Dog phobia in a motion-blind patient

INTRODUCTION: A prominent neurophysiological model of phobia generation holds that specific phobia might result from the uncoupling of unaware subcortical fear responses from aware cortical fear responses. Former responses are thought to be automatic and fast, providing approximate information about the external stimulus, whereas the latter responses are more controlled and allow comparison with previous experience. Since only the cortical pathway carries information available to awareness, this model also accounts for the striking irrationality of specific phobia in humans. METHODS: Here, we report neuropsychological and neuro-ophthalmological findings in a 41-year-old patient who developed severe dog phobia following bilateral parietal lobe damage. RESULTS: The examinations showed a severe deficit in visual motion perception (visual motion blindness or akinetopsia) as well as spatial vision. Importantly, the patient was largely unaware of his visual deficits. CONCLUSION: Based on the present observation it is argued that irrational fear, as found in specific phobia, might not only result from a general uncoupling of aware cortical from unaware subcortical fear responses, but also from a functionally similar dissociation at the cortical level.