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

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

BMC Psychiatry. 2004; 4: 10.
Published online 2004 April 19. doi: 10.1186/1471-244X-4-10.

By Rod Moore,1 Inger BrØdsgaard,2 and Nicole Rosenberg3
1Dental Phobia Research and Treatment Center, Department of Community Oral Health and Pediatric Dentistry, Royal Dental College, University of Aarhus, Aarhus, Denmark
2Department of Psychiatry, Psychiatric Hospital, University of Aarhus, Aarhus, Denmark
3Clinic for Anxiety and Personality Disorders, Department of Psychiatry, Psychiatric Hospital, University of Aarhus, Aarhus, Denmark

Rod Moore: roding@post8.tele.dk
Inger BrØdsgaard: inbr@hs.vejleamt.dk
Nicole Rosenberg: nkr@psykiatri.aaa.dk
Received December 17, 2003; Accepted April 19, 2004.

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, 20Ò65 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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