Phobic and anankastic disorders

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Phobic and anankastic phenomena have in common that the patient experiences them as unwanted but cannot suppress them. They often occur together. Phobic states

Phobias are inappropriate exagerated fears which are not under voluntary control, cannot be reasoned away, and entail avoidance behaviour. (4Z) The fears are kindled by particular stimuli. These may either be perceived objects, such as animals (animal phobia) or pustules (in some illness phobias), or situations such as open places (agoraphobia) or confined rooms (claustrophobia).

Phobias initially triggered by a very specific stimulus can eventually generalize. Thus an elevator phobia may become extended to all kinds of closed rooms. Some phobias are linked with broader circumstances from the beginning. In social phobia, for instance, patients avoid meeting people because they fear that they will be noticed because of certain body features or personality traits. Identical types of fears can be triggered by different stimuli in different subjects. Thus illness phobia is activated in some patients by observed body changes, but in others by situations involving the risk of infection.

Phobic states are characterized by avoidance behaviour: patients avoid anxiety-provoking objects or situations. Because of stimulus generalization, this can lead to severe impairments; for instance, they cannot leave home.

Anankastic states

Anankastic phenomena are divided into two subtypes.

1. Obsessions occur as repeated thoughts, memories, images, ruminations, or impulses that patients know to be their own but are unable to prevent. The content of these ideas is often unpleasant, terrifying, obscure, or aggressive.

2. Compulsions are actions, rituals, or behaviours that the patient recognizes as part of his own behaviour, but cannot resist successfully.

Combined syndromes

In phobic-anankastic syndromes patients attempt to reduce their phobic fears by certain actions, such as handwashing in the case of an infection phobia. If obsessional thoughts or impulses induce anxiety (e.g. obscene ideas during worship, or the impulse to lean too far over a balustrade) and entail the avoidance of the situations that provoke them, the term anankastic-phobic syndrome is used.

Phobias, obsessions, and compulsions result most frequently from neurotic intrapsychic conflicts, but they also arise in functional or organic mental disorders. In all cases, conditioning processes are involved. Anankastic personalities, characterized by perfectionism, rigidity, sensitivity, and indecisiveness, are especially prone to developing obsessions and compulsions.

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