Eaton William W, Bienvenu O Joseph, Miloyan Beyon
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Lancet Psychiatry. 2018 Aug;5(8):678-686. doi: 10.1016/S2215-0366(18)30169-X.
Anxiety disorders are among the most prevalent mental disorders, but the subcategory of specific phobias has not been well studied. Phobias involve both fear and avoidance. For people who have specific phobias, avoidance can reduce the constancy and severity of distress and impairment. However, these phobias are important because of their early onset and strong persistence over time. Studies indicate that the lifetime prevalence of specific phobias around the world ranges from 3% to 15%, with fears and phobias concerning heights and animals being the most common. The developmental course of phobias, which progress from fear to avoidance and then to diagnosis, suggests the possibility that interrupting the course of phobias could reduce their prevalence. Although specific phobias often begin in childhood, their incidence peaks during midlife and old age. Phobias persist for several years or even decades in 10-30% of cases, and are strongly predictive of onset of other anxiety, mood, and substance-use disorders. Their high comorbidity with other mental disorders, especially after onset of the phobia, suggests that early treatment of phobias could also alter the risk of other disorders. Exposure therapy remains the treatment of choice, although this approach might be less effective in the long term than previously believed. This Review discusses the literature regarding the prevalence, incidence, course, risk factors, and treatment of specific phobias, and presents epidemiological data from several population-based surveys.
焦虑症是最常见的精神障碍之一，但特定恐惧症这一亚类尚未得到充分研究。恐惧症涉及恐惧和回避。对于患有特定恐惧症的人来说，回避可以减轻痛苦和功能损害的持续性和严重程度。然而，这些恐惧症很重要，因为它们发病早且随着时间推移具有很强的持续性。研究表明，全球特定恐惧症的终生患病率在3%至15%之间，其中对高度和动物的恐惧最为常见。恐惧症的发展过程从恐惧到回避，再到诊断，这表明中断恐惧症的发展过程可能会降低其患病率。虽然特定恐惧症通常始于童年，但发病率在中年和老年达到峰值。在10%至30%的病例中，恐惧症会持续数年甚至数十年，并且强烈预示着其他焦虑、情绪和物质使用障碍的发作。它们与其他精神障碍的高共病性，尤其是在恐惧症发作后，表明早期治疗恐惧症也可能改变其他障碍的风险。暴露疗法仍然是首选治疗方法，尽管从长期来看，这种方法可能不如以前认为的那么有效。本综述讨论了有关特定恐惧症的患病率、发病率、病程、危险因素和治疗的文献，并展示了几项基于人群调查的流行病学数据。
