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Chapter 6

Psychology 2042A/B Chapter Notes - Chapter 6: Separation Anxiety Disorder, Generalized Anxiety Disorder, Anxiety Disorder


Department
Psychology
Course Code
PSYCH 2042A/B
Professor
Richard Brown
Chapter
6

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Psych 2042A
Chapter 6: Anxiety Disorders
children and adolescents with anxiety disorders tend to be anxious, fearful, withdrawn,
shy, depressed
they often have emotional difficulties that they take out on themselves -
internalizing disorders.
An Introduction to Internalizing Disorders
Internalizing Disorders were once identified 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
difficulty/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 difficulties.
there is a difference in the prevalence of specific anxiety disorders and types of
symptoms are reported.
Defining 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 oneʼs
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

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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
Classification 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 first diagnosed in
infancy, childhood, or adolescence” - Separation Anxiety Disorder
other anxiety disorders included in the DSM:
specific 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 specific anxiety
disorders (i.e. separation anxiety common in Hispanic community)

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Specific 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
specific phobia: persistent fear of object or situation that is unusual or excessive
Diagnostic Criteria
diagnostic criteria for specific 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 significantly 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 specific 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 difficulty 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
childrenʼs 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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