Fear; It is one of the basic emotions in human nature that protects people against dangers and occurs physiologically at all ages. However, sometimes the resulting fear is more severe than expected and the possible escape/avoidance behavior far exceeds normal limits.
All types of fear experienced lead to changes in three dimensions:
1.Experience dimension: It includes anxieties, experiences of restriction, and thoughts about how to avoid situations that arouse fear.
2.Behavior dimension: Escaping, avoiding, running away from relevant situations
It includes avoidance strategies such as staying away and safety measures such as ensuring the presence of a specific person and carrying medicine in the pocket, which are behaviors aimed at preventing the emergence of a very severe fear.
3.Physiological dimension : Includes known symptoms of fear such as sweating, tachycardia, tachypnea.
Fears are a part of development. Therefore, it is natural that they are seen more frequently in children and adolescents. Most physiological fears come to the fore temporarily during certain developmental periods.
Young children are generally afraid of momentary events in their environment. As they grow older and their cognitive abilities develop, the content of fears gradually changes from imaginary objects to real objects and future events. Young children are afraid more often than older children, however, as age increases, the number of objects of fear increases.
Table 1. Physiological fears seen in children and adolescents
AGE FEAR CONTENT0-6 MONTHSLoud sounds, sudden change of position,…6-9 MONTHSStrangers, separation9-12 MONTHSSeparation, injury2. AGEImaginary figures, death, thieves, darkness, strangers3. AGEAnimals (dog), loneliness, toilet training situations, strangers, separation4-6 YEARSDarkness, ghosts, storm, thunder , possibility of separation of parents, animals, physical injuryAGES 6-12School, injury, illness, rejection by social environment e, thunder, supernatural beings, bodily injury, abandonment, accident, death13-18 YEARSInjury, illness, failure in social environments, sexuality, physical disability, punishment at school situations that require
In distinguishing between phobic disorders, which can be considered as one of the most common psychiatric disorders in the child and adolescent age group, and physiological fears, the age at which the symptoms appear, their severity, and especially the level of severity that prevents healthy development. Helps with loss of functionality. Since they are very common and prevent healthy development, early diagnosis and appropriate treatment of these disorders become important.
There is no classification regarding the severity of phobic disorders seen in children and adolescents. The severity of the disorder is evaluated by the intensity and duration of symptoms and the effects of avoidance behavior on family, peer relationships, school and leisure activities.
CAUSES OF FEAR
According to Freud, phobias are related to unconscious conflicts and are related to the oedipal complex. Some repressed, unconscious fears are displaced and directed towards an object or situation that would not normally cause anxiety, and thus phobias develop.
2.Familial causes:
- Unsafe parent-child relationship
- The child takes the family members' fears as an example.
- Using fear as a tool of discipline.
- Raising the child as an overprotective/guardian
- Traumatic life events of the child such as traffic accident, earthquake, flood, death, sexual/physical/emotional abuse.
- Educational factors that cause concern for the child.
3. Reasons related to the child:
The child's tendency to fear due to negativities in the cognitive structure (thinking negatively about the situations encountered and perceiving them to be dangerous).
>4. Genetic causes:
Especially emphasis is placed on the dopaminergic and serotonergic systems. Specific phobia was detected in 31% of first-degree relatives of phobic patients. The same disorder occurs in 15% of children of people with specific phobia. has been detected. Familial relationships are stronger in fear of injury and blood-injection.
SPECIFIC PHOBI
Specific phobia It is a state of distinct, persistent and meaningless fear of clearly visible objects and situations. Specific phobias can last for decades, and symptoms can affect family life, social relationships, and success in school or work. The negative impact of the disorder on functionality is directly proportional to the severity of symptoms, and symptom severity often remains constant in the long term. Adolescents and adults are aware that this fear is excessive; However, children may not have this insight. For this reason, in order to diagnose specific phobia in children, awareness that the fear is meaningless should not be required. Avoiding encountering a phobic stimulus and, in cases where avoidance is not possible, being able to endure the phobic stimulus only with extreme distress are typical features of the disease.
Although the frequency and content of phobia may vary culturally, it can be said that the lifetime prevalence of specific phobia is approximately 9-12%. It is possible and is approximately 3 times more common in girls.
According to DSM-IV-TR diagnostic criteria; The definition of specific phobia is that phobic symptoms must have lasted for at least 6 months and have significantly limited daily activities.
According to DSM-IV diagnostic criteria. Specific phobia consists of 5 subtypes:
1st Situational Type:
Fear of being in public transportation vehicles, tunnels, bridges, elevators, airplanes Situations such as travel and driving initiate. It is most common in childhood and in the mid-twenties.
2.Natural Environment Type:
Natural conditions such as storms, high places, and water initiate fear. It usually begins in childhood.
3.Blood-injection-wound type:
Fear is triggered by blood, wounds, injections or invasive medical interventions. It is usually familial and is often marked by a strong vasovagal response. 75% of patients faint when they encounter these situations.
4.Animal Type:
The cause of fear is animals or insects. It usually begins in childhood.
5.Other Type :
It is a specific phobia subtype with the fear of choking, situations that may cause shortness of breath, vomiting or contracting a disease, loud noises or fairy tale characters.
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PROGRESSION OF SPECIFIC PHOBI
Although specific phobias usually begin in childhood (average age of onset: 7-8), they can also begin in early adulthood or adulthood. Most early-onset phobias disappear in a short time without treatment. Even if children can cope with their phobias, this does not mean that they will not develop other anxiety disorders later in life. Approximately 50% of adult specific phobias have a childhood onset. However, phobias that begin in adulthood are more resistant.
Specific phobias are often accompanied by other anxiety disorders (post-traumatic stress disorder, obsessive-compulsive disorder,…) and depression, especially social phobia.
HOW TO APPROACH A CHILD WITH FEAR?
Fear should never be used as a tool of discipline in raising children.
Children's fears should not be ignored, belittled or ridiculed by parents, teachers and other family members (e.g. What is there to fear? Are boys ever afraid?, you are now a big brother/sister,…)
The reasons for the child's fear should be investigated, the child should be tried to understand, and if there is a possible solution, it should be eliminated.
The child with fears should be treated patiently, given time to overcome his fears, and his efforts to overcome the fear should be taken into account. If sufficient time is not given and the struggle to overcome fear is ignored, the child may give up struggling after a while.
An overprotective attitude should not be shown towards the child from a young age (e.g., you may fall down, you cannot do it alone).
While trying to protect the child, the feeling that the environment is a place full of dangers should not be reflected too much with our words and actions.
The child should be helped to join a group of friends and develop his sense of self-confidence.
When the child is ready to talk about his fears, one should try to listen and understand him with an empathetic attitude. Because sometimes children do not want to share their fears, thinking that they will not be believed and/or ridiculed.
Children (especially children under the age of 8-9) should not be told scary fairy tales or watched scary movies.
All of these are examples of attitudes that should be taken into consideration before or after the onset of fear. However, what should be done during the treatment phase when fear begins?
The most commonly used type of therapy for phobias is cognitive behavioral therapy. The most commonly used technique in cognitive behavioral therapy is exposure therapy. In this method, the person is taught to deal with the resulting anxiety by addressing the situation or object that creates fear. Confrontation therapy can be applied in cases where motivation is sufficient, there are no depressive symptoms, and the phobic stimulus is clearly evident. After working sufficiently to understand whether the objects and situations that create fear actually pose no danger and possible misinformation about the phobic stimulus (cognitive treatment), patients are gradually confronted with the phobic stimulus from mild to severe. The aim is to desensitize patients.
However, what needs to be considered here is; Some fears are age specific. Positive attitudes and being a good model may be sufficient for this. If the child can cooperate well in overcoming the fear, he can gradually get used to what he is afraid of. However, if the child is unable to cooperate in any way in case of fear (such as age, severe fear, insufficient family support, presence of additional mental disorders such as depression), help should first be sought from experts, if necessary, psychopharmacological support should be given, the child should be treated for additional mental disorders and severe The fear should be reduced and then efforts to overcome the fear should be started.
From my experiences over the years, I can say that as a result of positive attitudes, positive parent-child, positive teacher-child, positive child-physician cooperation, the treatment period depends on the severity, prevalence and severity of the disease. Although it varies depending on the characteristics of the person, renewal
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