Anxiety DisordersAnxiety Disorders

Anxiety Disorders - TermsAnxiety Disorders - Terms

• Fear = emotional rxn to dangerFear = emotional rxn to danger

• Anxiety Anxiety – Future orientationFuture orientation– Feelings of apprehensionFeelings of apprehension– No danger may be presentNo danger may be present

• Panic – physiological rxn; fight or flightPanic – physiological rxn; fight or flight

• Phobias = pathological fearsPhobias = pathological fears

Fears vs. PhobiasFears vs. Phobias

1.1. Out of proportionOut of proportion

2.2. Cannot be explained awayCannot be explained away

3.3. Leads to avoidanceLeads to avoidance

4.4. Not adaptiveNot adaptive

5.5. Persists over timePersists over time

6.6. Not age or stage specificNot age or stage specific

FearsFears

• Common and normalCommon and normal• 90% of children have at least one 90% of children have at least one

specific fearspecific fear• 50% have numerous fears50% have numerous fears

• Generally decline with age; peak Generally decline with age; peak around 11around 11

• Phobias only 1%Phobias only 1%

Common fearsCommon fears

• Fears of physical injury or personal Fears of physical injury or personal lossloss

• Fears of natural or supernatural Fears of natural or supernatural dangerdanger

• Fears reflecting psychic distressFears reflecting psychic distress

• animalsanimals

Developmental changes in Developmental changes in fearsfears

• 11stst year: loud noises, separation from year: loud noises, separation from parentparent

• Preschoolers – animals, the dark, Preschoolers – animals, the dark, imaginary creaturesimaginary creatures

• school age – school, injury, social school age – school, injury, social fearsfears

• Adolescence – interpersonal fears, Adolescence – interpersonal fears, appearance, school, safetyappearance, school, safety

Difficulties in assessment of Difficulties in assessment of anxiety disorders in childrenanxiety disorders in children

1.1. Differentiate normal fears from pathological Differentiate normal fears from pathological anxietyanxiety

• impairmentimpairment

2.2. domains may not corresponddomains may not correspond• VerbalVerbal• BehavioralBehavioral• PhysiologicalPhysiological

3.3. Problems operationalizing behavioral Problems operationalizing behavioral manifestations of anxietymanifestations of anxiety

• Physiological measures limitedPhysiological measures limited• Verbal report - ??Verbal report - ??• Rating scales good but don’t distinguishRating scales good but don’t distinguish

DSM-IV Anxiety DisordersDSM-IV Anxiety Disorders

• 9 disorders9 disorders– Same as adult except for separation Same as adult except for separation

anxiety disorderanxiety disorder– OCD, PTSD, GAD, Panic Disorder, OCD, PTSD, GAD, Panic Disorder,

phobia, social phobia, agoraphobia, phobia, social phobia, agoraphobia, acute stress disorderacute stress disorder

Separation Anxiety DisorderSeparation Anxiety Disorder

• Excessive anxiety concerning Excessive anxiety concerning separation from home or caregivers separation from home or caregivers beyond that expected for beyond that expected for developmental leveldevelopmental level

• Lasts 4 weeks or moreLasts 4 weeks or more

• Often early age of onsetOften early age of onset

• Often precipitated by major stressorOften precipitated by major stressor

Social PhobiaSocial Phobia

• Extreme shynessExtreme shyness

• Children may not recognize why they Children may not recognize why they feel anxiousfeel anxious

• Must have capacity for social Must have capacity for social relationships with familiar peoplerelationships with familiar people

• Must occur in peer setting, not just Must occur in peer setting, not just with adultswith adults

Components of Treatment Components of Treatment

1.1. Avoidance/escape – exposureAvoidance/escape – exposure

2.2. Physiological reactions – relaxation Physiological reactions – relaxation training and/or medstraining and/or meds

3.3. Cognitive – alter distorted thinkingCognitive – alter distorted thinking

4.4. Cognitive – sense of control, self-Cognitive – sense of control, self-efficacyefficacy