Understanding Anxiety Disorders in Children and Families

1. PSYCHOPATHOLOGY OF CHILDREN AND FAMILY WEEK 6: 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-TR • 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. Your symptoms would be diagnosed as panic disorders if: • You have had two or more panic attacks • At least one of these attacks has been followed by one month (or more) of persistent concern about having another panic attack.

10. 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

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

12. 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

13. 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

14. 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

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

16. 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

17. 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

18. 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”

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

20. 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

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

22. 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

23. 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

24. 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

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

26. 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

27. 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.

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

29. 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

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

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