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Chapter 6

Chapter 6 - ONLINE

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Psychology 2042A/B
Richard Brown

Psych 2042A Chapter 6: Anxiety Disorders children and adolescents with anxiety disorders tend to be anxious, fearful, withdrawn, shy, depressed they often have emotional difculties that they take out on themselves - internalizing disorders. An Introduction to Internalizing Disorders Internalizing Disorders were once identied as neuroses. there has been an ongoing established relationship between certain anxiety and depressive disorders outlined in the DSM remember that considerable evidence shows that a child usually meets the criteria for more than one of the disorders (comorbidity) ALTHOUGH, sometimes these separate disorders may also be different expressions of a general disposition towards the development of an internalizing difculty/disorder research suggests that there are no differences among cultural groups in the overall prevalence of anxiety disorders or in the temperamental qualities that may underlie the development of anxiety difculties. there is a difference in the prevalence of specic anxiety disorders and types of symptoms are reported. Dening and Classifying Anxiety Disorders anxiety: best characterized as a future-oriented emotion, characterized by perceptions of uncontrollability and unpredictability over potentially aversive events and a rapid shift in attention to the focus of potentially dangerous events or ones own affective response to these events fear and anxiety have very much in common but a distinction can be made fear is an immediate/present threat characterized by an alarm reaction anxiety is a future-oriented emotion characterized by an elevated level of apprehension and lack of control fear and anxiety introduces a complex pattern of 3 types reactions: overt behavioural responses cognitive responses physiological responses worry is a cognitive component of anxiety anxiety is normal to a certain extent - this is a challenge faced by clinicians as sometimes they cannot tell whether the anxiety the child is exhibiting is normal or not Normal Fears, Worries, and Anxieties General Prevalence children exhibit a surprisingly large number of fears, worries, and anxieties Gender, age, and cultural differences girls exhibit a greater number of fears than boys (this is clear in older children) gender-role expectations play into part number and integrity of fears decline with age (worry becomes prominent at age of 7) certain fears appear to be more common with certain ages fear of strangers: 6-9 months fear of imaginary creatures: 2 year olds fear among the dark: 4 year olds social fears and fears of failure among adolescents cross-cultural examinations of common fears suggest similarities across cultures The Fear Survey Schedule for Children (FSSC-R) is an inventory for fear stimuli and situations - translated in different languages Classication of Anxiety Disorders anxieties requiring clinical attention are those which are quite intense or continued longer than expected BUT, even if fear and anxiety is short-lived and creates discomfort and interferes with functioning, it requires attention. DSM approach to classifying anxiety disorders is the most widely used DSM Approach DSM-IV-TR describes one type of anxiety that is usually rst diagnosed in infancy, childhood, or adolescence - Separation Anxiety Disorder other anxiety disorders included in the DSM: specic phobia social phobia panic disorder generalized anxiety disorder OCD PTSD acute stress disorder The empirical approach empirical systems that are based on statistical procedures have also yielded subcategories related to anxiety disorders Achenbach describes an anxious/depressed syndrome - suggesting that in youths, the various anxiety and depression symptoms tend to occur together there are also common physiological symptoms (somatic complaints) that are common with anxiety disorders: having headaches, dizziness, and feeling withdrawn/depressed Epidemiology of Anxiety Disorder anxiety disorders are the most common disorders experienced in child/adolescents prevalences may vary, but studies of community samples have generally reported that between 12-20% of school-age children and adolescents meet the diagnostic criteria for anxiety disorders appear to be no differences in prevalence of anxiety disorders among ethnic groups, BUT there are differences with regard to the prevalence of specic anxiety disorders (i.e. separation anxiety common in Hispanic community) Specic Phobias Phobias: fears that are excessive, cannot be reasoned away, are beyond voluntary control, lead to avoidance, and interference with functioning can be described as abnormal development of appropriate fears specic phobia: persistent fear of object or situation that is unusual or excessive Diagnostic Criteria diagnostic criteria for specic phobias in children recognize that anxiety may be expressed differently in children and that children may not realize their fears are excessive/unreasonable fear must produce marked distress or must interfere signicantly in functioning, routine, and social relationships have a duration of 6 months fear is usually cued by an object or a stimulus and evokes an immediate anxiety response can be further subcategorized into 5 types: animal, natural environment, blood- injection injury, situational and other Description youngsters with specic phobias try to avoid the situation or object that they fear (i.e. child with extreme fear of dogs refuses to go outside) may exhibit feelings of tension, panic, or disgust cognitive aspect includes catastrophic thoughts of events that may occur some physiological reactions: nausea, rapid HR, and difculty in breathing Epidemiology among one of the most commonly diagnosed anxiety disorders in children and adolescents more prevalent in girls - information regarding ethnic differences is limited usually comorbid with another disorder (i.e. depression, mood disorder, etc) Developmental Course childrens phobias are usually thought of as harmless and should go away over time without treatment Essau and colleagues found that phobic symptoms persist over time are are associated with impaired functioning (consistent with adults who have phobias) - suggest that phobias begin in childhood and persist throughout adulthood Social Anxiety Disorder (Social Phobia) Diagnostic Criteria marked by persistent fear of acting in an embarrassing or humiliating way in social or performance situations in children, there must be evidence of the capacity for age-appropriate social relationships - anxiety must be evident in peer settings for children to be diagnosed exposure to the feared situation provokes anxiety and its symptoms feared situations are avoided or are endured with intense distress children may not recognize this excessive fear themselves. Description excessive fear in social situations like speaking, reading, writing or performing in public, or even maintaining conversations with another person
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