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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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Extreme oral destruction due to phobic avoidance of dental treatment in a 26 yr old Danish man
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Figure 2: Extreme oral destruction due to phobic avoidance of dental treatment in a 26 yr old Danish man

Mentions: Embarrassment intensity increased with years of dental care avoidance (rs = 0.44; P = 0.02). Ss were nearly twice (OR = 1.9; CI = 1.3–2.8) as likely to have highly intense embarrassment (scores 3 or 4) after 4 years of treatment avoidance (?2 = 4.3; P = 0.04), compared to lower embarrassment levels (scores 0–2). Embarrassment intensity also correlated with the mouth-hiding behavior scale (rs = 0.53; P = 0.003). The mouth-hiding scale was rs = 0.32; P = 0.09 with years of avoidance. With greater numbers of years avoiding dental treatment, the following phenomena were noted in descriptions among embarrassed subjects (multiple possible) 1) guilty conscience as attributed to the act of neglecting dental care (n = 19), 2) actual dental damage from neglect that was visible (n = 22) (e.g. Fig. 2) or 3) unrealistic, exaggerated perceptions of tooth damage that were not as visible as patients perceived and thus were incongruent with actual dental status (n = 10). The latter appeared most often in cases where there were perceptions of negative social evaluation, guilty conscience and/or poor self-image/esteem.


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

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

Extreme oral destruction due to phobic avoidance of dental treatment in a 26 yr old Danish man
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Extreme oral destruction due to phobic avoidance of dental treatment in a 26 yr old Danish man
Mentions: Embarrassment intensity increased with years of dental care avoidance (rs = 0.44; P = 0.02). Ss were nearly twice (OR = 1.9; CI = 1.3–2.8) as likely to have highly intense embarrassment (scores 3 or 4) after 4 years of treatment avoidance (?2 = 4.3; P = 0.04), compared to lower embarrassment levels (scores 0–2). Embarrassment intensity also correlated with the mouth-hiding behavior scale (rs = 0.53; P = 0.003). The mouth-hiding scale was rs = 0.32; P = 0.09 with years of avoidance. With greater numbers of years avoiding dental treatment, the following phenomena were noted in descriptions among embarrassed subjects (multiple possible) 1) guilty conscience as attributed to the act of neglecting dental care (n = 19), 2) actual dental damage from neglect that was visible (n = 22) (e.g. Fig. 2) or 3) unrealistic, exaggerated perceptions of tooth damage that were not as visible as patients perceived and thus were incongruent with actual dental status (n = 10). The latter appeared most often in cases where there were perceptions of negative social evaluation, guilty conscience and/or poor self-image/esteem.

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