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Chapter 7

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Psychology 2320A/B
James M Olson

Chapter 7:Anxiety Disorders Types ofAnxiety - Separation anxiety – caused by separation - Generalized anxiety – caused by everything (broad) - Social anxiety – caused by social situations - OCD - Panic attack – when you have too much anxiety which turns to panic Intro to Anxiety - 8-30% people get anxiety disorder - Often unnoticed and not treated - If you have it as a kid, you’re likely to have it as an adult o Because it’s chronic and stable - Large societal costs Describing Disorder - Anxiety – tension in body, negative mood state (negative emotion), anticipate future danger (fear) - Excessive anxiety is known as an anxiety disorder o Kids suffer more than one at same time or not - Experiencing anxiety o Usually hits when we do something important  Good in small doses o Neurotic paradox – self-perpetuating, going nowhere o Fight-or-flight – confront the problem or run away from it - 3 systems effected o Physical system  SNS effected  Chemical (adrenalin and noradrenalin), cardiovascular (faster heart rate), respiratory (faster and deeper breathing), sweat gland (more sweat), other effects o Cognitive system  Constant search for threats • If no external threat, look for internal cause • Nervous, can’t focus, apprehensive o Behavioural system  Social constraints prevent shit like aggression and running  Fidgeting or deferring stuff • Temporary relief followed by more anxiety later on - Anxiety vs. fear and panic o Fear is present-oriented (SNS) o Anxiety is future-oriented (SNS) o Panic is physical symptoms of fight-or-flight - Normal fears, anxieties, worries, rituals o Normal fear  Little impact on kids, doesn’t last very long, goes away with age  Girls have more fears than boys at any age o Normal anxieties  Most common: test anxiety, separation anxiety, need for reassurance, harming parents, competence  Doesn’t go away with age  Kids have more of these (girls more than boys) o Normal worries  Good for development  Older you get, more complex they get o Normal ritual and repeating behavior  Kids have more  2 categories: repetitive behaviour, doing things right • Common with OCD symptoms - Anxiety disorder (DSM-IV-TR) 9 CATEGORIES o Separation anxiety, generalized anxiety, specific phobia, social phobia, OCD, panic disorder, panic disorder with agoraphobia, PTSD, acute stress disorder SeparationAnxiety Disorder (SAD) SAD - In kids from 7 months  preschool - Excessive demand for parental attention - one of two most - Physical complaints – fast heartbeat, nausea, dizziness, etcommon - Prevalence disorders o One of the two most common disorders in kids - earliest onset  2/3 have this and another o 4-10% all kids (more in girls) - school reluctance - DSM-IV-TR o 4 week disturbance before 18 years of age o Disturbance messes up functioning o Early onset – before 6 years old - Onset, course, outcome o Earliest onset of all disorders o Youngest age of referral o Usually after major stress (ex. Moving) o As adults…  Relationship difficulties  Other anxiety disorder  Impaired functioning - School reluctance and refusal (school refusal behaviour) o Ages 5-11 o They have a lot of physical complaints o Usually follows a period of staying at home or stress o Usually separation anxiety of leaving parents o People with this aren’t any stupider than other people o Treat them by sending them back to school GAD Generalized Anxiety Disorder (GAD) - Worry about many events at once - Episodic/continuous o Episodic or continuous - Wide focus - Inability to relax - Set high standards - Widespread focus of anxiety - “generalized worry disorder” - Uncontrollable worry - More in older kids (10- - Pick up on all things they can worry about o Always think of worst outcome - Self-conscious, self-doubting, always worried - Over-nurturing to people - Set high standards - Can never stop worrying, even if they know they have the problem (uncontrollable) - Diagnosis needs one somatic symptom - Cognitive avoidance  inhibit emotional processing - DSM-IV-TR o At least 6 months of uncontrollable worry o Focus is not confined to features ofAxis 1 disorder - Prevalence o 3-6% of kids o Anxiety and depression o Older kids have more specific phobias and extreme versions of disorder - Onset, course and outcome o 10-14 years old o Older kids have more of this o Cases that start out severe tend to have it for a longer time Specific Phobia - Clear fear of specific objects for 6 months at least o Usually threats to personal safety - Fear occurs even when stimulus isn’t present - Evolutionary theory – people fear shit that was encountered over evolutionary time (animals) - DSM-IV-TR o Five types: animal, natural environment, blood/injection/injury, situation, other o The fear is excessive and unreasonable - Prevalence o 4-10% of kids have many phobias  Increased risk if parents have specific phobia too o Blood phobia more common in girls Specific Phobia - Onset, course, and outcome - Threats to personal safety o 7-9 years old o Clinical phobias peak from 10-13 years old - Evolutionary theory - Animal, environment, injury, situation, other (AEIOS) - Peak 10-13 years - Stimulus presence not needed Social Phobia - Persistent fear of social or performance requirements (don’t want to be embarrassed) o Most common, doing things in front of others Social Phobia - Severe case: generalized social phobia - Fear of getting ridiculed o Scared to do anything social - Can cause fast heartbeat, panic attacks, etc. - Severe case: generalized - Prevalence, comorbidity, and course social phobia - More in girls o 6-12% in kids (twice as many in girls) nd o Girls show more brain activation with age, boys decline - 2 most common o 2nd most common anxiety disorder disorder o 2/3 with this have another disorder - Post-puberty  20% have depression - Lasts long (20 yrs) o Happens after puberty  Early/mid adolescence o Perception of not being accepted by peers is an early sign o Last 20-25 years - Selective mutism (NOT a disorder itself) o Don’t talk in specific social situations o Rare o An extreme type of social phobia o Caused by trauma? Auditory process deficit? Not too sure Obsessive-Compulsive Disorder (OCD) - Obsessions – persistent and intrusive thoughts o Most common: germs, injury, symmetry - Compulsions – repetitive, purposeful and intentional behaviour o Most common: bathing, touching, counting, hoarding - Involves family members - People try to hide their rituals o Easy at first, but gets so elaborate that it becomes too hard to hide - Normal activities of OCD people are reduced OCD - Prevalence o 1-3% in all ages - Rituals (that they o Twice as much in boys (supposedly) hide) - Onset, course, and outcome o 9-12 years old - Repeating stuff on o Early onset usually have chronic tic disorders purpose o <10% show complete remission - 2x in boys - Chronic tic disorder - <10% remission Panic - Panic attacks o Sudden period of intense fear and four or more cognitive or physical fight/fight symptoms o Sense of danger Panic Attack o Peaks at 10 minutes - Four or more o Increasing panic attacks with pubertal stage in girls cognitive/physical  Physical changes with puberty cause this symptoms o Can be caused by things other than fear - 10 min peak  Neurochemicals in the brain - Causes: fear,  Hyperventilation chemical, - Panic disorder hyperventilation - Girls (puberty) o Recurrent, unexpected attacks followed by concern o Causes avoidance of situations where panic attack could happen o Agoraphobia  Age 18 or older  Fear of panic attack in situations where escaping would be hard o Nocturnal panic – waking from anxiety attack - Prevalence o Panic attacks 3-4%, panic disorder 1%  More in females o Severe depression might lead to suicide - Onset, course and outcome Panic Disorder o 15-19 years old (post-pubertal) - Recurrent o Lowest rate of remission
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