PSYCHOPATHOLOGY OF CHILDREN AND FAMILY WEEK 6: ANXIETY DISORDERS

Anxiety disorder  Anxiety is a generalized state of apprehension  The focus of anxiety is more internal than external  It seems to be a response to a vague or unrecognized danger

 Anxiety is a physiological, behavioral and psychological reaction all at once  Therefore intervention programs in general should focus on: - to reduce physiological reactivity - to eliminate avoidance behavior - to change subjective reaction

 Free-floating anxiety Anxiety that comes out of blue  Situational Anxiety anxiety arises only in response to a specific situation but it is unrealistic situational anxiety will eventually become phobic when you start to avoid the situation  Anticipatory anxiety thinking about one particular situation

 Anticipatory anxiety is closely associated with the way you are thinking.  With panic disorder, thoughts are generally focused on worrying about having a panic attack in a situation that will result in embarrassment, extreme discomfort, a heart attack or even worse.

Different types of anxiety disorders defined by DSM-IV-TR  Panic disorders  Agoraphobia  Social Phobia  Generalized Anxiety Disorder  Obsessive Compulsive Disorder  Post Traumatic Stress Disorder

ANXIETY VS ANXIETY DISORDERS

Panic Disorder  Characterized by sudden episodes of acute apprehension or intense fear that occur “out of blue” without any apparent  Symptoms of panic disorder - Shortness of breath or a feeling of being smothered - Heart palpitations – pounding heart or accelerated heart rate - Dizziness, unsteadiness - Trembling or shaking - Feeling of choking - Sweating - Nausea or abdominal distress - Feeling of unreality - Numbness or tingling in hands and feet - Hot and cold - Chest pain or discomfort - Fears of going crazy or losing control - Fear of dying

Your symptoms would be diagnosed as panic disorders if:  You have had two or more panic attacks  At least one of these attacks has been followed by one month (or more) of persistent concern about having another panic attack.

 The panic doesn’t occur because you are thinking about, approaching or actually entering a phobic situation  It happens spontaneously and unexpectedly for no apparent reason

The causes of panic disorder  Heredity  chemical imbalances in the brain  personal distress major life changes may trigger the onset of panic attacks

Treatment Medication  antidepressant drugs such as tofranil and paxil Personal wellness program  regular exercise  daily practice of deep relaxation  good nutrition  a shift in attitude to a calmer and easy-going approach

Generalized Anxiety Disorder  Characterized by persistent feelings of anxiety that are not triggered by any specific object, situation or activity  GAD having at least three of the following six symptoms - Restlessness - Being easily fatigued - Difficulty concentrating - Irritability - Muscle tension - Difficulties with sleep

 No specific phobias associated with GAD but it is sustained by basic fears - Fear of losing control - Fear of not being able to cope - Fear of failure - Fear of rejection - Fear of death and disease

Phobic Disorders  The word phobia derives from the Greek phobos meaning fear  Phobic disorders are irrational fears of objects or situations

Specific Phobias  Persistent and excessive fears of specific objects or situations  The DSM-IV groups specific phobias within 5 subtypes - Animal Type - Natural Environment Type - Blood Injection Injury Type - Situational Type - Other Type

Social Phobia  Fear of embarrassment or humiliation in situations where you are exposed to the scrutiny of others  Typically your concern is that you will say or do something that will cause others to judge you as being anxious, weak, crazy or stupid  The most common - Fear of Public Speaking

Agoraphobia  The word agoraphobia means fear of open spaces / market places  Afraid of being in situations from which escape might be difficult or unavailable  Fear of embarrassment plays a key role  The most common feature of agoraphobia is anxiety about being far away from home or far from a “safe person”

 Agoraphobia appears to be engendered by panic disorder  Different level of agoraphobia - mild case - moderate case - severe case

Obsessive Compulsive Disorder  Obsessions are recurring ideas, thoughts, images or impulses  Compulsions are repetitive behaviors or behaviors or rituals that you perform to dispel the anxiety brought up by obsessions  Obsessions may occur by themselves without necessarily being accompanied by compulsions

 The most common compulsions include washing, checking and counting  Obsessive compulsive disorder is often accompanied by depression

Post Traumatic Stress Disorder  The essential feature of post traumatic stress disorder is the development of disabling psychological symptoms following a traumatic event  The traumatic event involves either actual or threatened death or serious physical injury or threat to one’s own or another’s physical safety

Symptoms of PTSD  Repetitive, distressing thoughts about the event  Nightmares related to the event  Flashbacks so intense that you feel or act as though the trauma were occurring all over again  An attempt to avoid thoughts or feelings associated with the trauma  An attempt to avoid activities or external situations associated with the trauma  Emotional numbness  Feeling of detachment or estrangement from others  Losing interest in activities that used to give you pleasure  Persistent symptoms of increased anxiety, such as difficulty falling or staying asleep, difficulty concentrating

 To receive a diagnosis of PTSD, these symptoms need to have persisted at least 1 month  Less than 1 month’s duration, the appropriate diagnosis is “acute stress disorder”  In addition, the disturbance must be causing you significant distress, interfering with social, vocational or other important areas of your life

PSYCHOPATHOLOGY OF CHILDREN AND FAMILY WEEK 7: ANXIETY DISORDERS

Theoretical Perspectives  Psychodynamic perspective - anxiety disorders are viewed as neurosis - the anxiety experienced in neurosis reflects; 1 – the efforts of unacceptable, repressed impulses to break into consciousness 2 – fear as what might happen if they do Stress on the roles of defense mechanisms

 Phobias develop through the use of defense mechanism of projection and displacement  A phobic reaction is believed to represent the projection of the person’s own threatening impulses onto the phobic object.

Learning Perspectives  Anxiety disorders are acquired through conditioning  Phobia -Classical conditioning -Operant conditioning -Observational learning – modeling

 Generalized anxiety -a product of stimulus generalization  Obsessive compulsive disorder -compulsive behavior are operant responses that are negatively reinforced by relief of the anxiety that is engendered by obsessional thoughts  PTSD-classical conditioning

Cognitive Perspectives  Overprediction of fear  Irrational beliefs  Oversensitivity to threats  Anxiety sensitivity  Misattribution for panic sensation  Low self-efficacy expentancies

Biological Perspectives  Genetic Factors  Neurotransmitter -Gammaaminobutyric acid (GABA)