|Year : 2018 | Volume
| Issue : 2 | Page : 147-149
A rare case report of alektorophobia in an adult male
Suvarna Jyothi Kantipudi, Navina Suresh, R Sathianathan
Department of Psychiatry, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
|Date of Web Publication||30-Nov-2018|
Suvarna Jyothi Kantipudi
Department of Psychiatry, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Alektorophobia is a term specific to fear of chickens/hens. It is a type of ornithophobia (fear of birds) which comes under specific phobia, animal type. Alektorophobia is derived from the Greek word ”Alektor” which means ”rooster” and ”phobos” meaning ”fear.” Specific phobia is a type of anxiety disorder and is relatively common in females, children, and adolescents. Although specific phobias are common type of anxiety disorder, alektorophobia is a rare entity. In our case report, we discuss a 32-year-old gentleman with a specific phobia for cocks and hens, who presented with significant distress and socio-occupational dysfunction. He was successfully treated with a combination of pharmacological agent selective serotonin reuptake inhibitors and nonpharmacological strategies (systematic desensitization) and remained symptom-free even after 9-month follow-up. This is the first case of alektorophobia reported in adult male to the best of our knowledge. This case emphasizes the need for understanding the role of psychological processes in the development of phobia and role of nonpharmacological strategies in the management.
Keywords: Alektorophobia, chicken, specific phobia, selective serotonin reuptake inhibitors, systematic desensitization
|How to cite this article:|
Kantipudi SJ, Suresh N, Sathianathan R. A rare case report of alektorophobia in an adult male. Ann Indian Psychiatry 2018;2:147-9
| Introduction|| |
Fear and anxiety evolved as adaptive responses. Unfortunately, fear and anxiety are not always adaptive. When they reach extreme levels in day-to-day situations, they cause significant impairment and distress and may meet the criteria for an anxiety disorder. Specific phobia is defined as ”a marked fear or anxiety about a specific object or situation”. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) defines 5 main types of specific phobia: Animal, natural environment, blood-injection-injury, situational, and other. Feelings of disgust or revulsion often accompany such specific phobias. Globally, the lifetime prevalence rate of specific phobia ranges from 0.63 to 11.3 based on individual studies., The prevalence of phobic disorders in Indian population is around 4.2%. Women are twice likely to be affected than men with specific phobia, especially animal type. Alektorophobia is derived from the Greek word ”alektor” which means ”rooster” and ”phobos” meaning ”fear” and comes under specific phobia, animal type. We report a case of alektorophobia with avoidance behavior successfully treated with selective serotonin reuptake inhibitors (SSRIs) and systematic desensitization. SSRIs were given only in the initial period in view of severe anxiety and patient's reluctance to nonpharmacological management. There are similar cases reports described in the literature for females, children, and adolescents. To the best of our knowledge, this is the first case of alektorophobia reported in an adult male.
| Case Report|| |
A 32-year-old man, a postgraduate degree holder in business management, employed in an IT company belonging to middle socioeconomic status Tamil speaking rural background, came accompanied by his wife to psychiatric outpatient services with chief complaints of fear and avoidance of cocks and hens for the past 27 years which had been aggravated for the previous 1-week causing significant distress. The patient had a history of fear of cocks, hens, and chickens since around 5 years of age. He had been on a visit to his grandparent's home in their ancestral village and had been playing outside when a cock which was nearby suddenly flew up and accidentally bumped into him giving him an unexpected fright. The patient said that from that time onwards he developed feelings of fear, dislike, and disgust toward cocks and hens which he used to experience intensely at mere sight of the creatures. He started avoiding places and roads where cocks/hens are expected and would take an alternate route even if it was time-consuming. Living in an urban city, he successfully managed the same, and thereafter even stopped visiting his ancestral village to avoid seeing them. Initially, his mother had tried to help him get over his fear by reassuring him and trying to convince him that he would not be harmed. On one occasion when he was around 6–7 years old, she tried to make him get over his fear by abruptly exposing him to a cock without any prior warning; however, he grew very afraid and reacted so adversely in fear that thereafter they stopped trying to force him to get over it. They also tried several magico-religious rituals and prayers to help him get over it to no avail. He said that his aversion was so extreme he would avoid even looking at pictures or videos of cocks, hens or chickens. One week before consultation, his neighbors in his apartment building had acquired some hens and were keeping them as pets. On seeing these hens at close quarters when coming out of his flat, patient would develop generalized fearfulness, his mind would go blank, he would develop generalized tremulousness, dry mouth, palpitations, blocking sensation in his chest followed by fearfulness that he would get a heart attack, and would find himself screaming in fear. For the past 1 week, he also developed increased anger and irritability over trivial issues and difficulty sleeping. For most part of the day, he found himself preoccupied with thoughts of coming into contact with the hens and wanting to avoid them at any cost. He could not enjoy his time with his family and experienced a subjective feeling of anxiety and apprehensiveness which persisted most of the time. He said he could realize the irrationality of his fear and avoidance behaviour but found himself unable to overcome his fear. When he began to develop occupational impairment, following having missed a day of work the previous day, due to fear of stepping out of his house, he came to the hospital. His day-to-day functioning and appetite were otherwise adequate. There was no history of other phobias, free-floating anxiety symptoms, persistent mood symptoms, and no history of psychotic symptoms, substance use, head injury, seizures, or thyroid disease. He had previously never consulted a psychiatrist. He had no significant medical or surgical history. There was also no significant family history of neuropsychiatric illness.
Premorbidly patient was a friendly person who could be called ambivert. He divulged that his mother had been overprotective toward him in childhood and he had been timid as a child; however, further details regarding childhood history and temperament were not available. According to his wife, he was a responsible person, who was particular about his work and being on time. At home, he was adjusting, even-tempered and affectionate with family members. The impression was a premorbidly well-adjusted person with no significant deviant traits.
Physical examination and routine blood investigations were within normal limits. Mental status examination revealed an appropriately groomed man with average psychomotor activity, anxious and at times irritable affect, with average speech productivity. His thought content revealed anxious ruminations and worries over his symptoms, fear about again encountering the cocks/hens and ideas of shame about being so fearful over something trivial. There were no perceptual abnormalities. He had intact higher mental functions and Grade 4 insight.
A diagnosis of specific phobia, animal type (alektorophobia) was made based on the clinical symptoms and history as per DSM of mental disorders, fifth edition diagnostic criteria as he had marked fear and anxiety about specific object which provoked immediate anxiety and which he had actively avoided since many years and was not better explained by symptoms of any other mental disorder.
He was asked to rate his symptoms on a self-report questionnaire ”severity measure for specific phobia-adult,” and the raw score was 37 (maximum score possible - 40). At index visit, patient and wife were psychoeducation regarding his disorder and informed regarding various treatment options. Patient was started on treatment with Selective Serotonin Reuptake Inhibitor (SSRI)-Cap. Fluoxetine 20mg/day in view of severe anxiety symptoms. After 1 week, cognitive restructuring was initiated by identifying the thoughts of situations encountering cocks/hens more dangerous than they really are, challenging the reality predictions of frightening thoughts and replacing those thoughts with realistic calming statements. At the third visit, principles of systematic desensitization were explained, and relaxation techniques were taught. His anxiety symptoms started improving from the 3rd week of treatment onward. The patient was encouraged to make a hierarchy of anxiety-provoking situations, and in each subsequent visit, he was supported to gradually expose himself to hens and cocks, initially in print medium, followed by videos and eventually in person at his neighbor's home. He was encouraged to practice relaxation techniques as and when he developed anxiety symptoms which he diligently followed. At the seventh visit, he was able to tolerate the proximity and vision of the birds without getting anxious. He continued to get exposed to the hens in person along with practicing relaxation exercises. He was asked to again rate the severity of his symptoms on severity measure for specific phobia-adult, and he scored 3 (maximum possible score-40).
Following around seven sessions of psychotherapy (1/week, each session lasting for 45–60 min) along with pharmacotherapy patient's symptoms subsided completely in 8 weeks. Fluoxetine was stopped after 8 weeks, and the patient continued to remain free from symptoms at the next 6 months' follow-up and was doing well.
| Discussion|| |
Specific phobias in adult male are uncommon. The mean age of onset for phobia of animals is early childhood. The lag time in presentation in our case could be explained by the avoidance behavior of the patient till his adult life. The sudden exposure to phobic agent in our case caused significant distress and impairment for the individual. The etiology of phobic disorders is complex and involves neurobiological and psychosocial factors. Patients with phobias use avoidance to escape the effects of anxiety which leads to behavioral negative reinforcement. Avoidance behavior prevents the uncomfortable symptoms that occur when one is frightened and thereby maintains the desire to avoid the phobic object and situation leading to phobia. In our case, factors to consider in the development of specific phobia included traumatic experience with hen, cognitive distortion of stimulus generalization and catastrophization, autonomic arousal symptoms such as panic attacks causing avoidance behavior leading to negative reinforcement and continuation of learned maladaptive behavior. Treatment options for specific phobia include pharmacotherapy as well as psychological therapies such as in vivo exposure, applied tension, applied relaxation, and cognitive therapy. Pharmacotherapy in the initial phase of treatment may help reduce anticipatory anxiety and panic sensations.
| Conclusion|| |
Specific phobias are among the more common psychiatric disorders and along with social anxiety disorder are the most common of anxiety disorders. On a positive note, specific phobias are also among the most treatable of anxiety disorders. Exposure-based treatments are effective and efficient for helping patients overcome specific phobias. Recent developments in technology such as videotapes and computer-guided self-exposure can be incorporated in management. While the management is usually nonpharmacological, augmentation with pharmacological treatment can also be considered during the initial phase of the management.
- Specific phobias are among the more common psychiatric disorders and along with social anxiety disorder are the most common of anxiety disorders
- On a positive note, specific phobias are also among the most treatable of anxiety disorders
- Exposure-based treatments are effective and efficient for helping patients overcome specific phobias
- Recent developments in technology such as videotapes and computer-guided self-exposure can be incorporated in the management
- While management is usually nonpharmacological, augmentation with pharmacological treatment can also be considered during the initial phase of management.
Specify contributions that need acknowledging but do not justify authorship, such as general support by a departmental chair and acknowledgments of technical.
We obtained informed consent from the patient for publishing this case report.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
McCabe RE, Hood HK, Antony MM. Anxiety disorders: Social anxiety disorder and specific phobia. In: Tasman A, Kay J, Lieberman JA, First MB, Riba MB, editors. 4th
ed. Chichester, UK: John Wiley & Sons, Ltd.; 2015.
American Psychiatric Association. Anxiety disorders. In: Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th
ed. Washington, DC: American Psychiatric Association; 2013. p. 189.
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al.
Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the united states. Results from the national comorbidity survey. Arch Gen Psychiatry 1994;51:8-19.
McConnell P, Bebbington P, McClelland R, Gillespie K, Houghton S. Prevalence of psychiatric disorder and the need for psychiatric care in Northern Ireland. Population study in the district of Derry. Br J Psychiatry 2002;181:214-9.
Somers JM, Goldner EM, Waraich P, Hsu L. Prevalence and incidence studies of anxiety disorders: A systematic review of the literature. Can J Psychiatry 2006;51:100-13.
Trivedi SK, Mangot AG, Munoli RN. A rare case of alektorophobia treated successfully with graded exposure therapy. Ind Psychiatry J 2016;25:116-8.
] [Full text]
Hofmann SG. Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders. Clin Psychol Rev 2008;28:199-210.
Meyerbröker K, Emmelkamp PM. Virtual reality exposure therapy in anxiety disorders: A systematic review of process-and-outcome studies. Depress Anxiety 2010;27:933-44.
Zwanzger P. Pharmacotherapy of anxiety disorders. Fortschr Neurol Psychiatr 2016;84:306-14.