Phobic Anxiety On The Auricle

Among anxiety disorders, panic attacks with or without agoraphobia are frequent and auricular diagnosis may confirm the existence of or the tendency to develop this mental disorder. There are certain areas that remain tender to pressure even several weeks after a single panic attack; it is possible, however, that such tenderness may reflect the patient's concern about further attacks (on the left of Fig. 5.21). Another possibility regarding this area may be associated with specific phobias brought

1614121 10-

"a

15 20 25

BNSQ scoring

Fig. 5.19 Regression line between the number of auricular tender points and BNSQ scoring in 153 consecutive subjects.

Table 5.3 Paired sample t-test comparing the mean of tender points per sector (right + left ear) in 62 poor sleepers and 91 better sleepers scored with BNSQ

Worse sleepers (BNSQ > 22)

Better sleepers (BNSQ < 21)

Sectors of the ear Mean

SD

Mean

SD

P

1 0.6

0.78

0.4

0.61

<0.05

2 1.2

1.00

0.5

0.64

<0.001

5 1.0

0.84

0.6

0.70

<0.005

8 1.5

1.13

0.4

0.68

<0.001

on by exposure to a particular feared object or animal, or with phobias provoked by certain types of social situations or performances. From the clinical psychological point of view it is possible to list five types of phobic response: social fears, agoraphobia, fear of physical harm, illness and death, fear of sexual and aggressive scenes and fear of harmless animals. Among the various scales conceived for measuring phobic anxiety with this five-dimensional model is the Fear Survey Schedule III (FSS III) validated by Arrindell36 and proposed to 11 different countries to determine the cross-national dimensional consistency of self-assessed fears. Subjects were required to indicate the degree of anxiety felt in relation to 52 different stimuli. This was measured on a five-point Likert-type scale ranging from 0 (not at all disturbed) to 4 (very disturbed).

I applied FSS III to 51 consecutive patients in my general practice (31 females, 20 males). Their average age was 41.2 years. None had ever suffered from panic attacks. My aim was to identify the areas that were more often sensitized by the phobic reaction or predisposition of every subject. In addition, their levels of anxiety and depression were measured using the Zung scales for anxiety and depression.37,38 Comparing the mean distribution of tender points in the two groups with paired sample t-test (respectively with at least 1 and 0 stimuli rated as 'very disturbing'), I identified some areas which were significantly more sensitized on

Fig. 5.20 Cluster of tender points in sleeping disorder; the colored sectors are those with a significantly higher concentration of points in the group of worse sleepers compared to better sleepers.

sectors 4, 5, 6, 12 and 39 (on the right of Fig. 5.21). The sensitization of sectors 4, 5 and 6 seems in particular therefore to indicate the possibility of both diagnosing a subject's phobic predisposition and treating patients concerned about a relapse of their panic attacks. It should be noted that subjects with at least one 'very disturbing' phobia were rated as significantly more anxious with the Zung scale for anxiety (P<0.005) and more depressed with the Zung scale for depression (P<0.001).

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