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Lecture 5

Lecture 5 anxiety disorders .docx

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Department
Psychology
Course
Psychology 2320A/B
Professor
Jeff St Pierre
Semester
Winter

Description
Lecture 5: Anxiety disorders February 12 th Description of Anxiety Disorders  Anxiety: a model state characterized by strong negative emotion and bodily symptoms tension in anticipation of future danger or misfortune  Anxiety disorders involve experiencing excessive and debilitating anxieties; occur in many forms  Many types of children with anxiety disorders suffer from more than one type Experiencing Anxiety:  Moderate amounts of anxiety are adaptive, we act more effectively an dcope with potentially dangerous situations  Excessive uncontrollable anxiety can be debilitating  The neurotic paradox is a self defeating behaviour pattern:  Despite knowing there is little to be afraid of, a child is terrified and does everything possible to escape/avoid he situation  Flight or fight system: immediate reaction to perceived danger or threat aimed at escaping potential harm Worry thoughts  Something terrible is going to happen  What if ????  I don’t know what to do?  I cant stand this  Its going to be my fault  I’m going to lose it  I need to make sure things are going to be ok  I have to get out of here Worry in the body:  Stomach aches  Tense muscles  Sweaty  Feeling like not there  Heart racing  Shallow breathing  Can sleep nightmares  Checking “ on the lookout” Anxious behaviour  Flight Avoid, refuse, “shut down”, detach, withdraw, run, turn awar, seeking reassurance, checking  Fight o Physical and verbal aggression – usually reactive  Freeze o Dissociation, numbing, self-medicating  anxiety disorders characterized by DSM-IV-TR are divided into 9 categories that closely define the types of reaction and avoidance Anxiety versus fear and panic:  Anxiety: future oriented mood state, which may occur in absence of realistic danger characterized by feelings of apprehension and lack of control over upcoming events.  Fear: Present-orientated emotional reactions to current danger characterized by strong escape tendencies and surge in sympathetic nervous system.  Panic: group of physical symptoms of fight/flight response that unexpectedly occur in the absence of obvious danger or threat. Separation anxiety disorder:  Separation anxiety is important for a young child’s survival  It is normal from about age 7 months through preschool years  Lack of separation anxiety at this age may suggest insecure attachment or other problems, but when anxiety persists for at least four weeks and severe child may have separation anxiety  When anxiety persists for more then 4 weeks and limits the vhilds behaviour such as going to school and normal recreational activities the child might have separation anxiety  Children with separation disorder children display age inappropriate excessive and diabling anxiety about being separated from the people they are close with  May have repeated nightmares about being taken away form parents  Display excessive demand to be noticed by parents  SAD children may fuss cry, scream or even threaten to kil themselves if their parents leave  Physical complaints are rapid heart beat dizziness, nausea and stomachaches Prevalence and comorbidity  SAD is one of the two most common childhood anxiety disorders  Occurs in 4-10% of children but is somewhat more prevalent in girls than in boys  More than 2/3 of children with SAD have another anxiety disorder  Children with SAD may also display specific fears of getting lost or of the dark  School reluctance or refusal is common in older children with SAD Onset course and outcome  SAD has the earliest reported age of onset of anxiety disorders and the youngest age at referral  Progresses from mild to severe  Associated with major stress such as moving to new neighborhood or entering a new school  SAD persists into adulthood for more then 1/3 of affected children and adolescents  Children with SAD are usually reasonably social skilled but school suffers from missed classes  As adults more likely to experience: Relationship difficulties, other anxiety disorders and mental health problems, functional impairment in social and personal life. School reluctance and refusal:  School refusal behaviour: refusal to attend classes or difficulty remaining in school for an entire day  Equally common in boys and girls  Occurs most often between ages 5-11 first occurring during preschool, kindergarten or first grade and peaking during second grade  Fear of school may be fear of leaving parents but could be other reasons  Serious long-term consequences if it remains untreated. Generalized Anxiety Disorder  Generalized anxiety disorder:  Excessive uncontrollable anxiety and worry about many events and activities on most days  “What if itis”  Worrying can be episodic or almost continuous  Symptoms include: irritability, lack of sleep restlessness lack of energy  Worry excessively about minor everyday occurrences even when they see they are making themselves and others unhappy (uncontrollable nature of worry)  Once thought that GAD children did not foucs on one thing to be worried about called free floating anxiety  Children with GAD pick up every frightening thing in a movie  Accompanied by at least one somatic symptom (eg. headaches, stomach aches, muscle tension and trembling) Prevalence and comorbidity:  3-6 % of children  Equally common in boys and girls with slightly higher prevalence in older adolescent females  High rate of other anxiety disorders and depression Onset course and outcome: average onset is 10-14  Older children have more symptoms and report higher levels of anxiety and depression but these symptoms may diminish with age  Symptoms persist over time. Specific Phobia  Age inappropriate persistent irrational or exaggerated fear that leads to avoidance of the feared object or event and causes impairment in normal routine  Lasts at least 6 months  Extreme and disabling fear of objects or situations that in reality pose little or no danger or threat  Child goes to great lengths to avoid the object/situation  Beliefs persist despite evidence no danger exists  If feared object situation is encountered often it van become a serious problem  Evolutionary theory: infants are biologically predisposed to learn certain fears  Five DSM-IV subtypes animal natural environment blood injection-injury situational other. Prevalence and comorbidity:  About 4-10% of children at some point in their lives although few are referred for treatment  More common in girls  Most common co occurring disorder is another anxiety disorder although comorbidity is lower than for other anxiety disorders Onset course and outcome  Phobias involving animals darkness, insects blood and injrut 7-9 years of age  Although consistent with normal development clinical phobas are more likely Social Phobia:  A marked persistent dear of social or performance requirements that expose the child to scrutiny and possible embarrassment  Anxiety over mundane activities  Most common fear is doing something in front of others  More likely than other children to be highly emotional. Socially fearful and inhibited sad and lonely  Generalized social phobia the most severe form involves fear of most social situations  View of social anxiety disorders as existing on a continuum  Recent research suggests that interaction and performance related social dear differ in many aspects.  Lifetime prevalence of 6-12% of children  Twice as common in girls who are more concerned with social competence, interpersonal relationships and evaluation by peers than are boys  Findings from FMRI brain******* Selective Mutism  Failure to talk in specific social situations even though they can speak loudly and frequently at home or other settings  Estimate to occur in 0.05% of children  Average age of onset is entry to preschool or school  Different pathways likely lead to this with many also experiencing social phobia speech and language deficits or delays cannot be the primary cause but they may be a perpetuating factor. Obsessive compulsive disorder:  Recurrent time consuming disturbing obsessions (persistent and intrusive thoughts ideas impulses or images )and compulsions (repetitive, purposeful and intentional behaviors or mental acts) performed to relieve anxiety  OCD is extremely resistant to reason ( its not logical)  OCD children often involve family members in rituals  Rituals fail to provide long term relief from anxiety resulting in time- consuming never ending cycle of obsessions and compulsions  Often leads to severe disruptions in normal activities, health, social and family relations and school functioning.  No logic in OCD Prevalence and comorbidity:  Lifetime prevalence in children and adolescents is 1-3%  Clinic based studies find it twice as common in boys but community samples don’t find a gender difference  Comorbidities most common are other anxiety disorders ass well as vocal and motor tics are also over presentenced Onset course and outcome:  Average age of onset is 9-12 years with peaks in early childhood and early adolescents.  Chronic disorder: as many as two thirds continue to have OCD 2-14 years after initial diagnosis Four Flavours of OCD 1=Bad thoughts OCD 2=Just right OCD 3=Contamination OCD 4=Hoarding OCD PANIC: Panic Attack:  Defined as sudden overwhelming period of intense dear or discomfort accompanied by four or more physical and cognitive symptoms characteristic of the flight/fight response  Rare in young children common in adolescents  Young children may lack cognitive ability to make catastrophic misinterpretation  Related to pubertal development, not age but biological Panic disorder:  Recurrent unexpected panic attacks followed by at least one month of persistent concern about having another ****  Prevalence and comorbidity:  Panic attacks 3-4% of teens  Panic disorder is less common  Panic attacks are more common in adolescent females than adolescent ***** Posttraumatic and acute stress disorders :  PTSD: persistent anxiety following an overwhelming traumatic event that occurs outside the range of usual human exp
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