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Phobias in children

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A [[phobia ]] (from the Greek <i>phobos</i>: "flight, [[fear]], fright") is an [[irrational ]] fear aroused by an [[object]], [[situation]], or [[activity ]] that does not involve [[real ]] [[danger]]. [[Anxiety]], the [[irrationality ]] of which is generally consciously recognized by the person, results in various defensive strategies: flight, avoidance, or the use of an object or person that enables the [[subject ]] to face the feared situation.The term first appeared in the [[psychiatric ]] [[literature ]] of the late nineteenth century (Karl Westphal, in 1872, cited [[agoraphobia]]); [[French ]] psychiatrists around the same [[time ]] (Albert Pitres and Emmanuel Régis) described a very large [[number ]] of phobias in [[terms ]] of the triggering object or situation ([[claustrophobia]], erythrophobia, [[zoophobia]], etc.).Pierre Janet, who linked [[phobic ]] [[symptoms ]] to psychasthenia, [[divided ]] phobias into [[three ]] [[categories ]] that remain in use: object phobias, situation phobias, and function phobias. Object phobias involve pointed or cutting [[objects ]] (scissors, knives, razor blades) associated with auto- or heteroaggressive [[fantasies ]] that may take the [[form ]] of phobias of impulsive [[acts ]] and that are often integrated into [[obsessional ]] [[neurosis]]. Similar to these are phobias of animals, which are very frequent in [[children ]] but can continue into [[adulthood ]] (fear of spiders, mice, snakes, birds, etc.).Situation phobias involve open spaces (agoraphobia), enclosed spaces (claustrophobia), or high places ([[vertigo]]). In function phobias, [[manifest ]] anxiety bears upon the functioning of the organism: fear of falling asleep or of swallowing. Similar to these are the fear of diseases (nosophobia) and [[social ]] phobias: fear of [[speaking ]] or blushing in [[public ]] (erythrophobia), and phobias of [[touching ]] or contact.
The term <i>pantophobia</i> is sometimes used to describe a diffuse anxiety aroused by several objects or
situations, but the [[absence ]] of specific [[conditions ]] for the emergence of anxiety makes the inclusion of such cases in the framework of the phobias questionable. Certain phobic behaviors can be likened to the [[rituals ]] seen with [[obsessional neurosis ]] (mixed, so-called phobo-obsessional forms).The [[clinical ]] study of phobias would be incomplete if it did not consider the behaviors that the person uses to fight against the anxiety associated with the phobogenic object. These behaviors derive from two types of defensive strategy: avoidance and reassurance. Avoidance can be expressed in maneuvers to flee or bypass the phobogenic situation or through varying degrees of restriction in the subject's activities. Reassurance enlists a person or object that makes it possible to face the phobogenic situation.The [[understanding ]] of phobias is one of the very earliest topics to engage Sigmund [[Freud]]'s [[theoretical ]] [[reflection]], as early as 1894-1895. One of his first articles on this theme, "Obsessions and Phobias: Their [[Psychical ]] [[Mechanism ]] and Their Aetiology" (1895c [1894]), originally published in French, discussed Janet's conceptions and clearly separated phobias from obsessions: in [[particular]], the relation to anxiety is specific to phobias. In these early works, Freud considered the phobias as a form of [[anxiety neurosis]], which he classed among the "actual" or [[defense ]] [[neuroses ]] and whose etiology he explained in terms of an accumulation of endogenous [[excitation]], "a veritable [[self]]-[[intoxication]], by means of a sort of engorgement of the [[sexual ]] substances."In his later writings, he linked phobias to [[hysterical ]] anxiety and thus to the [[transference ]] neuroses that are accessible to [[analysis]]. In hysterical anxiety, the [[libido ]] is unleashed in the form of anxiety and not converted as would normally happen in [[hysteria]]. [[Repression ]] bears upon an [[instinctual ]] impulse with [[projection ]] onto an object; anxiety cannot be totally avoided except at the cost, as Freud noted, of "all sorts of inhibitions and restrictions" to which the person must submit him- or herself.Freud developed his [[notion ]] of the [[formation ]] of phobias in the [[case ]] of Little [[Hans]], related in "Analysis of a Phobia in a Five-Year-Old Boy" (1909b), and in his [[return ]] to that case in that of the [[Wolf Man ]] in "Inhibitions, Symptoms and Anxiety" (1926 [1925]). The [[symptom ]] results from [[mental ]] [[work ]] that aims to "fix once again the anxiety that has become free." Freud showed how [[Little Hans]]'s phobia of the horse staged the [[representation ]] of the [[threat ]] of [[castration ]] by the [[father ]] [[figure]]. At the same time, through the motor [[inhibition ]] it entailed in the [[child]], the phobia realized a compromise between the incestuous desires directed toward the [[maternal ]] object and their repression (pre-vented by his phobia from going out, the boy could remain near his [[mother]]). Repression affects the [[totality ]] of the components of the [[Oedipus ]] [[complex]].Returning to this case in 1926, while maintaining the central [[role ]] of [[castration anxiety]], Freud placed greater emphasis on the repression of parricidal fantasies, as well as on the [[passive ]] [[homosexual ]] [[fantasy ]] of the father figure. The phobia could be [[understood ]] as an attempt to resolve the [[conflict ]] of [[ambivalence]]: Little Hans's symptom was a compromise between [[love ]] and hostility for the father. The [[displacement ]] onto [[another ]] object of the anxiety that results from a conflict of ambivalence protects the ego from instinctual danger. In this work Freud underscored the [[reversal ]] that analysis of the formation of phobias had compelled him to make in his [[theory ]] of anxiety: It is anxiety that is at the origin of repression, and not the reverse.In the subsequent [[development ]] of [[psychoanalysis]], phobias in children have incited numerous theoretical debates. [[Anna Freud ]] and her followers differentiated between phobias and the archaic fears that preexist all earlier experiences (fear of the dark, of storms, etc.). For these authors, these [[infantile ]] fears, merely an expression of the ego's immaturity, were not phobias in the strict [[sense]], in that they did not bring together [[condensation]], projection, and [[symbolization]]. However, they considered such fears to be the precursors to phobias. These authors believed that was is not possible to [[speak ]] in terms of a [[neurotic ]] organization before conflicts had been internalized at the end of the [[Oedipus complex]].According to Melanie [[Klein]], the [[primitive ]] Ego is subjected to experiences of intense anxiety. Phobia corresponds to the projection of the [[death ]] [[instinct ]] onto [[external ]] objects; it comes [[about ]] in relation to the forming of [[object relations ]] and the emergence of a terrifying, archaic [[superego ]] that is [[identified ]] with the paternal [[penis]]. This destructiveness, projected onto the introjected [[parents]], constitutes the [[internal ]] threat that is the source of phobias. Archaic anxiety produces fantasies of [[being ]] devoured; phobias of animals, especially, [[represent ]] the fear of being devoured by the superego. However, the phobia also expresses a [[sadistic]]
destructiveness that is linked to [[aggression ]] directed toward the paternal [[imago]]; the [[violence ]] of this destructive impulse is the source for massive anxiety that, in turn, becomes a source of [[persecution]].In 1956-1957 Jacques [[Lacan ]] introduced the notion of the phobic [[signifier]], the equivalent of the paternal [[metaphor ]] that makes it possible to [[symbolize ]] [[the Real ]] of [[phallic ]] <i>[[jouissance]]</i>. The phobogenic object masks the subject's fundamental anxiety and comes to occupy an intermediate [[position ]] between the [[phallic signifier ]] and an appeal to the [[Name]]-of-the-Father. Whereas the [[fetish ]] object, in [[perversion]], is the absolute condition for <i>jouissance</i>, the function of the phobic signifier is to protect the subject from the [[disappearance ]] of [[desire]].Although castration anxiety does indeed appear to be central in phobias, the [[affect ]] that characterizes it seems to originate in the [[experience ]] of [[separation]]. The absence of the mother, in the preverbal [[infant]]'s situation of [[helplessness ]] and distress (<i>[[Hilflosigkeit]]</i>), creates the [[traumatic ]] conditions for [[terror ]] (<i>Schreck</i>). The defensive mechanisms put into [[place ]] to cope with this can be seen as the precursors to the organizing mechanisms of phobia. According to Annie Birraux in <i>Éloge de la [[phobie]]</i> (In praise of phobia, 1994), phobia is "a primitive [[structure ]] of [[thought]]": Projection, one of its fundamental mechanisms, is to be linked to the primitive movement of [[expulsion ]] that Freud, in "[[Negation]]" (1925h), placed at the origins of the coming into being of the subject and the activity of thought.From a clinical viewpoint, Jean Mallet, in "Contributionà l'étude des phobies" (Contribution to the study of phobias, 1956), described the development of phobias in children as a function of age. He showed the continuity between the child's archaic fears and the phobias proper of the [[oedipal ]] period. The prototype of phobia can be seen at around eight months in the child's [[negative ]] reaction to the approach of a stranger; according to René Spitz, this reaction expresses the child's accession to a [[total ]] [[object relation ]] and thus to the experience of separation. This issue becomes the basis for the organization of the fears and phobias (or prephobias, according to some authors) of the [[pregenital ]] period.[[Anxieties ]] often manifest during [[sleep ]] or at bedtime: fear and [[refusal ]] to go to bed (the [[transitional object ]] can be considered as a precursor to the counterphobic object), or nightmares, which Mallet linked to night terrors. Around the age of two, [[dream ]] imagery takes the form of large animals that can bite or devour, and which translate fantasies related to orality—the source, according to Mallet, of the phobias of large animals that often occur around this age. Later, the shift toward phobias of small animals—a source of repulsion rather than fear, and with which the child avoids [[visual ]] or tactile contact—coincides with entrance into the [[genital ]] [[stage]]. These phobias can be understood as an expression of the [[prohibition ]] against the voyeuristic impulses and touching, and more generally against sexual curiosity.[[School ]] is one of the main places where phobic manifestations occur. While some [[intellectual ]] inhibitions can be related to castration anxiety and oedipal issues, most anxiety disorders centering on school are connected to difficulties of separation, whether in the form of transitory—although sometimes extremely intense—reactions against the early experience of being in school, or more serious and persistent phobias relating to school. Serge Lebovici has emphasized that serious school phobias appearing later in [[life ]] (in preadolescence or adolescence) are often congruent with a prepsychotic organization. This underscores the heterogenous [[nature ]] of phobic manifestations in children and the [[need ]] for a psychopathological evaluation of the [[developmental ]] and [[structural ]] context in which these manifestations emerge.
# Freud, Anna. (1977). Fears, anxieties, and phobic phenomena. [[Psychoanalytic ]] Study of the Child, 32, 85-90.# [[Freud, Sigmund]]. (1895c [1894]). Obsessions and phobias: their psychical mechanism and their aetiology. SE, 3: 69-82.
# ——. (1909b). Analysis of a phobia in a five-year-old boy. SE, 10: 1-149.
# ——. (1925h). Negation. SE, 19: 233-239.
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