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 phobic anxiety disorder or specific phobia.
The latest edition (fifth) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines these disorders as the appearance of intense, immediate (almost always) and disproportionate fear or anxiety in the face of specific objects or situations. And that, in general, they would not be considered dangerous and that, in addition, the patient tries to avoid or actively resist.
The “misadaptive” fear: That one which does not protect us
Phobias have as their starting point the basic emotion of fear. Normally, this has an eminently adaptive function for survival. It allows detecting real imminent threats and generate an appropriate response against them.
However, when said 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 nature.
In fact, the DSM-V, of the American Psychiatric Association, contemplates the following diagnostic criteria for phobia: fear, anxiety or avoidance causes clinically significant discomfort or deterioration in social, occupational, or other important areas of functioning. And this is precisely the fundamental characteristic that makes a phobia a mental health problem.
“The psychological impact of the pandemic and of Omicron may worsen over time”
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) is the perfect breeding ground for the appearance of disorders related to excessive fear.
Children at school
Containment measures and social isolation have harmed the mental health of many people. Malte Mueller/Getty Images
Thus, various studies have evaluated previous outbreaks of infectious diseases such as the Spanish flu, of 1918, or the Ebola outbreak in West Africa, in 2014. These have associated these with disproportionate cognitive, affective or behavioral responses compared to any aspect associated with them.
Aspects such as the risk of infection through physical contact or closed spaces are noteworthy. Also the death or infection of loved ones, containment measures, social isolation and loneliness, massive job loss or financial instability, among others.
In this context, we know that not everyone has the same chance of developing a phobia in response to 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 that of Covid-19), it has been seen that individual difference variables such as lack of tolerance for uncertainty, perceived vulnerability to illness or propensity to anxiety seem to play a fundamental role.
Phobias associated with confinement
The confinement measure imposed in practically all countries at the beginning of the pandemic led to the isolation of people. This has resulted in a drastic reduction in physical and social contact and an impact on mental health. Restrictions on leisure and free time also participated in this process.
The consequences of this have been diverse in relation to people’s mental health. On the one hand, directly associated with social isolation, agoraphobia stands out, 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 for social phobia.
Confinement can leave a psychological mark. Malte Mueller/Getty Images
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.
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“Coronaphobia” and other phobias associated with contagion
On one side, one of the phobias that the current pandemic has specifically generated is known as ‘coronaphobia’, excessive anxiety about contracting 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 in that it is strongly related to functional impairment and psychological distress and thus has important implications for mental well-being. Likewise, related to excessive fear of contagion, obsessive-compulsive disorder (OCD) is noteworthy, another alteration related to anxiety whose symptoms can be exacerbated in the context of Covid-19.
The DSM-V defines OCD as the presence of obsessions, compulsions, or both. First, obsessions are recurrent and persistent unwanted thoughts, urges, or images. For example, in the context of the pandemic, the idea of getting infected or of infecting loved ones. Second, the compulsions may appear to deal 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 another preventive measure against infection. However, this behavior is usually a frequent OCD compulsion associated with contamination. Thus, this action that is appropriate and healthy (not only in times of pandemic, but in general) can become the basis for the increased prevalence of OCD associated with Covid-19 in this case.
“Have I been preparing myself for the coronavirus pandemic for 20 years?”
Coronaphobia is a relatively new problem since it is a phobia specifically associated with Covid-19. However, there are studies on phobias related to other infectious diseases as mentioned 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 due to the possible exacerbation of the symptoms of patients undergoing treatment. Or, even, due to relapses that may occur in former patients who had already been discharged.
*Aránzazu Duque Moreno is a doctor in Neurosciences, director of the Degree in Psychology and Secretary of the Chair of Humanization of Health Care and member of the Psychology and Quality of Life research group at the International University of Valencia (Spain).
*Basilio Blanco Núñez is a research professor at the Faculty of Health Sciences of the International University of Valencia (Spain).