- Aránzazu Duque Moreno & Basilio Blanco Núñez
- The Conversation*
By 2030, the World Health Organization (WHO) estimates that mental health problems will be the leading cause of disability in the world.
According to a report from the Spanish Ministry of Health, anxiety disorder is the most frequent: it affects 6.7% of the population (8.8% in women, 4.5% in men). This figure reaches 10.4% if signs or symptoms of anxiety are included.
Within this spectrum of mental problems, one of the most frequent diagnoses is the disorder of phobic anxiety or specific phobia.
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V) defines these disorders as the appearance of intense fear or anxiety, immediate (almost always) and disproportionate to specific objects or situations that, in general, would not be considered dangerous and that, furthermore, the patient actively tries to avoid or resist.
The “maladaptive” fear, the one that does not protect us
Phobias start from the basic emotion of fear.
Normally, this has an eminently adaptive function for survival. It allows detecting real imminent threats and generating an appropriate response to them.
However, when this fear negatively interferes with the daily functioning of the person in any of the areas of their life because it is persistent, disproportionate, irrational and unfounded, it loses its adaptive character.
In fact, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V), of the American Psychiatric Association, contemplates the following diagnostic criteria for phobia: fear, anxiety or avoidance causes clinically significant distress or social impairment, labor or other important areas of functioning.
And this is precisely the fundamental characteristic that makes phobia a mental health problem.
The pandemic, a breeding ground for phobias
The covid-19 pandemic has eroded the mental health of a large part of society.
Similarly, in vulnerable or predisposed people it has led to an alarming increase in mental disorders. The most prevalent are depression and anxiety.
More specifically, any alarming or catastrophic situation (such as a pandemic) implies the perfect breeding ground for the appearance of disorders related to excessive fear.
Thus, various studies that have evaluated previous outbreaks of infectious diseases such as the Spanish flu in 1918 or the Ebola outbreak in West Africa in 2014 have associated these with disproportionate cognitive, affective or behavioral responses to any aspect associated with them.
Aspects such as the risk of infection through physical contact or closed spaces, death or infection of loved ones, containment measures, social isolation and loneliness, massive loss of employment or financial instability, among others, are noteworthy. .
In this context, we know that not everyone has the same chance of developing a phobia of a certain triggering event. It will depend on the presence of genetic and environmental factors, in addition to other factors specific to each type of phobia.
For example, in the case of phobias associated with pandemics (such as covid-19), it has been seen that individual difference variables such as lack of tolerance for uncertainty, perceived vulnerability to illness or propensity for anxiety they seem to play a key role.
Phobias associated with confinement
The confinement measure imposed in practically all countries at the beginning of the pandemic led to isolation.
This has resulted in a drastic reduction in physical and social contact and an impairment of mental health. In this process, the restrictions on leisure and free time.
The consequences of this have been diverse in relation to people’s mental health.
On the one hand, directly associated with social isolation highlights the agorafobia, a phobic anxiety disorder in which the person experiences intense fear of places or situations from which it would be difficult to flee or ask for help in an emergency.
On the other hand, isolation can also be associated with a negative impact on social skills, with a greater propensity to social phobia.
The population group that has been most affected are adolescents. In this case, fear occurs in social situations in which the individual is exposed to possible examination by other people.
“Coronaphobia” and other phobias associated with contagion
On the one hand, one of the phobias that the current pandemic has specifically generated is known as ‘coronaphobia’, an excessive anxiety to contract covid-19.
Thus, individuals with this extreme fear tend to experience a set of unpleasant physiological symptoms triggered by thoughts or information related to this disease.
This phobia is truly disabling insofar as it is strongly related to functional impairment and psychological distress and therefore has important implications for mental well-being.
Likewise, related to the excessive fear of contagion, the obsessive compulsive disorder (OCD), another disorder related to anxiety whose symptoms can be exacerbated in the context of covid-19.
DSM V defines OCD as the presence of obsessions, compulsions, or both.
First of all, obsessions are unwanted recurring and persistent thoughts, impulses, or images. For example, in the context of the pandemic, the idea of infecting yourself or your loved ones.
Second, compulsions can appear to cope with the discomfort generated by the obsessions in the form of repetitive behaviors that the person applies rigidly.
For example, frequent hand washing has been proposed as one more preventive measure against infection.
However, this behavior is usually a frequent compulsion of OCD associated with pollution.
Thus, this action, which is appropriate and healthy (not only in times of a pandemic, but also in general) can become the basis for the increased prevalence of OCD associated with covid-19 in this case.
Evaluation of coronaphobia
Coronaphobia is a relatively new problem since it involves a phobia specifically associated with covid-19.
However, there are studies on phobias related to other infectious diseases as discussed above.
Due to this, and following the recommendations of the American Psychiatric Association (APA), tools with valid psychometric properties are being developed for a correct diagnosis of this growing disorder.
An example of this type of evaluation instrument is the COVID-19 Phobia Scale.
This has demonstrated convergent and discriminant validity as well as internal consistency. In addition, it has been validated in populations from different parts of the world such as the United States, Korea and Iran.
Given the alarming situation associated with the pandemic that remains more or less latent in the long term, these types of instruments are essential.
They are not only important for diagnosing new specific cases of coronaphobia, but also for the possible exacerbation of the symptoms of patients under treatment.
Or, even, for the relapses that old patients who had already been discharged may present.
* Aránzazu Duque Moreno is a doctor in Neurosciences, director of the Degree in Psychology and Secretary of the Chair of Humanization of Healthcare and member of the Psychology and Quality of Life research group at the International University of Valencia (Spain).
* Basilio Blanco Núñez is a research teaching staff at the Faculty of Health Sciences of the International University of Valencia (Spain).
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Eddie is an Australian news reporter with over 9 years in the industry and has published on Forbes and tech crunch.