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Chapter 7

Chapter 7 - Anxiety Disorders Psych 2042B

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Western University
Psychology 2042A/B
Jeff St Pierre

Ch. 7 - Anxiety Disorders - very common, though tends to go unnoticed - long-lasting and costly problem anxiety - mood state characterized by strong negative emotion and bodily symptoms of tension which the child anticipates future danger or misfortune - strong negative emotion - element of fear - small doses good; prepares people psychologically for danger, important events anxiety disorder - excessive anxiety • neurotic paradox - when a child knows that the situation is not dangerous but still feel the need to escape. Self-perpetuating and self-defeating • fight/flight response - immediate reaction to perceived danger or threat. Protects us Symptoms expressed through three interconnected response systems; 1. Physical system - sympathetic nervous system response. Brings more oxygen to cells for quick response, makes body lighter for running • chemical - adrenaline released • cardiovascular - heart beat strengthens and quickens • respiratory - speed and depth of breathing increases • sweat glands - sweating increases • others - pupils widen, salivation, nausea, muscle pain etc. 2. Cognitive system - searches outside world for threats, or searches inside, or distorts reality. Apprehension, nervousness, difficulty concentrating, panic 3. Behavioural system - avoidance and/or aggression. Avoidance is negatively reinforced, will want to always avoid Anxiety versus fear and panic • fear - present-oriented emotional reaction to current danger, rather than anticipated danger (which is anxiety) • panic - physical symptoms of fight/flight absence of any threat (exp. sudden fast heart beat). May trigger fear or anxiety Normal Fears, Anxieties, Worries, and Rituals (table pg. 204) • Normal fears - lasts only a few weeks, no significant impact. Specific normal fears and intensities vary with age. Prominence in girls • Normal anxieties - 25% parents think their kids are too anxious. Tend to decrease with age, more prominent in girls • Normal worries - everyone worries, central feature of anxiety. Those with anxiety disorders worries the same amount but more intensely • Normal rituals and repetitive behaviour - makes world more predictable and safe. Two categories, 1.repetitive behaviour (exp. likes and dislikes) 2. making things "just right" (exp. getting rid of thread on sleeve) - 9 types of anxiety disorders according to DSM 1. Separation anxiety disorder (SAD) - age-inappropriate, excessive, disabling anxiety about being apart from their parents or away from home - expected in children 7 months old to preschool - disorder if longer than 4 weeks past this age frame and disrupts daily life - often physical symptoms - fear new situations Prevalence (DSM criteria pg. 204) - one of two most common anxiety disorders - 4-10% of all children affected - 2/3 of SAD develop other anxiety disorders, 1/2 develop depression Onset, Course, Outcome - earliest age of onset (7-8years), earliest referral - gets worse with time - usually after moving, death/illness in family, extended vacation etc. - school absences common - 1/3 lasts into adulthood causing relationship problems • school refusal behaviour - refusal to attend classes or difficulty in staying in school for a day. 5-11 years most prevalent, equal in girls and boys - result of being afraid of leaving parents, social anxiety, ridicule, etc. - Most have average or above average intelligence 2. Generalized Anxiety/Worry Disorder (GAD) - excessive and uncontrollable anxiety and worry about many events and activities on most days, big or small - unable to relax, physical symptoms (exp. inability to fall asleep, muscle tensions, headaches etc.) - expect the worst and don't think they can cope with bad situations (exp. news of accidents on TV) - over nurturing of others, low tolerance for uncertainty, excessive self-doubt and self-consciousness - chronic worrying covers up emotional response; child never gets to deal with issue (result similar to phobias) Prevalence - 3-6% of all children - slightly more common in adolescent females - usually common with ADHD, specific phobias, panic disorders, depression etc. Onset, Course, Outcome - usually at 10-14 years - symptoms diminish with age - severe anxiety persists over time 3. Specific Phobia - fear of clearly recognizable objects or situations for at least 6 months - fear for personal safety - usually fear stimuli do not pose a threat (dogs, lightening) - can fear anything, though more likely to develop fears of some things rather than others (exp. apiphobia; fear of bees, zemmiphobia; fear of mole rats) - traced back to human evolution, fear of certain things (exp. animals, blood) helped us survive Prevalence - 4-10% of all children - usually multiple phobias - not many referred to treatment bc parents don't think it's harmful - comorbidity (collision with other phobias) less frequent Onset, Course, Outcome - 7-9 years for animals, darkness, insects, blood, and injury - 10-13 years; peak for specific phobias - decline with age but severe phobias persist 4. Social Phobia/ Social Anxiety Disorder - persistent fear of social or performance requirements that expose them to scrutiny and possible embarrassment - fear of strangers - highly emotionally, socially fearful, inhibited, sad, lonely - want to be like other people but scared of humiliation, lack of social skills • generalized social phobia - intense social phobia (exp. don't make eye contact, meet strangers etc.) - recent research suggests that disorder exists on a continuum according to the number of situations, not generalized - variety of social fears - recent research suggest to sub-group interaction - and performance - related social fears Prevalence - 6-12% population - double in girls than boys; more concerned with social competence - study suggests; adolescent females may have an increasing biological sensitivity to being evaluated by peers, which overtime may increase their vulnerability to developing social anxiety disorders. Increased activity in hippocampus - most common first and second diagnosis for social anxiety problems - 2/3 have other anxiety problems, many depressed, use drugs - correlates with puberty, increases with age - long-lived condition that goes into adulthood • selective mutism - fails to talk in specific situations, usually can talk to family. 0.5% of population affected. - most have other social phobias, 40% have parent with social phobia - not a type of social phobia, many differences - types; 1) mildly oppositional 2) communication delayed 3) exclusively anxious - some display developmental delay, language impairments, auditory processing deficits etc. may have suffered trauma 5.Obsessive - Compulsive Disorder (OCD) - recurrent, time-consuming (more than 1 hr/day), and disturbing obsessions and compulsions • obsessions -persistent and intrusive thoughts, ideas, impulses, and images. Heightened worries about improbable, exaggerated events. Irrational - in children; symmetry, contamination common - in adolescence; sexual, religious preoccupations common • compulsions - repetitive, purposeful, and intentional behaviours or mental acts performed in response to obsession (exp. washing hands, counting things) - excessive washing and bathing most often, then repeating, checking, touching, counting, hoarding, arranging - usually a compulsion is linked to a specific obsession (exp. dislike for germs, washing hands) - children usually no it's unreasonable, but OCD stands against logic - compulsions used to reduce anxiety of obsession, to prevent bad thing from happening - often involves family. Ruins relationships, school etc. - can usually hide it, but will surface again Prevalence - 1-3% of population - boys twice as likely to be referred Onset, Course, Outcome - 9 - 10 years old, peaks in early adolescence and childhood - strong genetic influences for younger kids - tic disorder, trichotillomania (hair pulling) common for younger diagnosed people too - some kids try to hide their disorder, know it's abnormal, younger kids don't - less than 10% completely improves, most suffer problems later on in life 6. Panic panic attack - sudden and overwhelming period of intense fear or discomfort that is
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