Specific Phobias — MCQs
A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:
Fear of being in places or situations from which escape might be difficult, embarrassing, or where help may be unavailable in the event of a panic attack. This condition is called.
What type of therapy is desensitization commonly classified as?
Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
What is the definition of phobia?
Specific phobias are best classified under which of the following categories?
A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?
Along with a pleasant stimulus, noxious stimuli are given in the treatment of alcohol dependence or sexual disorder. This is which of the following types of behavior therapy?
A patient presented in casualty with a history of sudden palpitation, sensation of impending doom, and constriction in his chest. This lasted for about 10-15 minutes after which he recovered. What is the likely diagnosis?
What is the definition of a phobia?
Specific Phobias Indian Medical PG Practice Questions and MCQs
Question 1: A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:
- A. Illness Anxiety Disorder (Correct Answer)
- B. Phobia
- C. Psychogenic headache
- D. Depression
Explanation: ***Illness Anxiety Disorder*** - This patient exhibits persistent **preoccupation with having a serious illness** despite **repeated medical evaluations** showing no underlying pathology. - She continues to **seek multiple consultations**, demonstrating **excessive health-related behaviors** characteristic of health anxiety. - Despite reassurance and normal investigations, she **insists something is wrong**, which is the core feature of this disorder. - Note: The presence of headache doesn't exclude this diagnosis; the key is the **disproportionate anxiety and health-seeking behavior** relative to the symptom. *Phobia* - Phobias involve an **intense, irrational fear** of a specific object or situation (e.g., agoraphobia, social phobia). - The patient's concern is about having an illness and physical symptoms, not a fear of a specific trigger or situation. *Psychogenic headache* - This is a **symptom description**, not a psychiatric disorder diagnosis. - While the headache may have psychological factors, the question asks for the **disorder** that best explains the overall clinical picture. - The primary pathology here is the **persistent health anxiety and reassurance-seeking behavior**, not just the headache itself. *Depression* - Although **depression can present with somatic symptoms** like headaches, the **core features of major depression** are not mentioned (e.g., persistent low mood, anhedonia, sleep/appetite changes, hopelessness). - The patient's **preoccupation with having a disease** despite medical reassurance is more characteristic of Illness Anxiety Disorder than depression alone.
Question 2: Fear of being in places or situations from which escape might be difficult, embarrassing, or where help may be unavailable in the event of a panic attack. This condition is called.
- A. Fear of animals
- B. Fear of heights
- C. Fear of social situations
- D. Agoraphobia (Correct Answer)
Explanation: ***Agoraphobia*** - This condition is characterized by a significant and irrational **fear** of being in situations or places from which escape might be difficult, or help unavailable, often stemming from concerns about experiencing a **panic attack**. - Common agoraphobic situations include being in **crowded places**, open spaces, public transportation, or being outside of one's home alone. *Fear of animals* - This is a specific phobia, known as **zoophobia**, characterized by an intense and irrational fear of certain animals or animal types. - Unlike agoraphobia, the fear is specifically tied to the presence or anticipation of encountering an animal, not the general context of escape or help. *Fear of heights* - This is another specific phobia, called **acrophobia**, defined by an extreme and irrational fear of high places. - The fear is primarily triggered by elevated positions and the perceived danger of falling, not by concerns about being trapped or unable to get help during a panic attack. *Fear of social situations* - This describes **social anxiety disorder** (also known as social phobia), which involves intense fear and anxiety in social settings where one might be scrutinized or judged by others. - While it can be debilitating, the core fear is of social interaction and performance, not the broader concerns of entrapment or helplessness in a general environment as seen in agoraphobia.
Question 3: What type of therapy is desensitization commonly classified as?
- A. Psychotherapy
- B. Psychoanalysis
- C. Behavioral therapy (Correct Answer)
- D. Not applicable
Explanation: ***Behavioral therapy*** - Desensitization techniques, such as **systematic desensitization**, are a cornerstone of **behavioral therapy** due to their focus on changing learned dysfunctional responses. - This approach aims to reduce anxiety or phobic reactions by gradually exposing individuals to feared stimuli in a controlled manner. *Psychotherapy* - This is a very **broad category** that encompasses many types of talking therapies, including behavioral therapy. - While desensitization is a *type* of psychotherapy, **behavioral therapy** is a more specific and accurate classification. *Psychoanalysis* - This therapeutic approach, developed by Sigmund Freud, focuses on uncovering **unconscious conflicts** and past experiences, often through techniques like **free association** and dream analysis. - Desensitization does not primarily deal with unconscious drives or early childhood experiences as its core mechanism. *Not applicable* - This option is incorrect because desensitization is a well-established and recognized therapeutic technique that fits within a standard classification of psychotherapies. - It clearly has a defined application and theoretical framework.
Question 4: Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
- A. Cognitive behavioral therapy
- B. SSRIs
- C. Clomipramine
- D. Systematic desensitisation (Correct Answer)
Explanation: ***Systematic desensitisation*** - This therapy is primarily used to treat **phobias** and other **anxiety disorders** where avoidance is a key feature and a clear, single trigger can be identified. - While it involves exposure, the gradual hierarchy and relaxation training are less effective for the complex, intrusive thoughts and compulsive rituals characteristic of **OCD**. *Cognitive behavioral therapy* - **CBT, particularly Exposure and Response Prevention (ERP)**, is considered the gold standard psychotherapy for OCD. - It directly addresses the **obsessions** by exposing the individual to feared thoughts or situations and then preventing the ritualistic responses. *SSRIs* - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. - They work by increasing the availability of **serotonin** in the brain. *Clomipramine* - **Clomipramine** is a tricyclic antidepressant (TCA) with potent **serotonergic effects**, making it highly effective in treating OCD, often when SSRIs are partially effective or not tolerated. - It is specifically approved for OCD and is sometimes considered a second-line or augmentation strategy.
Question 5: What is the definition of phobia?
- A. An intense, irrational fear that leads to avoidance (Correct Answer)
- B. Fear of specific objects or situations
- C. A type of anxiety disorder characterized by excessive fear
- D. A severe anxiety disorder characterized by irrational fear
Explanation: ***An intense, irrational fear that leads to avoidance*** - A phobia is primarily an **intense and persistent fear** reaction that is **irrational** in nature, meaning it is disproportionate to the actual danger posed by the object or situation. - This overwhelming fear invariably leads to **avoidance behavior**, where the individual actively tries to stay away from the feared stimulus. *Fear of specific objects or situations* - While phobias often involve specific objects or situations, this definition alone is insufficient as it doesn't capture the **intensity**, **irrationality**, or the **avoidance** component that are hallmarks of a true phobia. - Many people experience fear of specific things without it reaching the clinical threshold of a phobia, as long as it doesn't cause significant distress or impairment. *A type of anxiety disorder characterized by excessive fear* - This definition is broadly correct but is not the most precise or complete definition of a phobia itself. - While phobias are indeed a type of **anxiety disorder** and involve excessive fear, the key defining features of **irrationality** and **avoidance** are not explicitly stated, nor is the clear distinction from generalized anxiety. *A severe anxiety disorder characterized by irrational fear* - Similar to the previous option, this highlights the **irrational fear** and categorizes it as an **anxiety disorder**. - However, it omits the crucial element of **avoidance**, which is a defining diagnostic criterion and a hallmark behavioral response in phobias, and it also uses the broad term "severe" when the impact can vary.
Question 6: Specific phobias are best classified under which of the following categories?
- A. Mood disorders
- B. Psychotic disorders
- C. Personality disorders
- D. Anxiety disorders (Correct Answer)
Explanation: **Anxiety disorders** - **Specific phobias** are characterized by marked and persistent fear of a specific object or situation, which falls under the umbrella of **anxiety disorders**. - The core feature is intense anxiety or panic when exposed to the phobic stimulus, leading to avoidance behavior. *Psychotic disorders* - These involve a significant loss of contact with reality, often featuring **hallucinations, delusions**, or disorganized thought and speech. - Specific phobias do not involve such a profound disruption of reality or psychotic symptoms. *Mood disorders* - These are primarily characterized by a disturbance in the person's sustained emotional state, such as **depression (low mood)** or **mania (elevated mood)**. - While anxiety can co-occur with mood disorders, specific phobias are distinct conditions defined by their fear response to specific triggers. *Personality disorders* - These are characterized by **enduring patterns of inner experience and behavior** that deviate significantly from cultural expectations, are pervasive and inflexible, and cause distress or impairment. - Specific phobias are not considered deeply ingrained, pervasive patterns of relating to the world, but rather a focused fear response.
Question 7: A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?
- A. Panic attack (Correct Answer)
- B. Acute stress disorder
- C. Generalised anxiety disorder
- D. Phobia
Explanation: ***Panic attack (Panic Disorder)*** - The sudden onset of intense fear or discomfort, along with symptoms like **choking sensation**, **breathlessness**, **sweating**, and **feeling of impending doom**, are characteristic of a **panic attack**. - The **recurrent episodes** occurring prior to exams indicate **Panic Disorder**, which is defined by recurrent unexpected panic attacks followed by persistent concern about future attacks. - The situational trigger (exams) suggests a pattern consistent with panic disorder, where attacks may be situationally predisposed. *Acute stress disorder* - This condition occurs within **one month of exposure to a traumatic event** and involves dissociative symptoms, intrusions, avoidance, and arousal symptoms. - The patient describes recurrent episodes tied to exams, not a single acute traumatic event with subsequent stress response. *Generalised anxiety disorder* - Characterized by excessive and **uncontrollable worry** about various events or activities for **at least six months**. - While anxiety is present, the sudden, intense, **episodic nature** of symptoms with a distinct "feeling of impending doom" points away from the chronic, pervasive worry of GAD. - GAD presents with chronic anxiety rather than discrete panic episodes. *Phobia* - A phobia is an **irrational and intense fear** of a specific object or situation (e.g., specific phobia) or social situations (social anxiety disorder). - While exam-related anxiety can be severe, the description points to a **full-blown panic response** with multiple autonomic symptoms (choking, breathlessness, sweating) and psychological distress (impending doom). - Unlike a phobia where avoidance is the primary feature, this patient experiences discrete panic episodes with characteristic somatic symptoms.
Question 8: Along with a pleasant stimulus, noxious stimuli are given in the treatment of alcohol dependence or sexual disorder. This is which of the following types of behavior therapy?
- A. Negative reinforcement
- B. Aversion therapy (Correct Answer)
- C. Punishment
- D. Flooding
Explanation: ### Explanation **Correct Answer: B. Aversion Therapy** **Aversion therapy** is a form of behavior therapy based on the principle of **Classical Conditioning**. It involves the repeated pairing of an undesirable but pleasant stimulus (e.g., alcohol or paraphilic triggers) with an unpleasant/noxious stimulus (e.g., electric shocks, emetics like disulfiram, or unpleasant odors). Over time, the patient develops a conditioned aversion to the previously pleasurable stimulus, leading to a reduction in the unwanted behavior. It is commonly used in treating alcohol dependence, smoking, and certain sexual disorders. **Why other options are incorrect:** * **A. Negative Reinforcement:** This involves the **removal** of an unpleasant stimulus to increase the frequency of a desired behavior (e.g., taking an aspirin to remove a headache). In the question, a noxious stimulus is *added*, not removed. * **C. Punishment:** While similar, punishment is an **Operant Conditioning** concept where a consequence follows a behavior to decrease its frequency. Aversion therapy is specifically the *pairing* of stimuli to change the emotional response (Classical Conditioning). * **D. Flooding:** This is a technique used for phobias and OCD where the patient is directly exposed to their maximum feared stimulus (prolonged exposure) until the anxiety response extinguishes. It does not involve noxious stimuli like shocks or chemicals. **High-Yield Clinical Pearls for NEET-PG:** * **Disulfiram (Antabuse):** A classic example of aversion therapy (pharmacological) used in alcohol dependence by causing a toxic reaction (DER). * **Covert Sensitization:** A variation of aversion therapy where the noxious stimulus is merely **imagined** rather than physically applied. * **Systematic Desensitization:** The opposite of flooding; it involves graded exposure combined with relaxation techniques (based on reciprocal inhibition).
Question 9: A patient presented in casualty with a history of sudden palpitation, sensation of impending doom, and constriction in his chest. This lasted for about 10-15 minutes after which he recovered. What is the likely diagnosis?
- A. Phobia
- B. Personality disorder
- C. Generalized Anxiety disorder
- D. Panic attack (Correct Answer)
Explanation: ### Explanation **Correct Option: D. Panic attack** The clinical presentation describes a classic **Panic Attack**. It is characterized by an abrupt surge of intense fear or discomfort that reaches a peak within minutes. Key diagnostic features present in this case include **autonomic hyperactivity** (palpitations), **chest discomfort** (constriction), and **cognitive symptoms** (sense of impending doom). A hallmark of panic attacks is their discrete nature—they typically last for 10–30 minutes and resolve spontaneously. **Why other options are incorrect:** * **A. Phobia:** While phobias can trigger panic symptoms, they are always linked to a **specific stimulus** (e.g., heights, spiders). The question describes a spontaneous episode without a specific trigger. * **B. Personality disorder:** These are enduring, pervasive patterns of behavior and inner experience that deviate from cultural expectations. They do not present as acute, episodic physical symptoms. * **C. Generalized Anxiety Disorder (GAD):** GAD is characterized by "free-floating anxiety" and excessive worry about daily events lasting for **at least 6 months**. It lacks the sudden, crescendo-like intensity and discrete "attack" nature seen here. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis of Panic Disorder:** Requires recurrent *unexpected* panic attacks followed by at least **one month** of persistent concern about future attacks or behavioral changes. * **Physical Mimics:** Always rule out Medical emergencies like Myocardial Infarction (MI), Pheochromocytoma, or Hyperthyroidism. * **Treatment:** * **Acute episode:** Benzodiazepines (e.g., Alprazolam, Lorazepam). * **Long-term/Prophylaxis:** SSRIs (Drug of Choice) + Cognitive Behavioral Therapy (CBT). * **Associated Symptom:** **Agoraphobia** (fear of places where escape might be difficult) frequently co-occurs with Panic Disorder.
Question 10: What is the definition of a phobia?
- A. Palpitation on thinking about a definite entity
- B. Excessive unreasonable fear about a specific situation (Correct Answer)
- C. Perception without stimulation
- D. Altered perception
Explanation: **Explanation:** **1. Why Option B is Correct:** A phobia is defined as an **excessive, irrational, and persistent fear** of a specific object, activity, or situation. The core medical concept involves three criteria: the fear is out of proportion to the actual danger (unreasonable), it leads to an immediate anxiety response, and it results in a compelling desire to **avoid** the stimulus. According to DSM-5 and ICD-11, this avoidance or distress must significantly interfere with the person’s normal routine or social functioning. **2. Why Other Options are Incorrect:** * **Option A:** Palpitations are a physiological symptom of anxiety (autonomic hyperactivity). While they occur during a phobic encounter, they are a *symptom*, not the definition of the disorder itself. * **Option B & D:** These refer to **Perceptual Disorders**. "Perception without stimulation" is the definition of a **Hallucination**. "Altered perception" (where a real stimulus is misinterpreted) is the definition of an **Illusion**. **3. NEET-PG High-Yield Pearls:** * **Most Common Phobia:** Specific phobias are the most common type of anxiety disorder in the general population. * **Agoraphobia:** Fear of being in situations where escape might be difficult (e.g., crowds, open spaces). It is often associated with Panic Disorder. * **Social Anxiety Disorder (Social Phobia):** Fear of scrutiny or embarrassment in social/performance situations. * **Treatment of Choice:** * **Behavioral Therapy:** Systematic Desensitization or Exposure Therapy (specifically "Flooding") is the most effective long-term treatment. * **Pharmacotherapy:** SSRIs are the first-line medication; Beta-blockers (Propranolol) are used for performance anxiety.
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