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Ptophobia: Phobic Fear of Falling and Its Clinical Management

Dr. Bhala is Associate Clinical Professor, Department of Physical Medicine and Rehabilitation, St. Luke's Hospital, 2900 W Oklahoma Ave, Milwaukee, WI 53215 (USA).
Dr. O'Donnell is Consultant Psychologist, St. Luke's Hospital, Milwaukee, WI.
Dr. Thoppil is Assistant Professor, Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin.

We have seen six patients, over the past two years, who had developed intense fear of standing or walking as a result of accidental falls. None of these patients showed any evidence of neuromuscular impairment that might account for their inability to walk. However, the results of psychological evaluations of all these patients revealed high degrees of focal anxiety that was phobic in nature and related to standing or walking. Personality assessments of these patients showed little or no evidence of psychopathology of a generalized nature or of personality trait disturbance. The phobic reaction was the primary psychological disturbance underlying their fear to stand or walk. Each patient demonstrated evidence of both reduction of anxiety and functional improvement in walking following behavioral desensitization and physical therapy. We believe this disorder is a distinct psychological problem unrelated to agoraphobia, and we propose using the term "ptophobia" when describing this clinical entity.

Key Words: Phobias • Gait • Behavior therapy • Physical therapy

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