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PANIC DISORDER DIAGNOSTIC CRITERIA

 represents anxiety in its most severe form Panic attacks

 person has recurrent, unexpected panic
 One or more panic attacks occurred
attacks that cause intense apprehension and
unexpectedly and weren't triggered by
feelings of impending doom
situations in which the patient was the focus
 frequency of panic attacks and the high level
of other people's attention.
of anxiety may cause functional impairments
 The panic attacks were followed by a period of
CAUSES at least a month of persistent fear of having
another attack.
 intense stress or a sudden loss may trigger  During a panic attack, at least four of these
panic disorder signs and symptoms developed abruptly and
 combination of genetic, biochemical, and reached a peak within 10 minutes:
other factors 1. shortness of breath or smothering
SIGNS AND SYMPTOMS sensations
2. dizziness or faintness
 palpitations and rapid heart, beat 3. palpitations or tachycardia
 sweating 4. trembling or shaking
 generalized weakness or trembling 5. sweating
 shortness of breath or rapid, shallow 6. feelings of choking
breathing 7. nausea or abdominal distress
 sensations of choking, smothering, or a lump 8. depersonalization (a sense of being
in the throat detached from the self) or derealization
 chest pain or pressure (feelings of unreality)
 abdominal pain, nausea, heartburn, diarrhea, 9. numbness or tingling sensations
or other GI distress 10. hot flashes or chills
 dizziness, tingling sensations, or light- 11. chest pain or discomfort
headedness 12. fear of dying or going crazy
 chills, pallor, or flushing
Other features
 diminished ability to focus or think clearly,
even with direction  The panic attacks don't result from direct
 fidgeting or pacing physiologic effects of a substance or a general
 rapid speech medical condition (such as hyperthyroidism).
 exaggerated startle reaction  The attacks aren't better explained by another
mental disorder.
DIAGNOSIS
With or without agoraphobia
 serum glucose measurements - can rule out
hypoglycemia, urine catecholamine and  Panic disorder may occur with or without
vanillylmandelic acid tests can exclude agoraphobia. When it occurs with
pheochromocytoma, and thyroid function agoraphobia, the patient has the symptoms
tests can eliminate hyperthyroidism described previously, plus fear or avoidance of
 urine and serum toxicology tests - can rule out any place outside of the home or a "safe"
the presence of psychoactive substances zone.
capable of triggering panic attacks, such as
TREATMENT
barbiturates, caffeine, and amphetamines
 official diagnosis is warranted if the patient Patient teaching
meets the criteria in the Diagnostic and
Statistical Manual of Mental Disorders, Fourth  can help her overcome disorder
Edition, Text Revision (DSM-IV-TR)
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 many patients experience some relief simply Between panic attacks

by understanding exactly what panic disorder
 Encourage the patient to discuss her fears.
is and how many others suffer from it.
Help her identify situations or events that
Behavioral therapy trigger the attacks.
 Discuss alternative coping mechanisms.
 involves desensitization, which resembles
 Monitor therapeutic and adverse effects of
interceptive exposure but lacks the cognitive
prescribed medications. Teach the patient
component
how to recognize adverse effects.
Relaxation techniques  Instruct the patient to notify the doctor before
discontinuing medication because abrupt
 help the patient cope with a panic attack by withdrawal could cause severe symptoms.
easing physical symptoms and directing her
attention elsewhere AGORAPHOBIA
 these techniques include:
 is the intense fear or avoidance of situations
1. deep-breathing exercises, which also
or places that may be difficult or embarrassing
reduces the risk of hyperventilation (a
to leave, or in which help might not be
contributing factor for anxiety)
available
2. progressive relaxation, which involves
 sufferers worry they won't be able to get
conscious tightening and relaxation of the
somewhere safe and may fear they'll have a
skeletal muscles in a sequential fashion
panic attack or panic symptoms (such as
3. positive visualization or guided imagery, in
dizziness, vomiting, loss of control, or difficulty
which the patient elicits peaceful mental
breathing) and eventually, they begin to avoid
images or some other purposeful thought
situations where they feel uncomfortable
or action, promoting feelings of relaxation,
renewed hope, and a sense of being in CAUSES
control of a stressful situation
4. listening to calming music  exact cause isn’t known but theories include
biochemical imbalances (especially related to
Pharmacologic therapy neurotransmitters) and environmental factors
 disorder may run in families, suggesting a
 doctor may prescribe antianxiety drugs
genetic basis
(especially benzodiazepines) or
antidepressants SIGNS AND SYMPTOMS
 combining an antianxiety drug with an
antidepressant promotes rapid stabilization of  fear and avoidance of open spaces or public
panic symptoms places
 beta blockers which control irregular  concern that help might not be available in
heartbeats public places
 if the patient has panic disorder, she may
NURSING INTERVENTIONS express concern that a panic attack in public
During a panic attack will lead to embarrassment or the inability to
escape
 Stay with the patient until the attack subsides.
DIAGNOSIS
If left alone, she may grow even more anxious.
 Avoid touching her until you've established  agoraphobia without panic disorder is
rapport. Unless she trusts you, she may be too diagnosed when the patient meets the criteria
stimulated or frightened to find touch in the DSM-IV-TR
reassuring.
 If the patient loses control, guide her to a
smaller, quieter area.
 Avoid insincere expressions of reassurance.
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DIAGNOSTIC CRITERIA RISK FACTORS

 The patient experiences agoraphobia intense  include unresolved conflicts, a tendency to

fear or avoidance of situations that maybe misinterpret events, and such behaviors as
hard to leave or help might not be available) shyness and avoidance of new situations
related to the level of developing panic
SIGNS AND SYMPTOMS
symptoms (for instances, dizziness or
diarrhea). Excessive physiologic arousal
 The patient has not met the criteria for
disorder.  shortness of breath
 The disturbance doesn't result from the  tachycardia or palpitations
disorder’s physiologic effects: substance or a  dry mouth
medical condition is associated general  sweating
medical condition is the fear of developing  nausea or diarrhea
panic like symptoms exceeds that usually  inability to relax
associated with medical condition.  muscle tension, aches, and spasms
 irritability
TREATMENT  fatigue
 doctor may prescribe a tricyclic antidepressant  restlessness
(TCA), such as amitriptyline (Elavil), or a  trembling
selective serotonin reuptake inhibitor (SSRI),  headache
such as paroxetine (Paxil)  cold, clammy hands
 benzodiazepine, such as alprazolam (Sanax) -  insomnia
to treat a panic attack in progress
Distorted cognitive processes
NURSING INTERVENTIONS
 poor concentration
 Encourage the patient to discuss the feared  unrealistic assessment of problems
object or situation.  excessive anxiety and worry over minor
 Collaborate with the patient and matters
multidisciplinary team to develop and  fears of grave misfortune or death
implement a systematic desensitization
Poor coping
program that exposes the patient gradually to
the feared situation in a controlled  avoidance
environment.  procrastination
 Provide training in assertiveness skills to  poor problem-solving skills
reduce submissive and fearful responses. Such
DIAGNOSIS
strategies allow the patient to experiment
with new coping skills and encourage her to  patient should undergo a psychiatric
discard ineffective evaluation to rule out phobias, OCD,
 Administer antianxiety or antidepressant depression, and acute schizophrenia
medications, as ordered.
DIAGNOSTIC CRITERIA
GENERALIZED ANXIETY DISORDER
Anxiety and associated symptoms
 in GAD, the anxiety is persistent,
overwhelming, uncontrollable, and out of  Excessive anxiety and worry about a number
proportion to the stimulus of events or activities occur more days than
not for at least 6 months.
 effects of GAD range from mild to severe and
incapacitating  The patient has difficulty controlling the
worry.
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 The anxiety and worry are associated with at

least three of these symptoms:
1. restlessness or feeling keyed up or on
edge Pharmacologic therapy
2. easy fatigue
3. difficulty concentrating or mind going  antianxiety agents - benzodiazepines as
blank diazepam (Valium) are commonly prescribed
4. irritability  benzodiazepines - reduce anxiety by
5. muscle tension decreasing vigilance and easing somatic
6. sleep disturbances (difficulty falling or symptoms (for instance, muscle tension)
staying asleep or restless, unsatisfying Other medications
sleep)
 Buspirone (BuSpar), TCAs (such as imipramine
Other features (Tofranil)
 The focus of the anxiety and worry isn't  SSRIs may be used in some cases
confined to the features of an Axis I disorder  Buspirone - prescribed for patients with
(a major mental disorder, such as chronic anxiety and those who relapse after
schizophrenia). benzodiazepine therapy; it is also the initial
 The anxiety, worry, or physical symptoms drug of choice for anxious patients with a
cause clinically significant distress or history of substance abuse
impairment in social, occupational, or other NURSING INTERVENTIONS
important areas of functioning.
 The disturbance doesn't result from the direct  Stay with the patient when she's anxious.
physiologic effects of a substance or a general Remain calm and non-Judgmental. Suggest
medical condition. activities that distract her from her anxiety.
 The disturbance doesn't occur exclusively  Encourage her to discuss her feelings.
during a mood d order, psychotic disorder, or  Reduce environmental stimuli.
pervasive developmental disorder
POSTTRAUMATIC STRESS DISORDER
TREATMENT
 may occur after someone experiences or
Cognitive therapy witnesses a serious traumatic event, such as
wartime combat, a natural disaster, rape,
 reduces cognitive distortions by teaching the murder, or torture
patient how to restructure her thoughts and
 characterized by persistent and recurrent
view her worries more realistically
flashbacks, reliving the event, or nightmares
Biofeedback training of the event — along with avoidance of
reminders of it
 eases physical symptoms of anxiety by  impairments can be mild or severe, affecting
teaching the patient how to become aware of nearly every aspect of the person's life
- and then consciously control — various body  PTSD sufferers are irritable, anxious, fatigued,
functions (including blood pressure, heart and forgetful, and socially withdrawn, and those
respiratory rates, skin temperature, and who survived a catastrophe that took many
perspiration) lives may also have survivor guilt
 using a biofeedback device, the patient learns
when changes in these functions occur and CAUSES
with adequate training, she can repeat this
 a traumatic event is the trigger for PTSD
response at will, even when not hooked up to
 some people may be biochemically
the biofeedback device
predisposed to the disorder (alpha, adrenergic
receptor response that inhibits stress induced
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release of norepinephrine is impaired in PTSD or threatened death or serious injury or a

patients which results in progressive threat to the physical integrity of the self or
behavioral sensitization and generalization to others.
stimulus cues from the original trauma, with  The patient's response involved intense fear,
responses of increased sympathetic activity) helplessness, or horror.

RISK FACTORS Reexperiencing of the trauma (at least 1)

 limited social supports  recurrent and intrusive distressing

 high anxiety levels recollections of the event, such as images,
 low self-esteem thoughts, or perceptions
 neurotic and extroverted characteristics  recurrent distressing dreams of the event
 history of psychiatric disorders  acting or feeling as if the traumatic event were
 previous diagnosis of an acute stress disorder recurring (such as a sense of reliving the
that failed to resolve within 1 month. experience, illusions, hallucinations, and
 PTSD can develop in anyone especially if the dissociative episodes that occur even on
stressor is extreme awakening or when intoxicated)
 genetic factors may also play a role  intense psychological distress at exposure to
internal or external cues that symbolize or
SIGNS AND SYMPTOMS resemble some aspect of the traumatic event
 anger Avoidance of reminders (at least 3)
 poor impulse control
 chronic anxiety and tension  efforts to avoid thoughts or feelings
 avoidance of people, places, and things associated with the trauma
associated with the traumatic experience  efforts to avoid activities, places, or people
 emotional detachment or numbness that arouse recollections of the trauma
 depersonalization (a sense of loss of identity  inability to recall an important aspect of the
as a person) traumatic event
 difficulty concentrating  markedly diminished interest in significant
 difficulty falling or staying asleep activities
 hyper alertness, hyperarousal, and  feeling of detachment or estrangement from
exaggerated startle reflex other people
 inability to recall details of the traumatic  restricted range of affect— for instance,
event inability to love others
 labile affect (rapid, easily changing affective  sense of a foreshortened future
expression) Increased arousal (at least 2)
 social withdrawal
 decreased self-esteem  difficulty falling or staying asleep
 loss of sustained beliefs about people or  irritability or angry outbursts
society  difficulty concentrating
 hopelessness  hypervigilance
 sense of being permanently damaged  exaggerated startle response
 relationship problems
Other features
 survivor's guilt
 duration of the disturbance is at least 1 month
DIAGNOSTIC CRITERIA
 disturbance causes clinically significant
Exposure to trauma (both) distress or impairment in social, occupational,
or other important areas of functioning
 The patient experienced, witnessed, or was
confronted with an event that involved actual
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 hyperarousal
 avoidance of reminders of the traumatic event
 persistent, intrusive recollections of the
Treatment traumatic event in flashbacks, dreams, or
recurrent thoughts or visual images
Pharmacologic treatment
 irritability
 benzodiazepines, beta blockers, monoamine  physical restlessness
oxidase inhibitors (MAOls), or TCAs - to relieve  sleep disturbances
PTSD symptoms  exaggerated startle reflex
 SSRI - antidepressant  poor concentration

Other treatments DIAGNOSIS

 the patient should undergo alcohol or drug  patient has a recent history of trauma
rehabilitation (when indicated)  physical examination - helps rule out organic
 more positive coping strategies should be causes of signs and symptoms
explored and practiced  patient is diagnosed with acute stress disorder
if she meets the criteria in the DSM-IV-TR
NURSING INTERVENTIONS
DIAGNOSTIC CRITERIA
 Establish trust by accepting the patient's
current level of functioning and assuming a Exposure to trauma (both)
positive, consistent, honest, and
 The patient experienced, witnessed, or was
nonjudgmental attitude.
confronted with an event that involved actual
 Encourage the patient to express her grief,
or threatened death or serious injury, or a
complete the mourning process, and gain
threat to the physical integrity of self or
coping skills to relieve anxiety and desensitize
others.
her to memories of the traumatic event.
 The patient's response involved intense fear,
 Use crisis intervention techniques as needed.
helplessness, or horror.
ACUTE STRESS DISORDER
Dissociative symptoms (3 or more)
 a syndrome of anxiety and behavioral
 subjective sense of numbing, detachment, or
disturbances that occurs within 4 weeks of an
absence of emotional responsiveness
extreme trauma, such as combat, rape, or a
 reduced awareness of surroundings (for
near-death experience in an accident
instance, feeling as though in a daze)
 symptoms start during or shortly after the
 derealization (a sense of unreality or loss of
trauma and impair functioning in at least one
reality)
key area
 depersonalization (a sense of loss of identity
 resolves within 4 weeks (if symptoms last
as a person)
longer than 4 weeks, the diagnosis may
 dissociative amnesia (inability to recall an
change to PTSD)
important aspect of the trauma)
 may begin as early as 2 days after the trauma
Reexperiencing of the trauma
CAUSES
 recurrent images, thoughts, dreams, illusions,
 exposure to trauma is the major precipitant of
flashbacks, or a sense of reliving the
acute anxiety disorder (may involve serious
experience
physical or emotional injury or threats to
 distress on exposure to reminders of the
one's life)
traumatic event
SIGNS AND SYMPTOMS
Avoidance of reminders
 generalized anxiety
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 patient avoids stimuli that trigger recollections

of the trauma (such as thoughts, feelings,
people, places, activities, and conversations)

Anxiety or arousal symptoms

NURSING INTERVENTIONS
 patient has pronounced symptoms of anxiety
or increased arousal, such as difficulty  Urge her to talk about her anxiety and her
sleeping, irritability, poor concentration, feelings about the trauma. This helps her
hypervigilance, exaggerated startle response, cope with the reality of the event.
or motor restlessness  Encourage the patient to identify any feelings
of survivor guilt, inadequacy, or blame.
Other features
Expressing these feelings helps her
 disturbance causes clinically significant understand that her survival may have been
distress or impairment in social, occupational, due to chance and not related to any personal
or other important areas of functioning or action or inaction by her.
impairs the patient's ability to pursue a  Teach relaxation techniques, such as
necessary task, such as obtaining required progressive muscle relaxation.
help  Administer antianxiety medications, as
 disturbance lasts at least 2 days and no more ordered.
than 4 weeks, and occurs within 4 weeks of
the traumatic event
SOCIAL PHOBIA
 disturbance doesn't result from the direct  sometimes called social anxiety disorder
physiologic effects of a substance or a general  refers to marked, persistent fear or anxiety in
medical condition social or performance situations
 disturbance isn't better explained by brief  anxiety causes the sufferer to avoid these
psychotic disorder situations whenever possible out of fear she'll
 disturbance isn't merely an exacerbation of a be embarrassed or ridiculed
preexisting Axis I disorder (a major mental  common situations that provoke anxiety
disorder, such as schizophrenia) or a include speaking or eating in public and using
preexisting Axis II disorder (such as a a public restroom
personality disorder)
SIGNS AND SYMPTOMS
TREATMENT
 fear or avoidance of eating, writing, or
 may include social supports, psychotherapy, speaking in public; being stared at; or meeting
cognitive or behavioral therapy, and strangers
pharmacotherapy  pronounced sensitivity to criticism
 relaxation techniques and deep-breathing  low self-esteem
exercises – for patient experiencing  scholastic underachievement because of test
hyperarousal anxiety
 supportive counseling or short-term
psychotherapy - examine the trauma in a Physical manifestations
supportive environment, strengthen  blushing
previously helpful coping mechanisms, and
 profuse sweating
learn new coping strategies
 trembling
 cognitive or behavioral therapy - may involve
 nausea or stomach upset
trauma education, cognitive restructuring of
 difficulty talking
the traumatic event to help the patient see it
from a different perspective, and gradual DIAGNOSTIC CRITERIA
reexposure with less avoidance
Fear of social situations
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 The patient has a marked and persistent fear  role playing in guided imagery - patient
of one or more social or performance rehearses ways to relax while confronting a
situations that involve exposure to unfamiliar feared object or situation
people or possible scrutiny by others. She  pharmacologic therapy - doctor may prescribe
fears shell act in a way or show anxiety such drugs as benzodiazepines, SSRIs.
symptoms that will be humiliating or  MAOIs, TCAs, or beta blockers (slow the heart
embarrassing. rate, lower blood pressure, and reduce
 Exposure to the feared social situation almost nervous tension, sweating, panic, and
always provokes anxiety, which may take the shakiness)
form of a panic attack.
NURSING INTERVENTIONS
 The patient acknowledges that the fear is
excessive or unreasonable.  No matter how illogical the patient's phobia
 The patient avoids the feared social or seems, avoid the urge to trivialize her fears.
performance situation, or endures it with Remember that her behavior represents an
intense anxiety or distress. essential coping mechanism. A facile pep talk
 Avoidance, anxious anticipation, or distress in or ridicule may alienate her or worsen her low
the feared social or performance situation self-esteem.
interferes significantly with the patient's  Keep in mind that the patient fears criticism.
normal routine, occupational or academic Encourage her to interact with others and
functioning, social activities, or relationships - provide continuous support and positive
or the patient has marked distress about reinforcement.
having the phobia.  Teach the patient progressive muscle
relaxation, guided imagery, or thought
Other features
stopping techniques as appropriate.
 In patients under age 18, the disorder lasts at
least 6 months.
SPECIFIC PHOBIA
 Fear or avoidance doesn't result from the  also called simple phobia
direct physiologic effects of a substance or a  a person experiences intense, irrational
general medical condition. anxiety when exposed to anticipating a
 Fear or avoidance isn't better explained by specific feared object (such as a snake) or
another mental disorder (such as panic situation (such as being in an enclosed space)
disorder, separation anxiety disorder, body  exposure can take place either in real life or
dysmorphic disorder, or schizoid personality through images from movies, television,
disorder). photographs, or the imagination
 If a general medical condition or another  for many, the anxiety leads to avoidance or
mental disorder is present, the patients fear disabling behavior that interferes with
isn't related to it. activities or even confines them to the home
 Generalized social phobia is specified if the  anxiety may reach panic levels, especially if
patient’s fears include most social situations. there's no apparent escape from the feared
TREATMENT thing or situation

 desensitization therapy - use to gradually TYPES

reintroduce the feared situation while 1. natural environment type (such as heights or
coaching the patient on relaxation techniques water)
 relaxation techniques - includes progressive 2. animal type
muscle relaxation, deep-breathing exercises, 3. blood-injection-injury type
or listening to calming music 4. situational type (such as flying in an airplane
or being in an enclosed space)
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5. other type (situations that may lead to Ecophobia: Fear of home

choking, vomiting, or contracting an illness) Eisoptrophobia: Fear of mirrors or seeing oneself in
a mirror
Emetophobia: Fear of vomiting
Enochlophobia: Fear of crowds
F
Febriphobia: Fear of fever
Frigophobia: Fear of cold or cold things

PHOBIA FILE

A G
Ablutophobia: Fear of washing Gamophobia: Fear of marriage
Acarophobia: Fear of itching or insects Gerascophobia: Fear of growing old
that cause itching Geumaphobia or geumophobia: Fear of taste
Acerophobia: Fear of sourness Glossophobia: Fear of speaking in public
Aerophobia: Fear of drafts Gynephobia or gynophobia: Fear of women
Achluophobia: Fear of darkness
H
Ailurophobia: Fear of cats
Heliophobia: Fear of the sun
Antlophobia: Fear of floods
Herpetophobia: Fear of reptiles or creepy, crawly
Apiphobia: Fear of bees
things
Arachnophobia: Fear of spiders
Heterophobia: Fear of the opposite sex
Astrapophobia: Fear of lightning
Hierophobia: Fear of religious or sacred things
B
Hippophobia: Fear of horses
Bacteriophobia: Fear of bacteria Hippopotomonstrosesquippedaliophobia: Fear of
Bathmophobia: Fear of stairs or steep slopes long words
Bathophobia: Fear of depth Hypsiphobia: Fear of height
Blennophobia: Fear of slime
I
Bogyphobia: Fear of the bogeyman
latrophobia: Fear of doctors
Botanophobia: Fear of plants
Ichthyophobia: Fear of fish
Bromidrosiphobia or bromidrophobia: Fear of body
Ideophobia: Fear of ideas
smells
Illyngophobia: Faar of vertigo or feeling dizzy when
C
looking down
Cacophobia: Fear of ugliness Iophobia: Fear of poison
Cancerophobia: Fear of cancer Insectophobia: Foar of insects
Carnophobia: Fear of meat Isolophobia: Fear of solitude
Catagelophobia: Fear of being ridiculed
K
Catapedaphobia: Fear of jumping from high or low
Kainolophobia: Fear of novelty
places
Kainophobia: Fear of anything new, novelty
Cathisophobia: Fear of sitting
Kakorrhaphiophobia: Fear of failure or defeat
Chaetophobia: Fear of hair
Katagelophobia: Fear of ridicule
Coprastasophobia: Fear of constipation
Kathisophobia: Fear of sitting down
D
Kopophobia: Fear of fatigue
Demophobia: Fear of crowds
L
Didaskaleinophobia: Fear of going to school
Levophobia: Fear of objects to the left
Dikephobia: Fear of justice
Ligyrophobia: Fear of loud noises
Dishabiliophobia: Fear of undressing in front of
Lilapsophobia: Fear of tornadoes and hurricanes
someone
Logophobia: Fear of words
Domatophobia or oikophobia: Fear of houses
M
Dysmorphophobia: Fear of deformity
Macrophobia: Fear of long waits
Dystychiphobia: Fear of accidents
Mageirocophobia: Fear of cooking
E
Maieusiophobia: Fear of childbirth
Ecclesiophobia: Fear of church
Medomalacuphobia: Fear of losing an erection
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Menophobia: Fear of menstruation Thalassophobia: Fear of the sea

Metallophobia: Fear of metal Thermophobia: Fear of heat
Microbiophobia: Fear of microbes Tocophobia: Fear of pregnancy or childbirth
Myctophobia: Fear of darkness Triskaidekaphobia: Fear of the number 13
Myrmecophobia: Fear of ants Trypanophobia: Fear of injections
N U
Neopharmaphobia: Fear of new drugs Uranophobia: Fear of heaven
Neophobia: Fear of anything new Urophobia: Fear of urine or urinating
Nephophobia: Fear of clouds V
Noctiphobia: Fear of the night Vaccinophobia: Fear of inoculations
Verbophobia: Fear of words
Verminophobia: Fear of germs
Vestiphobia: Fear of clothing
N
Nostophobia: Fear of returning home W
Novercaphobia: Fear of one's stepmother Wiccaphobia: Fear of witches and
O witchcraft
Oenophobia: Fear of wines X
Osmophobia: Fear of smells Xanthophobia: Fear of the color yellow or the word
Ombrophobia: Fear of rain yellow
Optophobia: Fear of opening one's eyes Xenophobia: Fear of strangers or foreigners
Ornithophobia: Fear of birds Xerophobia: Fear of dryness
P Xylophobia: Fear of wooden objects; fear of forests
Pagophobia: Fear of ice or frost Xyrophobia: Fear of razors
Pantophobia: Fear of everything Z
Pediculophobia: Fear of lice Zelophobia: Fear of jealousy
Pedophobia: Fear of children Zoophobia: Fear of animals
Peladophobia: Fear of becoming bald
Photophobia: Fear of light
Pogonophobia: Fear of beards CAUSES
Potamophobia: Fear of rivers
Prosophobia: Fear of progress  experiencing or observing a trauma
Psellismophobia: Fear of stuttering  repeated warnings of danger about the feared
Pyrophobia: Fear of fire object or situation
R  panic attacks when exposed to the feared
Ranidaphobia: Fear of frogs object or situation
Rhypophobia: Fear of defecation
Rhytiphobia: Fear of getting wrinkles SIGNS AND SYMPTOMS
Rupophobia: Fear of dirt
 severe anxiety when confronted with the
S
feared thing or situation, or even the threat of
Sciophobia: Fear of shadows
it
Scoleciphobia: Fear of worms
Scolionophobia: Fear of school  routinely avoids the object of her phobia
Scotophobia: Fear of darkness  have low self-esteem, depression, and feelings
Scriptophobia: Fear of writing in public of weakness, cowardice, or ineffectiveness
Selachophobia: Fear of sharks
DIAGNOSIS
Selaphobia: Fear of light flashes
Sesquipedalophobia: Fear of long words  has a history of anxiety when exposed to or
Siderodromophobia: Fear of trains anticipating a specific object or situation
Syngenesophobia: Fear of relatives  official diagnosis hinges on the patient
T
meeting the criteria in the DSM-IV-TR
Thaasophobia: Fear of sitting
Thanatophobia: Fear of death. DIAGNOSTIC CRITERIA
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Irrational fear  Collaborate with the patient and the

multidisciplinary team to develop and
 The patient has a marked and persistent fear
implement a systematic desensitization
that's unreason able or excessive. The fear is
program in which the patient is systematically
cued by confronting or anticipating a specific
exposed to the feared object or situation in a
object or situation (such as animals, flying,
controlled environment.
heights, injections, or seeing blood).
 Teach assertiveness skills to help reduce
 Exposure to the phobic stimulus almost
submissive, fearful responses. Such strategies
always causes an immediate anxiety response,
enable the patient to experiment with new
which may take the form of a panic attack.
coping skills and discard coping skills that
 The patient realizes the fear is unreasonable
haven't worked in the past.
or excessive.
 Instruct the patient in relaxation and thought-
 The patient avoids the phobic situation or
stopping techniques as appropriate.
endures it with intense anxiety or distress.
 The avoidance, anxious anticipation, or OBSESSIVE-COMPULSIVE DISORDER
distress aroused by the feared object or
 characterized by unwanted, recurrent,
situation interferes significantly with the
intrusive thoughts or images (obsessions),
patient's routine, occupational or academic
which the person tries to alleviate through
functioning, social activities or relationships or
repetitive behaviors or mental acts
the patient has marked distress about having
(compulsions)
the phobia.
 compulsions are meant to reduce the anxiety
Other features or prevent some dreaded event from
happening
 Anxiety, panic attacks, or phobic avoidance
 obsessions and compulsions may be simple or
aren't better explained by another mental
complex and ritualized
disorder, such as obsessive-compulsive
 compulsions include both overt behaviors,
disorder, posttraumatic stress disorder, social
such as hand washing or checking, and mental
phobia, separation anxiety disorder, panic
acts, such as praying or counting
disorder, or agoraphobia
CAUSES
TREATMENT
 genetic, biological, and psychological factors
 desensitization or exposure therapy - mental
may be involved in OCD development
health professional or a trusted companion
gradually exposes the patient to what RISK FACTORS
frightens her until the fear begins to fade
 relaxation, breathing exercises, and thought-  sociological factors as being young, divorced,
stopping - can reduce anxiety symptoms. Role separated, or unemployed, increase the risk
playing in guided imagery teaches the patient for OCD
to relax while confronting a feared object or SIGNS AND SYMPTOMS
situation.
 doctor may prescribe medications to reduce  repetitive thoughts that cause stress
anxiety symptoms in advance of a phobic (obsessions)
situation, such as flying in an airplane.  repetitive behaviors (compulsions), such as
 antianxiety drugs may be used to manage hand washing, counting, or checking and
short-term anxiety but aren't useful as long- rechecking whether a door is locked
term treatment  social impairment caused by preoccupation
with obsessions and compulsions
NURSING INTERVENTIONS  perceived need to achieve perfection
 Encourage the patient to discuss the feared DIAGNOSTIC CRITERA
object or situation.
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Either obsessions or compulsions disorder, or about guilt thoughts if she has

major depressive disorder.
 Recurrent and persistent thoughts, impulses,
 The disturbance isn't caused by the direct
or images that are experienced at some time
physiologic affects of a substance or a general
during the disturbance as intrusive and
medical condition.
inappropriate and that cause marked anxiety
or distress. TREATMENT
 The thoughts, impulses, or images aren't
 behavioral techniques
simply excessive worries about real-life
 relaxation techniques, such as deep breathing.
problems.
progressive muscle relaxation, meditation,
 The patient tries to ignore or suppress such
imagery, or music
thoughts or im-pulses, or to neutralize them
 support groups, which decrease the patient's
with some other thought or action.
isolation
 The patient recognizes that the obsessions are
 partial hospitalization and day treatment
the products of her mind and not externally
programs
imposed.
 medication (pharmacologic interventions may
 Compulsions are defined as all of these
include benzodiazepines, MAOIS, SSRIS, and
examples:
TCAs)
• Repetitive behaviors or mental acts
performed by the patient, who feels drive to NURSING INTERVENTIONS
perform them in response to an obsession or
according to rules that must be applied rigidly.  Approach the patient unhurriedly. Ask specific
• The behavior or mental acts are aimed at questions about her thoughts and behaviors,
preventing or reducing distress or preventing especially if you note physical cues, such as
some dreaded event or situation. However, chafed or reddened hands or hair loss due to
either the activity isn't connected in a realistic compulsive pulling.
way with what it's designed to neutralize or  Identify disturbing topics of conversation that
prevent, or it's clearly excessive. reflect underlying anxiety or terror.
• The patient recognizes that her behavior in  Keep the patient's physical health in mind. For
excessive or unreasonable. (This may not be example, compulsive hand washing may cause
true for young children or whose obsessions skin breakdown; rituals or preoccupations
have evolved into overvalued ideas. may cause inadequate food and fluid intake
and exhaustion. Provide for basic needs, such
Other features as rest, nutrition, and grooming, if the patient
 At some point, the patient recognizes that the becomes involved in ritualistic thoughts and
obsessions and compulsions are excessive or behaviors to the point of self-neglect.
unreasonable.
 The obsessions or compulsions cause matted
destress, a time-consuming (take more than 1
hour a day, or significantly interfere with the
patient's normal routine, occupational
functioning, or usual social activities or
relationships.
 If another Axis I disorder (a major mental
disorder a present, the content of the
obsession isn't related to it. For example,
ideas, thoughts, or images aren't about food it
the patient has an eating disorder, about
drugs if she has a psychoactive substance use