2.  Anxiety Disorders share features of excessive fear and anxiety, and related behavioral disturbances.  What kinds of behaviors do you think these are?

3.  Fear-The emotional response to a real or perceived threat, usually responded with “fight or flight”  Anxiety-anticipation of a future threat, often associated with muscle tension and cautious and avoidant behaviors  Panic Attacks-type of fear response, also found in other types of disorders

4.  However, anxiety can become a disorder when: › Anxiety is excessive › Anxiety is persistent (lasts 6 months or more)

5.  More prominent in women (2:1)  People overestimate the dangers that they are facing, which the clinician will decide, based on the cultural context  Many anxiety disorders develop in childhood and can get worse if left untreated  There are different anxiety disorders for different developmental ages

6.  1. Separation Anxiety Disorder  2. Selective Mutism  3. Specific Phobia  4. Social Anxiety Disorder  5.Panic Disorder  6.Agoraphobia  7.Generalized Anxiety Disorder  8. Substance/Medication Induced Anxiety Disorder  9. Anxiety Disorder Due to a Medical Condition  10. Other Specified Anxiety Disorder  11. Unspecified Anxiety Disorder

7.  Diagnostic Criteria: › Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least 3 of the following:  Recurrent distress when anticipation or experiencing separation  Persistent worry about losing major attachment figures to harm, illness or death  Persistent worry about experiencing an event that would cause separation (ie. Being kidnapped)  Persistent reluctance or refusal to go anywhere without the person  Persistent fear about being alone at home or other settings without the person  Persistent reluctance or refusal to sleep without the person  Repeated nightmares involving separation  Repeated complaints of physical pain and symptoms when separated from the person

8.  The disturbance must last for at least 4 weeks in children and teens, and 6 months in adults  Children with this disorder may get angry when separated, need constant attention, may be demanding and intrusive, and are often “homesick”  Remember that having some separation anxiety in children is normal!!!

9.  Prevalence: 0.9- 1.9% of adults  Prevalence: 4% of children  Often develops after a life stress, especially a big loss (pet, grandparent, etc.) but also after a move, divorce, etc.  Parental overprotection and intrusiveness is often associated with it  Heritability has been estimated as high as 73%  Often comorbid with Generalized Anxiety Disorder and Specific Phobia Disorder

10.  Differential Diagnosis (it looks a lot like...) › Generalized Anxiety Disorder › Panic Disorder › Agoraphobia › Conduct Disorder › Social Anxiety Disorder › Post Traumatic Stress Disorder › Illness Anxiety Disorder › Bereavement › Depressive Disorders › Oppositional Defiance Disorders › Psychotic Disorders › Personality Disorders

11.  This disorder is a consistent failure to speak in specific social situations in which there is an expectation for speaking (ie. School), despite being able to speak in other situations.  It interferes with educational or occupational achievement  Duration must be at least 1 month  Can not be explained by the individual having a lack of knowledge, or by a Communication Disorder (which is a Neurodevelopmental Disorder)  Occurs before age 5, and is found in 0.03-1.0% of children

12.  Diagnostic Criteria: › Marked fear or anxiety about a specific object or situation › The phobic object or situation always provokes immediate fear › The phobic object is avoided always › The fear is out of proportion to the actual threat › The fear is persistent, lasts more than 6 months › The fear causes signficant distress or impairment in social, occupational, or other important areas of functioning

13.  Several Specifiers for Specific Phobia Disorder:  A. Animals  B. Natural Environment  C. Blood-Injection-Injury  D. Situational  E. Other  Can you name an example of each?

14.  Most prevalent in North America (7-9%)  Usually develops in early childhood  Children’s symptoms are usually crying, tantrums, freezing, and clinging  Environmental risk factors include overprotective parents, parental loss and separation, physical and sexual abuse, and traumatic experience with the phobia before it started

15.  This is having marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.  Examples include social interactions (ie. Having a conversation), being observed (ie. Eating or drinking), and performing in front of others.  Impairs their professional life  Occurs in about 7% of the population, highest in North American countries, and in women  Usually starts around 8-15 years old. Why?  Differential Diagnosis is huge! It looks like several other disorders. Can you think of any?

16.  Panic Attacks must be recurrent!!! (A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time, the person experiences a lot of symptoms).  The person must have 4 symptoms in order for it to be called a Panic Attack  What do you think the symptoms of a panic attack are?

17.  Heart palpitations  Sweating  Trembling or shaking  Shortness or breath  Feelings of choking  Chest pain  Nausea or abdominal distress  Feeling dizzy or faint  Chills or heat sensations  Numbess or tingling  Delrealization or depersonalization  Fear of losing control or going crazy  Fear of dying  After panic attack, for at least 1 month, you must have persistent worry that you are going to have another one  Your behavior has to negatively change because of the panic attack

18.  Prevalence: 2-3% adults  Age of onset is around 20-24 years old  Rare in children  Negative emotions and anxiety sensitivity are risk factors  Reports of childhood physical and sexual abuse are more common in panic disorder than other anxiety disorders  Most people report identifiable stressors in the months before their first panic attack  Several genes confer vulnerability to panic disorder

19.  Marked fear or anxiety about two (or more) of the following situations: › Using public transportation › Being in open spaces › Being in enclosed spaces › Standing inline or being in a crowd › Being outside of the home alone  The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms

20.  Prevalence: 1.7% of adolescents and adults have it  Females are twice as likely as males to have it  Negative events in childhood and other stressful events, such as being attacked or mugged, are associated with the onset of agoraphobia  The family climate is characterized by reduced warmth and overprotective

21.  Excessive anxiety and worry, occurring more days than not, for at least 6 months, about any and all events and activities, which causes significant distress and impairment to the individual’s daily life.  The individual can not control the worry  Must have 3 of the following six symptoms: › Restlessness or feeling on edge › Being easily fatigued › Difficulty concentrating › Irritability › Muscle tension › Sleep disturbances

22.  Prevalence: 0.9% in teens  Prevalence: 2.9% in adults  What do teens and adults worry about?  Accounts for 110,000,000 sick days per year in the USA  Females are twice as likely as males to get GAD  Many report feeling nervous and anxious their entire life  No environmental factors specific to GAD  1/3 of the risk is genetic, and these genetic factors overlap with the risk of neuroticism and mood disorders, and depression

23.  GAD looks a lot like... › Anxiety disorder due to a medical condition › Substance/medication induced anxiety disorder › Social anxiety disorder › Obsessive-compulsive disorder › Posttraumatic stress disorder › Depressive disorders

24.  Substance Intoxication can produce anxiety  Substance Withdrawl can produce anxiety.  So why not just diagnose these people with an substance use disorder?  Their anxiety and panic attacks are so bad, it predominates, and they require clinical intervention  What kinds of substances do you think can cause this anxiety disorder?