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Anxiety Disorders

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Western University
Psychology 2320A/B
Elizabeth Hayden

10/30/2012 Lecture Notes Topics: Anxiety in Childhood and Adolescence  Anxiety, generally speaking  Short overview of modern classification  Prevalence and associated features  Comorbidity  Course  Etiological theories and models  Treatment Normative and Clinical Anxiety  Anxiety has physical, cognitive, and behavioural manifestations (see table 7-1 in text)  Anxiety is normal and often adaptive o Anxiety/fear in childhood is common (see table 7-2) o Rituals almost common  To diagnose, fears need to be persistent, excessive when compare to same-age children, cause harm/impairment Anxiety in Youth: Recent Classification Issues  DSM-III and III-R had multiple anxiety disorders specific to children  DSM-IV: child-specific diagnoses reduced, criteria applicable to children and adults developed o DSM-5 goes even further with separation anxiety disorder  Current: All 9 DSM-IV anxiety disorders concern a fearful/anxious response of some kind o Focus of the anxious fear and its expression differs across diagnostic categories  In DSM-IV, there are nine major Ads, including one specific (sort of) to children o Separation anxiety disorder (SAD) – predominantly child onset o Generalized anxiety disorder (GAD) – predominantly child and adolescent onset o Panic disorder (PD) – predominantly adolescent onset o Social phobia – predominantly adolescent onset o Specific phobia – predominantly child onset o Obsessive compulsive disorder (OCD) – predominantly child and adolescent onset o Agoraphobia without panic disorder (will not be discussed in class) o Post-traumatic stress disorder (will not be discussed in class) o Acute stress disorder (will not be discussed in class) Anxiety in Youth: DSM-IV Separation Anxiety Disorder  Only anxiety disorder described by DSM-IV as an anxiety disorder of childhood o Onset usually age 7-8  Excessive fear over separating from home or attachment figure (e.g. parent)  Fear is excessive for developmental stage o Separation anxiety is common between 7 months to age 6 Anxiety in Youth: DSM-IV Generalized Anxiety Disorder  GAD: uncontrollable, excessive worry about multiple domains, more days than not, for at least 6 months o Worry + at least one other symptom of anxiety, which may include restlessness, fatigue, muscle tension, sleep disturbance o Onset usually between 10-14 years of age  GAD has low inter-rater reliability, rarely occurs without another comorbid disorder Anxiety in Youth: DSM-IV Specific Phobia  Specific phobia: marked fear of circumscribed objects or situations o Animal, blood, “environmental” phobias all common in childhood o Phobic stimulus avoided or endured with intense anxiety o Onset of most phobias around ages 7 – 9 Anxiety in Youth: DSM-IV Social Phobia  Social phobia: persistent fear of social/performance situations that would expose them to scrutiny, embarrassment o Fear of acting in embarrassing/humiliating manner, or fear they will show anxious symptoms o Usually onsets after puberty; rare prior to age 10 Anxiety in Youth: DSM-IV Panic Disorder  Panic attacks: sudden, discrete episodes of intense fear and physical and cognitive symptoms o Heart palpitations, sweating, trembling, nausea, shortness of breath o Feelings of detachment, fear of losing control, going “crazy”, dying  Pain attacks ≠ panic disorder o Panic attacks are common in other anxiety disorders  Panic disorder: recurrent, spontaneous panic attacks accompanied by: o Fear of consequences of attacks o Concern about future attacks o Or significant behaviour change due to attacks (e.g. avoidance)  Can be accompanied by agoraphobia  Panic disorder = fear of anxious symptoms  Usually diagnosed between ages 15 – 19 Anxiety in Youth: DSM-IV Obsessive Compulsive Disorder  Obsessions: recurrent and intrusive thoughts, images, impulses that cause anxiety/distress  Compulsions: repetitive behaviours experienced as impossible to resist, aimed at reducing anxiety but are not realistic (or are excessive)  Obsessions without compulsions are rate  Compulsions without obsessions are not uncommon  Onset between ages 9 – 12, but earlier onset (ages 6 – 10) not unsual  Examples of obsessions: worries about becoming dirty or contaminated, fears that one may injure someone, symmetry/exactness concerns, etc.  Examples of compulsions: checking, cleaning, doing things in a certain order (dressing or grooming), doing things a certain number of times in a row, etc. Anxiety in Youth: Prevalence and Associated Features  Prevalence of youth anxiety disorders = 8 – 27% o SAD to be most common = 4 – 13% o Specific phobia = 4 – 10% o GAD = 3 – 6% o Social phobia = 6 – 12% o OCD and PD less common (OCD = 1 – 3%, PD = 1%)  NCS replication: 3-% lifetime anxiety disorder prevalence  Overall, these are common disorders (most common) Anxiety in Youth: Associated Features  Gender differences: o From a young age, girls are more fearful than boys o Literature somewhat mixed for youth, but many stu
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