventory, and the Test Anxiety Inventory. Their work was also rated by their classroom teachers according to the Connors Teacher Rating Scale criteria. The PTSD group was found to evidence higher levels of self-reported anxiety, depression, and behavior problems than other groups. The simple phobia group presented higher levels of self-reported test anxiety than other groups. Findings support the DSM-III PTSD classification as it applies to adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety, locus of control, type of preparatory information, and adjustment to dental surgery.

Evaluated the effects of 2 types of preparatory information (general, specific), given prior to dental surgery, on state anxiety and adjustment in the dental situation for 63 19-74 yr old dental patients who differed in locus of control orientation and generalized level of dental anxiety. N. L. Corah's Dental Anxiety Scale, administered an average of 24 days presurgery, predicted differential elevations in state anxiety in the dental situation. This finding is discussed in terms of the need to develop situation-specific trait anxiety measures for physical threat situations. Internal Ss viewing the specific information tape showed better adjustment during surgery than internals who viewed the general tape. The converse was true of external Ss, who responded more favorably to the general information tape. Findings are discussed in terms of the locus of control construct and are viewed as supporting the need for the development of differential treatment strategies for homogeneous patient groups. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediation of changes in anxiety and depression during treatment of social phobia.

To investigate the interactive process of changes in social anxiety and depression during treatment, the authors assessed weekly symptoms in 66 adult outpatients with social phobia (social anxiety disorder) who participated in cognitive- behavioral group therapy. Multilevel mediational analyses revealed that improvements in social anxiety mediated 91% of the improvements in depression over time. Conversely, decreases in depression only accounted for 6% of the decreases in social anxiety over time. Changes in social anxiety fully mediated changes in depression during the course of treatment. The theoretical and clinical implications of these findings for the relationship between anxiety and depression are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social phobia in youth: The diagnostic utility of feared social situations.

The present study evaluated the utility of parent- and child-reported social fears for reaching a diagnosis of social phobia in youth. The diagnostic utility of (a) the number of fears and (b) specific feared social situations was examined. The sample included 140 youth and their parents: youth diagnosed with social phobia (n = 50), youth diagnosed with generalized anxiety disorder or separation anxiety disorder but not social phobia (n = 49), and youth without an anxiety disorder (n = 41). Youth and their parents were interviewed separately using the Anxiety Disorders Interview Schedule for Children and Parents. Analyses indicate that a cut score of 4 parent-endorsed social fears optimally distinguished youth with and without social phobia. Analyses of child-reported fears did not identify a meaningful cut score. Conditional probability and odds ratio analyses indicated that several specific social fears have high diagnostic efficiency, and others were found to have limited diagnostic efficiency. Results are discussed with regard to informing diagnostic interviews and diagnostic systems for social phobia in youth. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Co-morbidity and familial aggregation of alcoholism and anxiety disorders

BACKGROUND: This study examined the patterns of familial aggregation and co-morbidity of alcoholism and anxiety disorders in the relatives of 165 probands selected for alcoholism and/or anxiety disorders compared to those of 61 unaffected controls. METHODS: Probands were either selected from treatment settings or at random from the community. DSM-III-R diagnoses were obtained for all probands and their 1053 first-degree relatives, based on direct interview or family history information. RESULTS: The findings indicate that: (1) alcoholism was associated with anxiety disorders in the relatives, particularly among females; (2) both alcoholism and anxiety disorders were highly familial; (3) the familial aggregation of alcoholism was attributable to alcohol dependence rather than to alcohol abuse, particularly among male relatives; and (4) the the pattern of co-aggregation of alcohol dependence and anxiety disorders in families differed according to the subtype of anxiety disorder; there was evidence of a partly shared diathesis underlying panic and alcoholism, whereas social phobia and alcoholism tended to aggregate independently. CONCLUSIONS: The finding that the onset of social phobia tended to precede that of alcoholism, when taken together with the independence of familial aggregation of social phobia and alcoholism support a self-medication hypothesis as the explanation for the co-occurrence of social phobia and alcoholism. In contrast, the lack of a systematic pattern in the order of onset of panic and alcoholism among subjects with both disorders as well as evidence for shared underlying familial risk factors suggests that co-morbidity between panic disorder and alcoholism is not a consequence of self-medication of panic symptoms. The results of this study emphasize the importance of examining co-morbid disorders and subtypes thereof in identifying sources of heterogeneity in the pathogenesis of alcoholism.     

Comorbidity of panic disorder with agoraphobia and specific phobia: relationship with the subtypes of specific phobia

The study objectives were to determine comorbidity rates for various subtypes of specific phobia (SP) in a sample of patients with the principal diagnosis of panic disorder with agoraphobia (PDA) and to examine the possible etiologic relatedness of these SP subtypes to PDA. Ninety consecutive day clinic patients with PDA were administered the Structured Clinical Interview for DSM-III-R (SCID) modified for DSM-IV. The overall comorbidity rate for SP was 65.6%. The most frequent subtypes of SP were situational phobia and dental phobia, followed by natural environment phobia, phobia of funerals, cemeteries, dead bodies, and other death-related phenomena and objects (referred to as death-related phobia), and blood-injection-injury phobia. Except for death-related phobia, other subtypes of SP clearly tended to precede the onset of PDA, often by many years. The smallest difference between the age of onset for PDA and particular subtypes of SP (temporal distance) was found for death-related phobia, whereas the temporal difference was longer for situational phobia, hospital phobia, and blood-injection-injury phobia. The frequency and temporal distance data suggest that death-related phobia may constitute a risk factor for developing PDA or that it is a prodrome of PDA, whereas situational phobia, hospital phobia, and blood-injection-injury phobia appear to predispose to PDA to a lesser degree. Of the three broadly conceived groups of SP, mutilation phobias (which include death-related phobia, hospital phobia, blood-injection-injury phobia, and dental phobia) appear most etiologically relevant for PDA, with the group of situational phobias (which also includes the natural environment subtype of SP) being less relevant, and animal phobias showing a negligible etiologic relatedness to PDA.