ch #9 anxiety disorders textbook notes

Question 1

anxiety

Answer 1

A mood state characterized by strong negative affect, bodily symptoms of tension, and apprehensive anticipation of future danger or misfortune.

Question 2

anxiety disorders

Answer 2

A disorder in which the child experiences excessive and debilitating anxiety.

Question 3

neurotic paradox

Answer 3

The pattern of self-perpetuating behavior in which children who are overly anxious in various situations, even while being aware that the anxiety may be unnecessary or excessive, find themselves unable to abandon their self-defeating behaviors.

Question 4

fight/flight response

Answer 4

The immediate reaction to perceived danger or threat whereby efforts are directed toward protecting against potential harm, either by confronting the source of danger (fight), or by escaping from the situation (flight)

Question 5

The activation of the physical system produces many important chemical and physical effects that mobilize the body for action:

Answer 5

Chemical effects. Adrenaline and noradrenaline are released from the adrenal glands.

Cardiovascular effects. Heart rate and strength of the heart beat increase, readying the body for action by speeding up blood flow and improving delivery of oxygen to the tissues.

Respiratory effects. Speed and depth of breathing increase, which brings oxygen to the tissues and removes waste. This may produce feelings of breathlessness, choking or smothering, or chest pains.

Sweat gland effects. Sweating increases, which cools the body and makes the skin slippery.

Other physical effects. The pupils widen to let in more light, which may lead to blurred vision or spots in front of the eyes. Salivation decreases, resulting in a dry mouth. Decreased activity in the digestive system may lead to nausea and a heavy feeling in the stomach. Muscles tense in readiness for fight or flight, leading to subjective feelings of tension, aches and pains, and trembling.

Question 6

fear

Answer 6

An alarm reaction to current danger or life-threatening emergencies; marked by strong escape-oriented tendencies and a surge in the sympathetic nervous system.

Question 7

panic

Answer 7

A group of unexpected physical symptoms of the fight/flight response that occur in the absence of any obvious threat or danger.

Question 8

separation anxiety disorder

Answer 8

Characterized by excessive worry regarding separation from home or parents. Youths may show signs of distress and physical symptoms on separation, experience unrealistic worries about harm to self or others when separated, and display an unwillingness to be alone.

Question 9

specific phobias

Answer 9

Characterized by severe and unreasonable fears and avoidance of a specific object or situation, for example, dogs, spiders, darkness, or riding on a bus.

Question 10

social anxiety disorder

Answer 10

Characterized by a severe and unreasonable fear of being embarrassed or humiliated when doing something in front of peers or adults.

Question 11

selective mutism

Answer 11

Characterized by a consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., school), even though the child may speak loudly and frequently at home or in other settings.

Question 12

panic disorder

Answer 12

Characterized by recurrent, unexpected and severe panic attacks. These attacks may consist of an accelerated heart rate, shortness of breath, sweating, upset stomach, dizziness, fear of dying, and others. The individual also experiences a persistent concern or worry about additional panic attacks or their consequences, or displays a significant maladaptive change in behavior to avoid having panic attacks (e.g., avoidance of exercise or new situations).

Question 13

agoraphobia

Answer 13

Characterized by fear or anxiety about two or more situations such as using public transportation, being in open spaces (e.g., parking lots, marketplaces), being in enclosed spaces (e.g., theaters), being in a crowd, or being outside of the home alone. The fear or anxiety about these situations occurs because the individual thinks that escape might be difficult or help not available if they were to develop panic-like or other incapacitating symptoms.

Question 14

generalized anxiety disorder

Answer 14

Characterized by ongoing and excessive worry about many events and activities. Youths may worry about their grades in school, their relations with peers, and their own or others’ safety. They may constantly seek comfort or approval from others to help reduce their worry.

Question 15

diagnostic criteria for separation anxiety

Answer 15

(A)
Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

(1)
Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.

(2)
Persistent or excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.

(3)
Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.

(4)
Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.

(5)
Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.

(6)
Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.

(7)
Repeated nightmares involving the theme of separation.

(8)
Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

(B)
The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

(C)
The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.

(D)
The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.

Question 16

what are some physical symptoms associated with separation disorder?

Answer 16

physical symptoms may include rapid heartbeat, dizziness, headaches, stomachaches, and nausea.

Question 17

diagnostic criteria for specific phobias

Answer 17

(A)
Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.

(B)
The phobic object or situation almost always provokes immediate fear or anxiety.

(C)
The phobic object or situation is actively avoided or endured with intense fear or anxiety.

(D)
The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.

(E)
The fear, anxiety, or avoidance is persistent, typically lasting 6 months or more.

(F)
The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

(G)
The disturbance is not better accounted for by another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive–compulsive disorder); reminders of traumatic events (as in post-traumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Specify if (code based on the phobic stimulus):

Animal (e.g., spiders, insects, dogs)

Natural environment (e.g., heights, storms, water)

Blood, injection, injury (e.g., needles, invasive medical procedures)

Situational (e.g., airplanes, elevators, enclosed places)

Other (e.g., situations that may lead to choking or vomiting; in children, loud sounds or costumed characters)

Question 18

diagnostic criteria for social anxiety

Answer 18

(A)
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), or performing in front of others (e.g., giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

(B)
The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

(C)
The social situations almost always provoke fear or anxiety.

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking away, or failing to speak in social situations.

(D)
The social situations are avoided or endured with intense fear or anxiety.

(E)
The fear or anxiety is out of proportion to the actual danger posed by the social situation and to the sociocultural context.

(F)
The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

(G)
The fear, anxiety, and avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

(H)
The fear, anxiety, and avoidance is not attributable to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

(I)
The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

(J)
If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

Specify if:

Performance only: If the fear is restricted to speaking or performing in public.

Question 19

what are some symptoms associated with social anxiety?

Answer 19

stammering, sweating, upset stomach, rapid heartbeat, or a full-scale panic attack.

Question 20

describe the diagnostic criteria for selective mutism

Answer 20

the DSM-5 criteria also require that the child’s disturbance interferes with educational or work achievement or with social communication, that it is present for at least one month, that it is not limited to a lack of knowledge or discomfort with the spoken language required in the social situation, that it is not better explained by a communication disorder, and that it does not occur only during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder

Question 21

diagnostic criteria for panic disorder

Answer 21

Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four (or more) of the following symptoms occur:

Note: The abrupt surge can occur from a calm state or an anxious state.

(1)
Palpitations, pounding heart, or accelerated heart rate.

(2)
Sweating.

(3)
Trembling or shaking.

(4)
Sensations or shortness of breath or smothering.

(5)
Feelings of choking.

(6)
Chest pain or discomfort.

(7)
Nausea or abdominal distress.

(8)
Feeling dizzy, unsteady, light-headed, or faint.

(9)
Chills or heat sensations.

(10)
Paresthesias (numbness or tingling sensations).

(11)
Derealization (feelings of unreality) or depersonalization (being detached from oneself).

(12)
Fear of losing control or “going crazy.”

(13)
Fear of dying.

Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

(B)
At least one of the attacks has been followed by 1 month (or more) of one or both of the following:

(1)
Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).

(2)
Significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).

(C)
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).

(D)
The disturbance is not better accounted for by another mental disorder

Question 22

panic attack

Answer 22

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time is accompanied by four (or more) physical and cognitive symptoms (e.g., palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, chills, numbness, fear of losing control, fear of dying).

Question 23

diagnostic criteria for agoraphobia

Answer 23

(A)
Marked fear or anxiety about two (or more) of the following five situations:

(1)
Using public transportation (e.g., automobiles, buses, trains, ships, planes).

(2)
Being in open spaces (e.g., parking lots, marketplaces, bridges).

(3)
Being in enclosed spaces (e.g., shops, theatres, cinemas).

(4)
Standing in line or being in a crowd.

(5)
Being outside of the home alone.

(B)
The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence).

(C)
The agoraphobic situations almost always provoke fear or anxiety.

(D)
The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

(E)
The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.

(F)
The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

(G)
The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

(H)
If another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly excessive.

(I)
The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder.

Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.

Question 24

diagnostic criteria for generalized anxiety disorder

Answer 24

(A)
Excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

(B)
The individual finds it difficult to control the worry.

(C)
The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).

Note: Only one item is required for children.

(1)
Restlessness or feeling keyed up or on edge.

(2)
Being easily fatigued.

(3)
Difficulty concentrating or mind going blank.

(4)
Irritability.

(5)
Muscle tension.

(6)
Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).

(D)
The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

(E)
The disturbance is not due to the general physiological effects of a substance (e.g., a drug of abuse, a medication) or a another medical condition (e.g., hyperthyroidism).

(F)
The disturbance is not better explained by another mental disorder.

Question 25

body dysmorphic disorder

Answer 25

is characterized by a preoccupation with defects or flaws in physical appearance that are not observable or appear slight to others. During the course of the disorder, the individual engages in repetitive behaviors (e.g., mirror checking, excessive grooming, seeking reassurance) or mental acts (comparing her or his appearance to others) in response to appearance concerns. This preoccupation causes significant distress or impairment in important areas of life functioning (e.g., social, occupational).

Question 26

hoarding disorder

Answer 26

is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. The difficulty discarding possessions results in an accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. The hoarding causes significant distress or impairment in important areas of life functioning (e.g., social, occupational, maintaining a safe environment).

Question 27

trichotillamania

Answer 27

is characterized by recurrent pulling out of one’s hair, resulting in hair loss (not attributable to another medical condition), repeated attempts to decrease or stop hair pulling, and significant distress or impairment in important areas of life functioning.

Question 28

excoriation disorder

Answer 28

is characterized by recurrent skin picking resulting in skin lesions, repeated attempts to stop skin picking, and significant distress or impairment in important areas of life functioning.

Question 29

obsessive compulsion disorder

Answer 29

A disorder in which the individual experiences recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted and that in most individuals cause marked anxiety or distress; the individual attempts to ignore or suppress such thoughts, urges, or images or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Question 30

obsessions

Answer 30

Persistent, intrusive, and irrational thoughts, ideas, impulses, or images that focus on improbable or unrealistic events or on real-life events that are greatly exaggerated.

Question 31

compulsions

Answer 31

Repetitive, purposeful, and intentional behaviors or mental acts that are performed in response to an obsession.

Question 32

diagnostic criteria for OCD

Answer 32

(A)
Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

(1)
Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

(2)
The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

(1)
Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

(2)
The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

(B)
The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

(C)
The obsessive–compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

(D)
The disturbance is not better explained by the symptoms of another mental disorder.

Specify if:

With good or fair insight: The individual recognizes that obsessive–compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight: The individual thinks obsessive–compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely convinced that obsessive–compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.

Question 33

negative affectivity

Answer 33

A persistent negative mood evidenced by nervousness, sadness, anger, and guilt.

Question 34

positive affectivity

Answer 34

A persistent positive mood as reflected in states such as joy, enthusiasm, and energy.

Question 35

behaviour lens principle

Answer 35

A principle that states that child psychopathology reflects a mixture of actual child behavior and the lens through which it is viewed by others in a child’s culture.

Question 36

two factor theory

Answer 36

Theory used to explain the learning and maintenance of fears through a combination of classical and operant conditioning.

Question 37

exposure

Answer 37

A behavioral therapy technique for treating anxiety disorders that exposes the subject to the source of his or her fear while providing appropriate and effective ways of coping with the fear (other than through escape and avoidance).

Question 38

graded exposure

Answer 38

Gradual exposure of a subject to a feared situation.

Question 39

systematic desensitization

Answer 39

A three-step behavior therapy technique for treating anxiety whereby: (1) the child is taught to relax, (2) an anxiety hierarchy is constructed, and (3) the anxiety-provoking stimuli are presented sequentially while the child remains relaxed.

Question 40

flooding

Answer 40

A procedure for treating anxiety that involves prolonged and repeated exposure to the anxiety-provoking situation until the subject’s level of anxiety has diminished.

Question 41

response prevention

Answer 41

A procedure used in the treatment of anxiety that prevents the child from engaging in escape or avoidance behaviors. This procedure is usually used in conjunction with flooding.