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A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.
Phobias can be divided into specific phobias, social anxiety disorder, and agoraphobia. Specific phobias are further divided to include certain animals, natural environment, blood or injury, and particular situations. The most common are fear of spiders, fear of snakes, and fear of heights. Specific phobias may be caused by a negative experience with the object or situation in early childhood. Social phobia is when a person fears a situation due to worries about others judging them. Agoraphobia is a fear of a situation due to perceived difficulty or inability to escape.
It is recommended that specific phobias be treated with exposure therapy, in which the person is introduced to the situation or object in question until the fear resolves. Medications are not helpful for specific phobias. Social phobia and agoraphobia may be treated with counseling, medications, or a combination of both. Medications used include antidepressants, benzodiazepines, or beta-blockers.
The International Classification of Diseases (11th version: ICD-11) is a globally used diagnostic tool for epidemiology, health management and clinical purposes maintained by the World Health Organization (WHO). The ICD classifies phobic disorders under the category of mental, behavioural or neurodevelopmental disorders. The ICD-10 differentiates between Phobic anxiety disorders, such as Agoraphobia, and Other anxiety disorders, such as Generalized anxiety disorder. The ICD-11 merges both groups together as Anxiety or fear-related disorders.
Most phobias are classified into 3 categories. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), such phobias are considered subtypes of anxiety disorder. The categories are:
There are multiple theories about how phobias develop and likely occur due to a combination of environmental and genetic factors. The degree to whether environment or genetic influences have a more significant role varies by condition, with social anxiety disorder and agoraphobia having around a 50% heritability rate.
Rachman proposed three pathways for the development of phobias: direct or classical conditioning (exposure to phobic stimulus), vicarious acquisition (seeing others experience phobic stimulus), and informational/instructional acquisition (learning about phobic stimulus from others).
Much of the progress in understanding the acquisition of fear responses in phobias can be attributed to classical conditioning (Pavlovian model). When an aversive stimulus and a neutral one are paired together, for instance, when an electric shock is given in a specific room, the subject can start to fear not only the shock but the room as well. In behavioral terms, the room is a conditioned stimulus (CS). When paired with an aversive unconditioned stimulus (UCS) (the shock), it creates a conditioned response (CR) (fear for the room) (CS+UCS=CR). For example, in case of the fear of heights (acrophobia), the CS is heights. Such as a balcony on the top floors of a high rise building. The UCS can originate from an aversive or traumatizing event in the person's life, such as almost falling from a great height. The original fear of nearly falling is associated with being high, leading to a fear of heights. In other words, the CS (heights) asso