PSYCHOPATHOLOGY OF CHILDREN AND FAMILY

1. PSYCHOPATHOLOGY OF CHILDREN AND FAMILY WEEK 7: ANXIETY DISORDERS

2. Anxiety disorder • Anxiety is a generalized state of apprehension • The focus of anxiety is more internal than external • It seems to be a response to a vague or unrecognized danger

3. Anxiety is a physiological, behavioral and psychological reaction all at once • Therefore intervention programs in general should focus on: - to reduce physiological reactivity - to eliminate avoidance behavior - to change subjective reaction

4. Free-floating anxiety Anxiety that comes out of blue • Situational Anxiety anxiety arises only in response to a specific situation but it is unrealistic situational anxiety will eventually become phobic when you start to avoid the situation • Anticipatory anxiety thinking about one particular situation

5. Anticipatory anxiety is closely associated with the way you are thinking. • With panic disorder, thoughts are generally focused on worrying about having a panic attack in a situation that will result in embarrassment, extreme discomfort, a heart attack or even worse.

6. Different types of anxiety disorders defined by DSM-IV • Panic disorders • Agoraphobia • Social Phobia • Generalized Anxiety Disorder • Obsessive Compulsive Disorder • Post Traumatic Stress Disorder

7. ANXIETY VS ANXIETY DISORDERS

8. Panic Disorder • Characterized by sudden episodes of acute apprehension or intense fear that occur “out of blue” without any apparent • Symptoms of panic disorder - Shortness of breath or a feeling of being smothered - Heart palpitations – pounding heart or accelerated heart rate - Dizziness, unsteadiness - Trembling or shaking - Feeling of choking - Sweating - Nausea or abdominal distress - Feeling of unreality - Numbness or tingling in hands and feet - Hot and cold - Chest pain or discomfort - Fears of going crazy or losing control - Fear of dying

9. The panic doesn’t occur because you are thinking about, approaching or actually entering a phobic situation • It happens spontaneously and unexpectedly for no apparent reason

10. The causes of panic disorder • Heredity • chemical imbalances in the brain • personal distress major life changes may trigger the onset of panic attacks

11. Treatment Medication • antidepressant drugs such as tofranil and paxil Personal wellness program • regular exercise • daily practice of deep relaxation • good nutrition • a shift in attitude to a calmer and easy-going approach

12. Generalized Anxiety Disorder • Characterized by persistent feelings of anxiety that are not triggered by any specific object, situation or activity • GAD having at least three of the following six symptoms - Restlessness - Being easily fatigued - Difficulty concentrating - Irritability - Muscle tension - Difficulties with sleep

13. No specific phobias associated with GAD but it is sustained by basic fears - Fear of losing control - Fear of not being able to cope - Fear of failure - Fear of rejection - Fear of death and disease

14. Phobic Disorders • The word phobia derives from the Greek phobos meaning fear • Phobic disorders are irrational fears of objects or situations

15. Specific Phobias • Persistent and excessive fears of specific objects or situations • The DSM-IV groups specific phobias within 5 subtypes - Animal Type - Natural Environment Type - Blood Injection Injury Type - Situational Type - Other Type

16. Social Phobia • Fear of embarrassment or humiliation in situations where you are exposed to the scrutiny of others • Typically your concern is that you will say or do something that will cause others to judge you as being anxious, weak, crazy or stupid • The most common - Fear of Public Speaking

17. Agoraphobia • The word agoraphobia means fear of open spaces / market places • Afraid of being in situations from which escape might be difficult or unavailable • Fear of embarrassment plays a key role • The most common feature of agoraphobia is anxiety about being far away from home or far from a “safe person”

18. Agoraphobia appears to be engendered by panic disorder • Different level of agoraphobia - mild case - moderate case - severe case

19. Obsessive Compulsive Disorder • Obsessions are recurring ideas, thoughts, images or impulses • Compulsions are repetitive behaviors or behaviors or rituals that you perform to dispel the anxiety brought up by obsessions • Obsessions may occur by themselves without necessarily being accompanied by compulsions

20. The most common compulsions include washing, checking and counting • Obsessive compulsive disorder is often accompanied by depression

21. Post Traumatic Stress Disorder • The essential feature of post traumatic stress disorder is the development of disabling psychological symptoms following a traumatic event • The traumatic event involves either actual or threatened death or serious physical injury or threat to one’s own or another’s physical safety

22. Symptoms of PTSD • Repetitive, distressing thoughts about the event • Nightmares related to the event • Flashbacks so intense that you feel or act as though the trauma were occurring all over again • An attempt to avoid thoughts or feelings associated with the trauma • An attempt to avoid activities or external situations associated with the trauma • Emotional numbness • Feeling of detachment or estrangement from others • Losing interest in activities that used to give you pleasure • Persistent symptoms of increased anxiety, such as difficulty falling or staying asleep, difficulty concentrating

23. To receive a diagnosis of PTSD, these symptoms need to have persisted at least 1 month • Less than 1 month’s duration, the appropriate diagnosis is “acute stress disorder” • In addition, the disturbance must be causing you significant distress, interfering with social, vocational or other important areas of your life

24. Theoretical Perspectives • Psychodynamic perspective - anxiety disorders are viewed as neurosis - the anxiety experienced in neurosis reflects; 1 – the efforts of unacceptable, repressed impulses to break into consciousness 2 – fear as what might happen if they do Stress on the roles of defense mechanisms

25. Phobias develop through the use of defense mechanism of projection and displacement • A phobic reaction is believed to represent the projection of the person’s own threatening impulses onto the phobic object.

26. Learning Perspectives • Anxiety disorders are acquired through conditioning • Phobia - Classical conditioning - Operant conditioning - Observational learning – modeling

27. Generalized anxiety - a product of stimulus generalization • Obsessive compulsive disorder - compulsive behavior are operant responses that are negatively reinforced by relief of the anxiety that is engendered by obsessional thoughts • PTSD - classical conditioning

28. Cognitive Perspectives • Overprediction of fear • Irrational beliefs • Oversensitivity to threats • Anxiety sensitivity • Misattribution for panic sensation • Low self-efficacy expentancies

29. Biological Perspectives • Genetic Factors • Neurotransmitter - Gammaaminobutyric acid (GABA)