Anxiety Disorders Flashcards
core characteristics of anxiety
strong negative emotion, tension, apprehension, a sense of fear/dread
- anticipating future danger
- anxiety is expected in situations that may affect safety or wellbeing (it’s normal)
- but excessive, persistent, debilitating anxiety signals dysregulation of the anxiety response system (too much anxiety is bad)
- it may occur in response to specific stimuli or as a generalized state of worry
symptoms of anxiety
physical: abdominal pain, nausea, vomiting, sweating, dizzy, inc. heartrate, dry mouth, blushing
cognitive: worrying, poor concentration, blanking out, self-critical thoughts, thoughts of being scared/hurt, etc
behavioral: avoidance (most common), crying, screaming, trembling voice, nail biting, shaking, avoidance of eye contact, twitching, etc
anxiety
future-oriented emotional state, feelings of apprehension and lack of control; no danger present
fear
present-oriented, immediate emotional reaction to current danger
panic
unexpected physical symptoms in the absence of threat/danger
associated characteristics of anxiety
cognitive - avg intelligence, probs w/ attention, memory, concentration, cognitive biases, less adaptive coping strategies
physical/health - sleep problems and less risk-taking behaviors
social - lower social competence, problematic peer and sibling interactions, more loneliness (lower self report of self esteem, more shy)
sex and age differences in anxiety
- 10-15% of school-aged children have at least 1 anxiety disorder
- specific phobia, social anxiety, and separation anxiety are more common during childhood and adolescence
- no sex diff in preschool
- for school-aged and older, most anxiety disorders are common in girls (persists into adulthood)
comorbidity
- comorbidity among anxiety disorders and between anxiety disorders and other disorders (depression) makes diagnosis hard
- combos usually persist into adulthood
- anxiety also co-occurs w/ ADHD, eating disorders, and substance use disorders
what factors cause anxiety (just list)
biological
individual
environmental
biological factors
- heritability is moderate (.35) and nonspecific (parent has social anxiety, you are now on path to anxiety, but could be diff type)
- over/underactivity of neural circuits, structural abnormalities, right-left asymmetries
- altered serotonin and norepinephrine functioning
individual factors
- tend to focus on temperament in childhood an personality in adulthood
- behavioral inhibition is a risk factor only (children afraid to try new things)
environmental factors
overprotective parenting, critical parenting, parent modeling of anxious behavior and avoidant coping increases risk
- children learn from modeled behavior
- some parents reinforce child’s anxiety by allowing avoidance behaviors (stay home from school and miss test)
4 types of interventions for anxiety
behavior therapy
CBT
family interventions
medications
- exposure to source of anxiety is main approach
behavior therapy
- graded exposure to fear (make list least feared to most and start talking it through, rate distress SUDS)
- flooding: prevent avoidance behaviors, exposure in prolonged and repeated doses
CBT
- modify maladaptive thoughts to decrease symptoms (if scared of panic attack - spin in circle and tell self i’m okay)
- coping cat ages 7-13: decrease negative thinking, increase active problem solving
family interventions
- children view selves as less competent, parent’s perspective of child may change
- greater parental involvement in modeling and reinforcing coping techniques
medications
- SSRIs can be used
- not first pick, try CBT first
- for some CBT doesn’t work, or anxiety is too severe and need medication to be able to do therapy
core characteristics of separation anxiety
- excessive, prolonged anxiety about being away from home/parents (when developmentally inappropriate)
- reluctance/refusal to attend school or sleep alone, clingy, physical complaints
- typical at 7/8 mos of age; declines after 2yrs old, but expected during transition to school or after major stressor
sex and age differences of separation anxiety
sex: community samples more girls; clinical boys and girls same
age: avg age of onset = 7-8yrs (but 70% or more who develop disorder do so before age 4)
comorbidity of separation anxiety
majority of children have another disorder, usually anxiety, but 1/2 develop comorbid depression. substance use disorder may be found in adolescents
etiology of separation anxiety
biological factors: genetics, neurological factors, inhibited temperament
environmental factors: highly involved parents (overprotective), occurrence of major life stressor is important (moving, death/illness in family, new school)
outcomes of separation anxiety
- SAD may develop suddenly or gradually
- course: some have brief probs, symptoms come/go, for others symptoms are chronic
- chronic course is more likely when older age at onset, parental psychopathology, marital distress, comorbid diagnoses in childhood
core characteristics of social anxiety
- intense fear of social situations thar involve possible scrutiny by others and risk of evaluation or embarrassment
- individuals tend to be unassertive, make less eye contact, seem shy, may find it hard to go to school or activities
- many cases overlooked because shyness common
sex and age differences in social anxiety
sex: community 2X more girls; clinical no diff
age: onset is often in late childhood or early adolescence (80% who develop do so by age 18)
comorbidity of social anxiety
co-occurrence of another disorder is common; 1/5 have comorbid depression, substance use probs may also develop
- in boys/men - higher rates of ODD, CD, and substance use disorders
- girls/women - higher rates of another anxiety or depression
etiology of social anxiety
often develops after a highly stressful event, but may develop gradually
- biological predispositions likely interact w/ individual and/or environmental factors
outcomes of social anxiety
- course is variable; some have remission, some have symptoms come/go, for others symptoms are chronic
- adults may experience impairments in education, employment, social, and relationship domains
- rates of long-lasting remission is very low
anxiety in preschoolers (5 points)
- most prevalent diagnosis in preschoolers, they cause impairment in young children and their families
- the most significant barrier to ID and intervention: widespread belief among adults that children will outgrow symptoms (not true!!!)
- anxiety in young children presents as specific disorders as it does for other ages (separation, social, specific phobia, GAD, etc)
- less able to describe internal experiences, so it is shown through behavior
- some symptoms are misinterpreted as irritability and/or defiance
prevalence of anxiety in preschoolerrs
about 20% have an anxiety disorder - very high rates
- no sex diff in this age group
etiology in preschoolers
bio and environ. factors contribute, but environment makes stronger contribution
- more likely to a) have parent w/ anxiety or depression; b) have parent who is younger and less education/income; c) have experienced recent stressor
interventions for preschoolers
- parent who is empathic, firm, and encourages exposure to fear is good
- CBT w/ more parent involvement is first used, meds only considered really if no access to CBT, or if child doesn’t respond to it
selective mutism core characteristics
children don’t speak in some situations and speak normally in others. not speaking is a way to avoid intense anxiety associated w/ social interactions
- also shows little/no eye contact, tantrums, sleep problems, stomach aches, nausea
comorbidity in selective mutism
most common comorbid diagnosis is social anxiety disorder; higher rates of other anxiety disorders, depression, OCD also occur, may have speech/language problems
