Anxiety Flashcards
Difference between obsessions and compulsions: OBSESSIONS
- Recurrent, persistent, unwanted thoughts, impulses or images
- Intrusive, cause distress
- Examples:
- Contamination
- Inappropriate sexual thoughts (LE)
- Violent thoughts, religious fears or “blasphemous” thoughts
- *Young children do not have to identify fears as irrational
Difference between obsessions and compulsions: COMPULSIONS
- Repetitive behaviors or mental acts (praying, counting)
- Person feels driven to perform in response to obsession or rigid rules
- Performed to neutralize obsessive thoughts or prevent some dreaded situation
- Not connected in realistic way
- Provide temporary relief
- Not performing causes marked increase in anxiety
- Examples: repetitive and excessive hand washing, checking doors, arranging objects, counting items
Vulnerabilities to developing anxiety
b. Behavioral Inhibition
c. Genetic
d. Neuroimaging
e. Neurotransmitter
f. Neuroendocrine
g. Learned Responses
h. Attachment Research
i. Psychoanalytic
Differentiating “expected” anxiety from “disorders”
Clinician must be able to distinguish developmentally normal from abnormal fears and worries.
While some degree of worry is normal, those children with high levels of anxiety early in life are more likely to continue to suffer from anxiety as they age.
As children age, their anxiety often tends to diminish, but in some cases the anxiety simply finds a new expression.
One must see if this is the appropriate age to worry about these things, degree of distress is reasonable for developmental stage, is the anxiety interfering with the child’s life on an everyday basis, and how is the child’s social, academic, and family functioning affected by the anxiety.
Theories of how fears develop: infants
– Fear of loud noises
– Fear of being startled
– Fear of strangers (around 8 – 10 months)
theories of how fears develop: toddlers
– Fears of imaginary creatures
– Fears of darkness
– Normative separation anxiety
theories of how fears develop: school age children
– Worries about injury and natural events (e.g., storms, lightening, earthquakes, volcanoes)
– Children who are characterized as confident and eager to explore novel situations at 5 years are less likely to manifest anxiety in childhood and adolescence
– Children who are passive, shy, fearful, and avoid new situations at 3 and 5 years are more likely to exhibit anxiety later in life
– In general, girls tend to endorse more anxiety symptoms than boys
– Younger children are more likely to experience anxiety symptoms than older children
– Anxious children interpret ambiguous situations in a negative way and may underestimate their competencies
– The most common anxiety disorders in middle childhood are Separation Anxiety, GAD, and Specific Phobias
theories of how fears develop: adolescents
– Fears related to school
– Fears related to social competence
– Fears related to health issues
What is BEHAVIORAL INHIBITION
- Behavioral Inhibition” (a lab-based temperamental construct) is defined as the tendency to be unusually withdrawn or timid and to show fear and withdrawal in novel and/or unfamiliar social and nonsocial situations
- Those who are withdrawn in social situations only are considered “shy”
- Both behavioral inhibition and shyness are associated with anxiety disorders in both children and adults
- The tendency to approach or withdraw from novelty is an enduring, temperamental trait
- Studies of children who are behaviorally inhibited are more likely to have multiple psychiatric disorders and two or more anxiety disorders (especially Avoidant D/O, Separation Anxiety D/O, and Agoraphobia)
- Thus, Behavioral Inhibition is a risk factor for the development of anxiety disorders in children
What role does the HIPPOCAMPUS play
- Involved in the storage of sensory information and is very sensitive to stress
- Threat alters the ability of the hippocampus and connected cortical areas to store certain types of cognitive information (verbal) but not nonverbal information
- Many of the cognitive distortions that are associated with anxiety disorders may be related to anxiety related alterations in the tone of the hippocampus and associated cortical areas
what role does the AMYGDALA play
• Receive neural projections from many areas (sensory thalamus, hippocampus, entorhinal cortex) and plays a central role in orchestrating the brain’s response to this sensory input by sending projections to motor, autonomic, and neuroendocrine systems.
changes in child/adolescent anxiety diagnoses between DSM IV and DSM V
• DSM-IV disorders include: (1) Separation Anxiety Disorders (2) Panic Disorder (3) Specific Phobia (4) Social Phobia (Social Anxiety Disorder) (5) Obsessive-Compulsive Disorder (6) Posttraumatic Stress Disorder (7) Acute Stress Disorder (8) Generalized Anxiety Disorder • Others: – Selective Mutism – Somatic symptoms – Trichotillomania
Risk and protective factors
- Behaviorally inhibited young children have a greater likelihood of anxiety disorders in middle childhood
- Offspring of parents with anxiety disorders have a greater risk of anxiety disorder and high levels of functional impairment
- Insecure attachment relationships with caregivers (specifically anxious/resistant attachment) increases the risk of childhood anxiety disorders
Differentiate between a panic attack and panic disorder : ATTACK
- NOT A DISORDER!
- Quite common – about 1 in 40 adults experience them
- A discrete period of intense fear or discomfort, in which 4 or more of the following develop abruptly and reach a peak within 10 minutes:
- Palpatations, heart rate increase
- Sweating
- Trembling
- Shortness of breath/smothering
- Feeling of Choking
- Chest Pain
- Nausea
- Dizzy/lightheaded
- Derealization (feeling of unreality)-or depersonalization (being detached from oneself)
- Fear of going crazy or losing control
- Fear of dying
- Individuals typically report a desire to flee or leave
- 3 characteristic types of panic: (1) Unexpected (uncued); (2) situation bound (cued); and (3) situationally predisposed.
- With unexpected panic attacks, over time the attacks typically become situationally bound or predisposed, although unexpected attacks may occur
- The occurrence of unexpected panic attacks is required for a dx of Panic D/O; situationally bound or predisposed attacks are common in Panic D/O but also occur in the context of other anxiety disorders (e.g., specific and social phobia, PTSD)
Differentiate between a panic attack and panic disorder:
DISORDER
• PANIC DISORDER is characterized by the
– Recurrent unexpected panic attacks
– At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
• persistent concern about having additional attacks
• worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)
• a significant change in behavior related to the attacks
• Might look like:
– Preoccupation with having future attacks
– Avoiding places or situations where the child thinks a Panic Attack may occur
– Worry about being trapped in places where help would be unavailable if an attack occurred
• Can occur with or without AGORAPHOBIA
• Fear of open spaces
– anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms.
– Typically involve fears of characteristic clusters of situations that include being outside the home alone, being in a crowd, standing in a line, being on a bridge, and traveling in a bus, train, or automobile.
– Generally avoid places with large numbers of unfamiliar people – for kids: auditoriums at school, parties, restaurants, etc.
• Up to ½ of community samples have comorbid agoraphobia, but the co-occurrence is much higher in clinical samples
• The disorder can be seen as a “fear of fear itself”
• Reported rates of comorbid MDD are high, ranging from 10-65%; in 2/3 of these individuals depression co-occurs with panic d/o or follows panic; in the remaining 1/3, the depression precedes the panic
• Comorbidity with other anxiety disorders is common – social phobia and GAD (15-30%), specific phobia (2-20%), and OCD (up to 10%). PTSD and Separation Anxiety are also strongly comorbid, along with hypochondriasis.
• Clinical Presentation
– Kurt is a 13-year-old boy who has experienced several unexplained panic attacks since age 7.
• Intensity: worry about having another one that is out of proportion given the event
• Impairment: social life and academic achievement
• Inability to Recover: worries about another attack even though a month has passed since his last one.
*Untreated at age 7
• Cued panic attacks can occur with any anxiety disorder, or independently, and are common among adolescents
• Uncommon before the peri-pubertal period (adult retrospective studies have shown that symptoms commonly begin in adolescence or young adulthood)
• Peak age of onset of panic d/o is age 15 – 19
• 1st degree biological relatives are up to 8x more likely to develop Panic d/o; if age of onset is <20 y/o, 1st degree relatives are up to 20x more likely to develop same.
