ANXIETY DISORDERS

I. Definitions

    A. Anxiety - mood state characterized by marked negative affect and somatic symptoms of tension in which a person apprehensively anticipates future danger or misfortune.
    B. Fear - immediate alarm reaction to present danger
    C. Panic attack - abrupt experience of intense fear accompanied by a number of physical symptoms.
    palpitations, sweating, trembling, shortness of breath, choking, chest pain, nausea, dizziness
    depersonalization, fear of going crazy or dying, chills or hot flashes
        1. Situationally bound
        2. Unexpected
        3. Situationally predisposed

II. Causes of Panic and Anxiety
    A. Genetic

    B. Neurobiological

    C. Psychological

        1. Anxiety - uncontrollability
        2. Panic - conditioning and cognitions
            Psychodynamic - conflicts of childhood origin

    D. Social
        1.Stressful life events
        2. Learning theorists - conditioned fears acquired early in childhood avoidance of the feared stimuli isreinforced by reduction of anxiety
        3.Cognitive social - observational learning (learning from other's reactions)

    E. Issues to Consider When Diagnosing Anxiety Disorders in Children
        1. Reliability and Validity
        2. Comorbidity

SEPARATION ANXIETY DISORDER

excessive anxiety or distress upon separation, or threat of separation from a major attachment figure or from the home

I. Diagnostic Criteria (must meet three of the nine criteria)
    A. Developmentally inappropriate and excessive anxiety concerning separation from the home or from those to whom the child is attached, as evidenced by at least three of the following:
        1. Persistent and excessive worry about losing or possible harm befalling, major attachment figure
        2. Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g.: getting lost or kidnaped)
        3. Persistent reluctance or refusal to go to school or elsewhere because of fear of separation
        4. Persistently or excessively scared or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
        5. Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
        6. Repeated nightmares involving the theme of separation
        7. Repeated complaints of physical symptoms, e.g., headaches, stomachaches, nausea, or vomiting, when separation from major attachment figure is anticipated or involved
        8. Recurrent excessive distress when separation from major attachment figure is anticipated or involved
    B. Duration of disturbance of at least four weeks
    C. Onset before the age of 18
    D. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
    E. Occurrence not exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or any other psychotic disorder

II. Statistics and Course

III. Causes

    1. Familial

    2. Genetic

IV. Treatment
    A. Behavior Therapy- Contingency management, systematic desensitization, implosion and flooding, modeling, and self-control

    B. Pharmacological Therapy

GENERALIZED ANXIETY DISORDER

I. Diagnostic Criteria
    A. Excessive anxiety and worry for at least 6 months about a number of events or activities
    B. Difficult to control or stop the worry
    C. Associated with at least three of the following (only one for children):
        1. Restlessness
        2. Fatigued
        3. Difficulty concentrating
        4. Irritability
        5. Muscle tension
        6. Sleep disturbance
    D. Focus of anxiety and worry is not confined to features of another disorder

II. Statistics and Course

III. Causes
physiological responsivity
chronically tense

IV. Treatment

SPECIFIC PHOBIAS

Unreasonable fear of a specific object or situation that markedly interferes with ability to function we all experience specific fears....must be excessive and persistent, unreasonable

I. Diagnostic criteria
    A. Fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation
    B. Exposure to the phobic stimulus provoke immediate anxiety response
        (Children - crying, tantrums, freezing, clinging)
    C. The person recognizes that the fear is excessive or unreasonable
        (May be absent in children)
    D. Phobic situation is avoided or endured with distress

II. Subtypes
    A. Animal type
    B. natural environment type, water, height
    C. blood-injection type
    D. situational type - elevators, planes
    E. Other phobias
        illness phobia
        choking phobia
        school phobia

III. Statistics and course
    very common
    predominantly female
    11% of population , tends to be chronic

IV. Causes
    direct experience, observational learning, vicarious learning - being told
    traumatic experience
    prone to anxiety
    social and cultural factors

V. Treatment
    Exposure

SOCIAL PHOBIA

Extreme, enduring, irrational fear and avoidance of social or performance situations; fear of evaluation

I. Diagnostic criteria
    A. Marked and persistent fear of social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. Fear of humiliation or embarrassment
    B. Exposure to the feared social situation provokes anxiety, which may take the form of a panic attack
        (Children - crying, tantrum of freezing)
    C. Person recognizes that the fear is excessive or unreasonable
        (May be absent in children)
    D. Feared social or performance situations are avoided or endured with intense anxiety or distress

II. Statistics and course

III. Causes
    preparedness
    temperament (Kagan)
    inherit vulnerability
    adolescence - stressful life events
    experience real social trauma

IV. Treatment
    Rehearsal or role playing
    Cognitive therapy

OBSESSIVE-COMPULSIVE DISORDER

unwanted, persistent, intrusive thoughts and impulses and repetitive actions used to suppress them
dangerous event is internal (thought, impulse, etc.)

Obsessions - intrusive and nonsensical thoughts, images or urges
    contamination, aggression, sexual, somatic, symmetry

Compulsions - thoughts or actions designated to suppress the thoughts
    behavioral - checking
    mental - counting

I. Diagnostic Criteria
    A. Either obsessions or compulsions

Obsessions defined by 1, 2, 3, and 4
        1. Recurrent and persistent thoughts, impulses, images that are experienced as intrusive and inappropriate and cause marked anxiety or distress
        2. Not simply excessive worries about real-life problems
        3. Attempts to ignore or suppress these or to neutralize them with some other thought or action
        4. Recognizes that these are a product of own mind

Compulsions as defined by 1 and 2:
        1. Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
        2. Aimed at preventing or reducing distress or preventing some dreaded event or situation - not connected in a realistic way with that they are designed to neutralize or prevent, or are clearly excessive

II. Statistics and course
    2.6% prevalence
    Average age of onset = males 9-12
    Females 20-24
    similar across cultures

III. Causes
    early learning that some thoughts are dangerous and must be repressed
    biological and psychological vulnerabilities

IV. Treatment
    A. Drugs
        Prozac

    B. Therapy
        systematic exposure and desensitization
        preventing rituals

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