Anxiety DisordersAnxiety Disorders

Danielle Winder

Kathia Johnson

Susie Berrin

Definition of Anxiety DisordersDefinition 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 DisordersClassification 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 DisordersClassification 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-withdrawn (refusing to talk)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 FearsDevelopmental Characteristics of Children’s Fears

General Prevalence(1) Jersild and

Holmes(1935)(2) MacFarlane, Allen, &

Honzik(1954)(3) Bell-Dolan, Last, &

Strauss(1990)

Sex and Age Diff.(1) King(1989);

Kilpatrick(1984)

(1) 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 ARTICLE Relationship Between Specific Adverse Life Events and Psychiatric Disorders

(Weems, Silverman, La Greca)

Hypothesis:1) Depressive disorders (MDD and Dysthymia) and disruptive disorders (CD and ODD)

would be highly associated with many adverse life events.2) Some life events are associated with a specific group of psychiatric disorders.

Results:1) Both disruptive disorders and depressive disorders were closely associated with a

broad range of adverse life events (17-22 /25) 2) ADHD and phobias were associated with fewer of the events (3 or less)3) It showed that being a victim of crime, violence, or assault was strongly related to CD

and ODD in both boys and girls.4) A parent being jailed was strongly associated with CD and Dysthymia in boys, and CD

and Overanxious Disorder in girls.5) Getting a new stepparent had a strong impact on CD and Dysthymia in boys and

Overanxious Disorder in girls.6) *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- Specific Phobias- Epidemiology and Developmental CourseEpidemiology 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 PhobiasSpecific Phobias

DSM-IV Criteria

Specific PhobiasSpecific Phobias

1. Animal Type

2. Natural Environmental Type

3. Blood-Injection-Injury Type

4. Situational Type:

5. 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 PhobiasSpecific Phobias

Treatment Options1. Systematic desensitization and exposure 2. Beta-blockers may be effective in treating performance-anxiety symptoms. 3. Drugs used in generalized social phobias include SSRIs or an MAOI (such as

phenelzine).

Associated Features1. Depressed Mood 2. Anxious or Fearful or Dependent Personality

Differential Diagnosis1. Panic Disorder With Agoraphobia

Social PhobiaPosttraumatic Stress DisorderObsessive-Compulsive DisorderSeparation Anxiety Disorder

Social PhobiaSocial Phobia

• DSM IV- Criteria

Social PhobiaSocial Phobia

Treatment Options1. cognitive behavioral therapy2. Drugs used in generalized social phobias include SSRIs or an MAOI (such as phenelzine).

Associated Features1. Depressed Mood 2. Somatic or Sexual Dysfunction 3. Addiction

4. Anxious or Fearful or Dependent Personality

Differential Diagnosis1. Panic Disorder With Agoraphobia or Agoraphobia Without History of Panic Disorder

Separation Anxiety DisorderGeneralized Anxiety DisorderSpecific PhobiaSchizoid Personality DisorderAvoidant Personality DisorderPerformance anxiety, stage fright, and shyness…

Separation Anxiety & School RefusalSeparation Anxiety & School Refusal

DSM IV Criteria

Separation AnxietySeparation Anxiety

Associated Features1. Depressed Mood

2. Somatic or Sexual Dysfunction

3. Anxious or Fearful or Dependent Personality

Differential Diagnoses1. Pervasive Developmental Disorders

Schizophrenia, or other Psychotic DisordersGeneralized Anxiety Disorder Panic Disorder with AgoraphobiaAgoraphobia Without History of Panic Disorder

Conduct DisorderDevelopmentally appropriate levels of separation anxiety

Generalized Anxiety DisorderGeneralized Anxiety Disorder

DSM IV- Criteria

Generalized Anxiety DisorderGeneralized Anxiety Disorder

Treatment Options1. 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

2. General measures: Regular exercise and avoidance of caffeine and alcohol. 3. Medications: Selective Serotonin Reuptake Inhibitors (SSRIs).

Assoiciated Features1. Depressed Mood 2. Somatic or Sexual Dysfunction

3. Anxious or Fearful or Dependent Personality Differential Diagnosis1. Anxiety Disorder Due to a General Medical Condition

Substance-Induced Anxiety DisorderPanic Disorder Social PhobiaObsessive-Compulsive DisorderAnorexia NervosaSomatization DisorderSeparation Anxiety DisorderObsessional thoughts…

Any Questions?Any Questions?