Specific phobia is a persistent and unreasonable fear of clearly visible objects and situations. Specific phobias can last for decades, and symptoms can affect family life, social relationships, and success in school or work. The negative effect of the disorder on functionality is directly proportional to the severity of the symptoms, and the severity of the symptoms often remains constant in the long term. Adolescents and adults are aware that this fear is excessive; however, this insight may not be found in children. For this reason, in order to diagnose specific phobia in children, it should not be necessary to be aware that fear is meaningless. Avoidance of encountering the phobic stimulus and in cases where avoidance is not possible, being able to endure the phobic stimulus only with extreme distress are typical features of the disease.
Although the incidence and content of phobia may differ culturally, it is possible to say that the lifetime prevalence of specific phobia is approximately 9-12%, and it is seen approximately 3 times more frequently in girls.
According to DSM-IV-TR diagnostic criteria; The definition of specific phobia is that the phobic symptoms have persisted for at least 6 months and have significantly limited daily activities.
Specific phobia consists of 5 subtypes according to DSM-IV diagnostic criteria:
1. Situational Type:
Fear of being in public transport, tunnels, bridges, elevators, air travel, driving situations such as It is most common in childhood and mid-twenties.
2.Natural Environment Type:
Fear is initiated by natural conditions such as storms, high places, and water. It usually starts in childhood.
3.Blood-injection-wound type:
Fear initiates blood, wound, injection or invasive medical interventions. It is usually familial and often marked by a strong vasovagal response. 75% of patients faint when faced with these situations.
4.Animal Type:
Fear is caused by animals or insects. It usually starts in childhood.
5. Other Type:
It is a specific subtype of phobia that is specific to fear of situations that may lead to suffocation, shortness of breath, vomiting or catching an illness, loud noises or fairy tale heroes.
PROGRESS OF SPECIFIC PHOBIA
Although specific phobias usually start in childhood (mean head age: 7-8) they can also start in early adulthood or adulthood. Most early-onset phobias go away without treatment. Even if children can cope with their phobias, this does not mean that they will not develop other anxiety disorders later on. Approximately 50% of specific phobias in adulthood have childhood onset. However, phobias that begin in adulthood are more resistant.
Specific phobias are often accompanied by social phobia, other anxiety disorders (posttraumatic stress disorder, obsessive-compulsive disorder,…) and depression.
HOW TO APPROACH A CHILD WITH FEAR?
Fear should never be used as a discipline tool in raising children.
Children’s fears should not be ignored, belittled or ridiculed by parents, teachers and other family members (e.g., what is there to be afraid of? Is a man ever afraid?, you are now a brother/sister,…)
The reasons for the fear in the child should be investigated, the child should be tried to understand and if there is a possible solution, it should be tried to be eliminated.
The child with fears should be treated patiently, time should be given to overcome their fears and the effort he made to overcome the fear should be taken into account. If enough time is not given and the struggle to overcome the fear is ignored, the child may give up the struggle after a while.
The child should not be overprotective/protective from his childhood (eg, you will fall!, you cannot do it alone).
While trying to protect the child, the feeling that the environment is full of dangers should not be reflected too much by our words and actions.
The child should be helped to enter the group of friends and develop self-confidence.
When the child is ready to talk about his/her fears, he/she should listen and understand him/her with an empathetic attitude. Because sometimes children do not want to share their fears by having negative thoughts such as that they will not be believed and/or ridiculed.
Children (especially children younger than 8-9 years old) should not be told scary tales and movies with horror content should not be watched.
All of these are examples of attitudes that should be considered before or after the onset of fear. However, when the fear starts, what should be done during the treatment phase;
The most commonly used type of therapy in phobias is cognitive behavioral therapy. The most commonly used technique in cognitive behavioral therapy is exposure therapy. In this method, the person is taught to deal with the anxiety that arises by going over the situation or object that causes fear. Confrontation therapy can be applied in cases where motivation is sufficient, depressive symptoms are absent, and the phobic stimulus is clearly evident. After adequate study (cognitive therapy) that fearful objects and situations pose no real danger and possible misinformation about the phobic stimulus, patients are gradually confronted with the phobic stimulus from mild to severe. The aim is to desensitize patients.
However, the thing to note here is; Some fears are age specific. Positive attitudes and being a good model may be enough for this. If the child can cooperate well in addressing the fear, he or she can gradually become accustomed to what he fears. However, if the child is unable to cooperate in any way in fear of fear (such as age, severe fear, insufficient family support, additional mental disorders such as depression), help from specialists should be sought first, psychopharmacological support should be provided if necessary, additional mental disorder treatment of the child and severe The fear should be reduced and then the work on dealing with the fear should be started.
I can say from my experience over the years that as a result of positive attitudes, positive parent-child, positive teacher-child, positive child-physician cooperation, the duration of treatment varies according to the severity, prevalence and characteristics of the person, but there is hardly any fear that cannot be overcome.
