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A 34-year-old secretary climbs 12 flights of stairs every day to reach her office, because she is terrified by the thought of being trapped in the elevator.
Her diagnosis is
a.Social phobia
b.Performance anxiety
c.Generalized anxiety disorder
d.Specific phobia
e.Agoraphobia
The treatment of choice for this disorder is
a.Imipramine
b.Clonazepam
c.Propanolol
d.Exposure
e.Psychoanalysis
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ANSWERS
The answers are d,d. (DSM-IV, p 405; Hales, 3/e, pp 598–599.) Specific phobias are characterized by an unreasonable or excessive fear of an object, an animal, or a situation (flying, being trapped in close spaces, heights, blood, spiders, etc.). Since the exposure to the feared situation, animal, or object causes an immediate surge of anxiety, patients carefully avoid the phobic stimuli. The diagnosis of specific phobia requires the presence of reduced functioning and interference with social activities and relationships due to the avoidant behavior, the anticipatory anxiety, and the distress caused by the exposure to the feared stimulus. In social phobias and performance anxiety, the patients fear social interactions (in general or limited to specific situations) and public performance (public speaking, acting, playing an instrument), respectively. In generalized anxiety disorder, the anxiety is more chronic and less intense than in a phobic disorder and it is 148 Psychiatry not limited to a specific situation or item. Agoraphobic patients fear places where escape may be difficult or help may not be available in case the patient has a panic attack. Agoraphobic patients are often prisoners in their own homes and depend on a companion when they need to go out. No medication has proved to be effective in treating specific phobias. The treatment of choice in specific phobias is exposure, in vivo or using imaginal techniques. The patient can be exposed to the feared stimulus gradually or the patient can be asked to immediately confront the most anxietyprovoking situation (flooding).
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MCQs 
