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The contribution of embarrassment to phobic dental anxiety: a qualitative research study.

Moore R, Brødsgaard I, Rosenberg N - BMC Psychiatry (2004)

Bottom Line: Chief complaints in the sample: 30% had fear of pain; 47% cited powerlessness in relation to dental social situations, some specific to embarrassment and 23% named co-morbid psychosocial dysfunction due to effects of sexual abuse, general anxiety, gagging, fainting or panic attacks.Secrecy, taboo-thinking, and mouth-hiding were associated with intense embarrassment.Some cases exhibited manifestations similar to psychiatric criteria for social anxiety disorder as chief complaint, while most manifested embarrassment as a side effect.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dental Phobia Research and Treatment Center, Department of Community Oral Health and Pediatric Dentistry, Royal Dental College, University of Aarhus, Aarhus, Denmark. roding@post8.tele.dk

ABSTRACT

Background: Embarrassment is emphasized, yet scantily described as a factor in extreme dental anxiety or phobia. Present study aimed to describe details of social aspects of anxiety in dental situations, especially focusing on embarrassment phenomena.

Methods: Subjects (Ss) were consecutive specialist clinic patients, 16 men, 14 women, 20-65 yr, who avoided treatment mean 12.7 yr due to anxiety. Electronic patient records and transcribed initial assessment and exit interviews were analyzed using QSR"N4" software to aid in exploring contexts related to social aspects of dental anxiety and embarrassment phenomena. Qualitative findings were co-validated with tests of association between embarrassment intensity ratings, years of treatment avoidance, and mouth-hiding behavioral ratings.

Results: Embarrassment was a complaint in all but three cases. Chief complaints in the sample: 30% had fear of pain; 47% cited powerlessness in relation to dental social situations, some specific to embarrassment and 23% named co-morbid psychosocial dysfunction due to effects of sexual abuse, general anxiety, gagging, fainting or panic attacks. Intense embarrassment was manifested in both clinical and non-clinical situations due to poor dental status or perceived neglect, often (n = 9) with fear of negative social evaluation as chief complaint. These nine cases were qualitatively different from other cases with chief complaints of social powerlessness associated with conditioned distrust of dentists and their negative behaviors. The majority of embarrassed Ss to some degree inhibited smiling/laughing by hiding with lips, hands or changed head position. Secrecy, taboo-thinking, and mouth-hiding were associated with intense embarrassment. Especially after many years of avoidance, embarrassment phenomena lead to feelings of self-punishment, poor self-image/esteem and in some cases personality changes in a vicious circle of anxiety and avoidance. Embarrassment intensity ratings were positively correlated with years of avoidance and degree of mouth-hiding behaviors.

Conclusions: Embarrassment is a complex dental anxiety manifestation with qualitative differences by complaint characteristics and perceived intensity. Some cases exhibited manifestations similar to psychiatric criteria for social anxiety disorder as chief complaint, while most manifested embarrassment as a side effect.

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Vicious circle of dental anxiety as described by Berggren [11]
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Figure 1: Vicious circle of dental anxiety as described by Berggren [11]

Mentions: Earlier Scandinavian studies [7,8,11,12] indicated existence of a vicious circle of dental anxiety, in which embarrassment, shame or guilt have a central role in facilitating both anxiety and treatment avoidance, but they gave few details as to the exact role of embarrassment in this vicious circle (see Fig. 1). Since symptomatology and clinical significance are important in differential diagnosis of anxiety disorders, it seems that the influences of embarrassment, shame or guilt on dental anxiety have been relatively neglected in the literature. Inspite of the fact that the dentist-patient clinical situation is a social situation and that several studies have also pointed to negative dentist behavior as highly anxiety provoking [4,7,8,11,13-16], descriptions of possibilities for the existence of social anxiety, defined as intense fear of negative evaluation [17,18] or humiliation [19] in social situations, have been few for patients suffering with dental anxiety [7,8,13].


The contribution of embarrassment to phobic dental anxiety: a qualitative research study.

Moore R, Brødsgaard I, Rosenberg N - BMC Psychiatry (2004)

Vicious circle of dental anxiety as described by Berggren [11]
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC411042&req=5

Figure 1: Vicious circle of dental anxiety as described by Berggren [11]
Mentions: Earlier Scandinavian studies [7,8,11,12] indicated existence of a vicious circle of dental anxiety, in which embarrassment, shame or guilt have a central role in facilitating both anxiety and treatment avoidance, but they gave few details as to the exact role of embarrassment in this vicious circle (see Fig. 1). Since symptomatology and clinical significance are important in differential diagnosis of anxiety disorders, it seems that the influences of embarrassment, shame or guilt on dental anxiety have been relatively neglected in the literature. Inspite of the fact that the dentist-patient clinical situation is a social situation and that several studies have also pointed to negative dentist behavior as highly anxiety provoking [4,7,8,11,13-16], descriptions of possibilities for the existence of social anxiety, defined as intense fear of negative evaluation [17,18] or humiliation [19] in social situations, have been few for patients suffering with dental anxiety [7,8,13].

Bottom Line: Chief complaints in the sample: 30% had fear of pain; 47% cited powerlessness in relation to dental social situations, some specific to embarrassment and 23% named co-morbid psychosocial dysfunction due to effects of sexual abuse, general anxiety, gagging, fainting or panic attacks.Secrecy, taboo-thinking, and mouth-hiding were associated with intense embarrassment.Some cases exhibited manifestations similar to psychiatric criteria for social anxiety disorder as chief complaint, while most manifested embarrassment as a side effect.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dental Phobia Research and Treatment Center, Department of Community Oral Health and Pediatric Dentistry, Royal Dental College, University of Aarhus, Aarhus, Denmark. roding@post8.tele.dk

ABSTRACT

Background: Embarrassment is emphasized, yet scantily described as a factor in extreme dental anxiety or phobia. Present study aimed to describe details of social aspects of anxiety in dental situations, especially focusing on embarrassment phenomena.

Methods: Subjects (Ss) were consecutive specialist clinic patients, 16 men, 14 women, 20-65 yr, who avoided treatment mean 12.7 yr due to anxiety. Electronic patient records and transcribed initial assessment and exit interviews were analyzed using QSR"N4" software to aid in exploring contexts related to social aspects of dental anxiety and embarrassment phenomena. Qualitative findings were co-validated with tests of association between embarrassment intensity ratings, years of treatment avoidance, and mouth-hiding behavioral ratings.

Results: Embarrassment was a complaint in all but three cases. Chief complaints in the sample: 30% had fear of pain; 47% cited powerlessness in relation to dental social situations, some specific to embarrassment and 23% named co-morbid psychosocial dysfunction due to effects of sexual abuse, general anxiety, gagging, fainting or panic attacks. Intense embarrassment was manifested in both clinical and non-clinical situations due to poor dental status or perceived neglect, often (n = 9) with fear of negative social evaluation as chief complaint. These nine cases were qualitatively different from other cases with chief complaints of social powerlessness associated with conditioned distrust of dentists and their negative behaviors. The majority of embarrassed Ss to some degree inhibited smiling/laughing by hiding with lips, hands or changed head position. Secrecy, taboo-thinking, and mouth-hiding were associated with intense embarrassment. Especially after many years of avoidance, embarrassment phenomena lead to feelings of self-punishment, poor self-image/esteem and in some cases personality changes in a vicious circle of anxiety and avoidance. Embarrassment intensity ratings were positively correlated with years of avoidance and degree of mouth-hiding behaviors.

Conclusions: Embarrassment is a complex dental anxiety manifestation with qualitative differences by complaint characteristics and perceived intensity. Some cases exhibited manifestations similar to psychiatric criteria for social anxiety disorder as chief complaint, while most manifested embarrassment as a side effect.

Show MeSH
Related in: MedlinePlus