Anxiety/Obsessive Disorders/Trauma

Question 1

obsessions definition

Answer 1

Recurrent, persistent, unwanted thoughts, impulses or images

• intrusive; causes distress

Question 2

compulsions definition

Answer 2

Repetitive behaviors or mental acts
- Provide temporary relief
- Not performing causes marked increase in anxiety

Question 3

behavioral inhibition

Answer 3

a lab-based temperamental construct !!

• the tendency to be unusually withdrawn or timid and to show fear and withdrawal in novel and/or unfamiliar social and nonsocial situations

THIS IS A RISK FACTOR for the development of anxiety disorders in children

Question 4

attachment research

Answer 4

insecure attachment
- hyperactivating
- clingy with caregivers

THIS IS A RISK FACTOR for the development of childhood anxiety disorders

Question 5

differentiating “expected” anxiety from “disorders”

Answer 5

Expected
- anxiety is needed for adaptation and survival
- fears and worries are common in children

Disorder
- Children with anxiety disorders may present with fear or worry but may not recognize their fears as unreasonable
- THERE ARE PHYSICAL SYMPTOMS !!
- headaches
- upset stomach or nausea
- increased heart rate
- sleep disturbance
- tightness in chest

Question 6

questions to ask when differentiating expected vs disorder anxiety (6 CATEGORIES)

Answer 6

INTENSITY: Is the degree of distress unrealistic given the child’s developmental stage and the object/event?

IMPAIRMENT: Does the distress interfere with the child’s

SOCIAL FUNCTIONING: unable to make friends

ACADEMIC FUNCTIONING: failing classes

FAMILY FUNCTIONING: creating conflicts, limiting family choices

ABILITY TO RECOVER: Is the child able to recover from distress when the event is not present?
- Tend to worry about future occurrences of event/object
- Distress occurs across multiple settings

Question 7

2 theories on how fears develop

Answer 7

1. Psychoanalysis
2. Classical Learning Theory

Question 8

psychoanalysis

Answer 8

• Phobias develop as defense against anxiety which is produced by repressed “id” impulses
• Anxiety is displaced from the “id” impulses to a fear object that is linked symbolically
• By avoiding the phobic object, one avoids dealing with repressed childhood conflicts

Question 9

classical learning theory

Answer 9

says anxiety can be learned
- john b watson
- “little albert” theory

• Most specific fears (phobias) are related to paired or misplaced internalization of cues with anxiety from previous experience
• During infancy and childhood children mirror their caretakers’ responses when interpreting internal states of pain, arousal, and anxiety

Question 10

importance of the amygdala

Answer 10

The amygdala serves as an “early warning system”
- response system to fear and anxiety

It perceives danger through the five senses, evaluating the “emotional meaning” of sensory input, then setting in motion hormonal stress releases and somatic reactions that instantaneously active fight/flight/freeze response

Question 11

importance of the hippocampus

Answer 11

–> the hippocampus is a bridge that connects the amygdala to the prefrontal cortex (rational meaning) which enables us to reassess and decide if we are safe, or propels us to take action to get safer

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)

Many of the cognitive distortions that are associated with anxiety disorders may be related to anxiety related alterations in the tone of the hippocampus

ESSENTIALLY:
when there is threat, alters ability to encode, verbal memory, leads to distorisons

Question 12

changes in child/adolescent anxiety diagnoses between DSM-IV & DSM-5

Answer 12

Obsessive compulsive disorder and Trichotillomania were moved outside of the anxiety section

Made a separate section for trauma !!

Question 13

risk factors of anxiety

Answer 13

• Behaviorally inhibited young children
• Offspring of parents with anxiety disorders
• Insecure attachment relationships with caregivers

Question 14

protective factors of anxiety

Answer 14

• strong support and caring family system
• no family history of anxiety
• not behavioral inhibited children

Question 15

difference between a panic attack and a panic disorder

Answer 15

panic attack:
- A discrete period of intense fear or comfort, in which 4 or more of the following develop abruptly and reach a peak within 10 minutes:
- sweating, trembling, nausea, chest pain, dizzy, shortness of breath

panic disorder:
- recurrent unexpected panic attacks
- Fear of fear itself, overtime fear that you are going to have more

Question 16

when do anxiety disorders develop

Answer 16

Anxiety is the most prevalent mental health disorder in children and teens
- Estimated at 6-20%

Commonly diagnosed issue in childhood
- Separation anxiety ! right from the beginning
- Develop phobias - ex: shots

Often in adults we recognize our fears are irrational, kids don’t necessarily think that their fears are irrational
- Makes sense to them

Question 17

differential diagnosis of GAD

Answer 17

generalized anxiety disorder

Characterized by chronic, excessive worry in a number of areas (e.g., schoolwork, social interactions, family, health/safety, world events, and natural disasters) with at least one associated somatic symptom

Somatic Symptoms ex: stomachaches, headaches, etc

Question 18

differential diagnosis of SAD

Answer 18

separation anxiety disorder

Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached

–> Excessive worry about:
–> be alone
–> separation from home
–> safety/harm of a caregiver

Question 19

differential diagnosis of social anxiety disorder

Answer 19

—– child feels scared or uncomfortable in social situations (including classrooms and extracurricular activities)
—— they fear they are being scrutinized constantly or doing something embarrassing
—— LARGE GROUPS

Shown through:
- attending social events
- raising hand and talking in class

Question 20

differential diagnosis of SM

Answer 20

selective mutism

Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school despite speaking in other situations)
–> at least one month

refusing to speak even though they are able to do so

Question 21

trichotillomania

Answer 21

Recurrent pulling out of hair resulting in noticeable hair loss

Pleasure, gratification, or relief when pulling out the hair

Question 22

simple tics vs tourettes

Answer 22

Tics:
A “tic” is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vulcanization
- common comorbidity to anxiety
- motor tic, twitch in neck, etc

Tourettes:
Involves uncontrollable repetitive movements or unwanted sounds
- starts in childhood
- Over the course of the year
- Lasting a long time
- Complex
- Wax and wane over time
- Worse in times over stress