Danielle Winder Kathia Johnson Susie Berrin Anxiety Disorders Danielle Winder Kathia Johnson Susie Berrin

Definition of Anxiety Disorders Anxiety or fear is defined as a complex pattern of three types of reactions to a perceived threat. (Lang,1984) What are the three types of reactions? Give an example of each. 1. Overt Behavioral Responses -Running away, trembling voice, closing eyes 2. Physiological Responses - Changes in heart rate and respiration, muscle tension, stomach upset 3. Subjective Responses - Thoughts of being scared, images of bodily harm

Classification of Anxiety Disorders 1.) DSM Approach -The DSM IV describes several types of anxiety disorders. -Match the disorder to the respective definition: 1.Separation Anxiety Disorder a) -is characterized by sudden attacks of intense anxiety. -these attacks do not occur only in response to a particular phobic stimulus or threatening situation. - symptoms peak within 10 minutes, and often subside within 20-30 minutes. 2. Phobic Disorder b) –is characterized by frequent and excessive anxiety or worry about a number of activities of events rather than anxiety being focused on particular objects or situations. -anxiety occurring most days for a period of 6 months or more 3. Panic Disorder c.) -characterized by fear or avoidance of specific objects or situations other than separation or involvement with strangers. 4.Generalized Anxiety Disorder d.) –is characterized by the child’s excessive distress when separated from persons to whom there is a strong attachment and by the avoidance of situations that require separation. d c a b

Classification of Anxiety Disorders 2.) _________ Approach -The empirical approach to classification describes subcategories of internalizing disorders. EX: Achenbach (1991a) -The existence of a single anxious/depressed syndrome suggests that these problems tend to co-occur. *Other internalizing syndromes, such as: -somatic complaints (dizzy, stomach ache) -withdrawn (refusing to talk) TABLE 6-1 Behavior Problems included in Anxious/Depressed Syndrome Lonely Cries a lot Fears impulses Needs to be perfect Feels unloved Feels persecute Feels worthless Nervous, tense Fearful, anxious Feels too guilty Self-conscious…

Developmental Characteristics of Children’s Fears General Prevalence Jersild and Holmes(1935) MacFarlane, Allen, & Honzik(1954) Bell-Dolan, Last, & Strauss(1990) Sex and Age Diff. King(1989); Kilpatrick(1984) King(1989); MacFarlane(1954) Reported that children aged 2-6 had between four and five fears and exhibited fearful reactions once every 4 ½ days. In their longitudinal study of children from 2-14, found that specific fears were reported in 90% of their sample. Use of semi structured interviews with nonreferred children indicates that between 10.7 and 22.6% of children endorsed symptoms of phobias. Most research suggests that girls exhibit a greater number of fears than boys. It is most commonly reported that both the number and the intensity of fears experienced by children decline with age. Also, certain fears appear to be more common at particular ages.

ARTICLE Relationship Between Specific Adverse Life Events and Psychiatric Disorders (Weems, Silverman, La Greca) Hypothesis: Depressive disorders (MDD and Dysthymia) and disruptive disorders (CD and ODD) would be highly associated with many adverse life events. Some life events are associated with a specific group of psychiatric disorders. Results: Both disruptive disorders and depressive disorders were closely associated with a broad range of adverse life events (17-22 /25) ADHD and phobias were associated with fewer of the events (3 or less) It showed that being a victim of crime, violence, or assault was strongly related to CD and ODD in both boys and girls. A parent being jailed was strongly associated with CD and Dysthymia in boys, and CD and Overanxious Disorder in girls. Getting a new stepparent had a strong impact on CD and Dysthymia in boys and Overanxious Disorder in girls. *Strong association between school change and several psychiatric disorders in boys. Boys who started a new school had more than a threefold increase in Separation Anxiety Disorder and Social Phobia, and more than a fivefold increase in ADHD, ODD, Depression, and Agoraphobia.

Specific Phobias- Epidemiology and Developmental Course Most commonly diagnosed anxiety disorders in children and adolescents. Specific phobias appear to have the earliest age of onset and to occur during childhood. Specific phobias are likely to begin during childhood and that for at least some individuals, they may persist over time. Youngsters with specific phobias are also likely to meet criteria of other diagnoses. (other anxiety disorders, depression, mood disorders) Also, many experience co-occurring disorders.

Specific Phobias DSM-IV Criteria

Specific Phobias Animal Type Natural Environmental Type Blood-Injection-Injury Type Situational Type: Other: animals or insects storms, heights, water, etc. getting injections, seeing blood, seeing injuries, watching invasive medical procedures elevators, flying, driving, bridges, escalators, trains, tunnels, closets, etc avoidance of loud sounds or costumed characters

Specific Phobias Treatment Options Associated Features Systematic desensitization and exposure Beta-blockers may be effective in treating performance-anxiety symptoms. Drugs used in generalized social phobias include SSRIs or an MAOI (such as phenelzine). Associated Features Depressed Mood Anxious or Fearful or Dependent Personality Differential Diagnosis Panic Disorder With Agoraphobia Social Phobia Posttraumatic Stress Disorder Obsessive-Compulsive Disorder Separation Anxiety Disorder

Social Phobia DSM IV- Criteria A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Persistent and significant fear of one of more social situations in which the child or adolescent is exposed to unfamiliar persons or scrutiny by others and feels he or she will behave in a way that will be embarrassing or humiliating. Exposure to the feared social situations almost always causes significant anxiety, even a panic attack despite the fact that the anxiety is seen as excessive and unreasonable. This belief may lead to avoidance of such situations or endurance under extreme distress, leading to marked interference in development.

Social Phobia Treatment Options Associated Features cognitive behavioral therapy Drugs used in generalized social phobias include SSRIs or an MAOI (such as phenelzine). Associated Features Depressed Mood Somatic or Sexual Dysfunction Addiction Anxious or Fearful or Dependent Personality Differential Diagnosis Panic Disorder With Agoraphobia or Agoraphobia Without History of Panic Disorder Separation Anxiety Disorder Generalized Anxiety Disorder Specific Phobia Schizoid Personality Disorder Avoidant Personality Disorder Performance anxiety, stage fright, and shyness…

Separation Anxiety & School Refusal DSM IV Criteria

Separation Anxiety Associated Features Differential Diagnoses Depressed Mood Somatic or Sexual Dysfunction Anxious or Fearful or Dependent Personality Differential Diagnoses Pervasive Developmental Disorders Schizophrenia, or other Psychotic Disorders Generalized Anxiety Disorder Panic Disorder with Agoraphobia Agoraphobia Without History of Panic Disorder Conduct Disorder Developmentally appropriate levels of separation anxiety

Generalized Anxiety Disorder DSM IV- Criteria A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Persistent and significant fear of one of more social situations in which the child or adolescent is exposed to unfamiliar persons or scrutiny by others and feels he or she will behave in a way that will be embarrassing or humiliating. Exposure to the feared social situations almost always causes significant anxiety, even a panic attack despite the fact that the anxiety is seen as excessive and unreasonable. This belief may lead to avoidance of such situations or endurance under extreme distress, leading to marked interference in development.

Generalized Anxiety Disorder Treatment Options Therapy Psychotherapy: Most patients with mild symptoms can be treated with supportive counseling and education without need for medication. Other therapies: Relaxation training and cognitive therapy General measures: Regular exercise and avoidance of caffeine and alcohol. Medications: Selective Serotonin Reuptake Inhibitors (SSRIs). Assoiciated Features Depressed Mood Somatic or Sexual Dysfunction Anxious or Fearful or Dependent Personality Differential Diagnosis Anxiety Disorder Due to a General Medical Condition Substance-Induced Anxiety Disorder Panic Disorder Social Phobia Obsessive-Compulsive Disorder Anorexia Nervosa Somatization Disorder Separation Anxiety Disorder Obsessional thoughts…

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