DSM Anxiety Part 1 (General, Separation, Selective Mutism, Specific Phobia, Social Anxiety) Flashcards
what is “fear”
the EMOTIONAL response to real or perceived imminent threat
more often associated with surges of autonomic arousal necessary for FIGHT or FLIGHT, thoughts of immediate danger, and escape behaviours
what is “anxiety”
the ANTICIPATION of FUTURE threat
more often associated with muscle tension, vigilance in preparation for future danger and cautious or avoidant behaviours
what are panic attacks generally? are they limited to anxiety disorders?
a particular type of fear response
NOT limited to anxiety disorders
in what ways do the anxiety disorders differ from one another
the types of objects or situations that induce fear, anxiety or avoidance behaviour
the associated cognitive ideation
how do the anxiety disorders differ from developmentally normative fear or anxiety?
how do the differ from transient fear or anxiety?
by being EXCESSIVE or PERSISTING beyond developmentally appropriate periods
are PERSISTENT (6 mo or more)–> though duration criterion is intended as GENERAL GUIDE
when do many anxiety disorders develop
in childhood
tend to persist if not treated
is there a gender bias in anxiety disorders
yes–> more women than men (2:1)
is there a specific cognitive ideation associated with specific phobias
no, unlike in other anxiety disorders
define panic attack
abrupt surges of intense fear or intense discomfort that reach a peak within minutes, accompanied by physical and/or cognitive symptoms
may be expected or unexpected
*function as a marker and PROGNOSTIC factor for severity of diagnosis, course and comorbidity across an array of disorders
criterion A for separation anxiety disorder
developmentally INAPPROPRIATE and excessive fear or anxiety concerning the separation from those to whom the individual is attached as evidenced by at least THREE of the following:
- recurrent excessive DISTRESS when anticipating or experiencing separation from home or from major attachment figures
- persistent and excessive worry about LOSING major attachment figures or about possible harm to them such as illness, injury, disasters, death
- persistent and excessive worry about experiencing an UNTOWARD EVENT (getting lost, kidnapped, having accident, becoming ill) that CAUSES separation from major attachment figure
- persistent RELUCTANCE OR REFUSAL to go out, away from home, to school, to work or elsewhere because of fear of separation
- persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
- reluctance/refusal to sleep away from home or go to sleep without being near a major attachment figure
- repeated NIGHTMARES involving theme of separation
- complaints of PHYSICAL SYMPTOMS when separated from major attachment figures or when separation anticipated
how many symptoms are required to meet criterion A of separation anxiety disorder
3
what is the time criteria for separation anxiety disorder (criterion B)
at least 4 weeks in kids and teens, or 6+ months in adults
criterion C for separation anxiety disorder
causes clinically significant distress/impairment
criterion D separation anxiety disorder
not better explained by other mental disorder (i.e due to autism)
what is the essential feature of separation anxiety disorder
excessive fear or anxiety concerning separation from home or attachment figures (above developmental level)
how might separation anxiety disorder affect bedtime
often have difficulty as bedtime–> may insist someone stay with them until fall asleep
may make way to parents bed in the night
how might children with separation anxiety disorder present when not with a major attachment figure
may exhibit:
social withdrawal
apathy
sadness
difficulty concentrating on work or play
may lead to school refusal
what are some themes of “worry thoughts” that can be present for kids with separation anxiety disorder
may have fear of animals, monsters, the dark, muggers, burglars, kidnappers, car accidents, pane travel and other situations perceived as danger to family or themselves
how might kids with separation anxiety disorder present when anticipating a separation
may become extremely upset, showing anger or occasionally aggression towards someone who is forcing separation
how might separation anxiety disorder affect perceptual experiences
when alone, especially in evenings or in the dark, young children may report unusual perceptual experiences (i.e seeing people peering into their room)
how might kids with separation anxiety disorder be described
can be “described as demanding, intrusive and in need of constant attention”
as adults–> may appear “dependent and overprotective”
what is the 12 month prevalence of separation anxiety disorder among US adults
0.9-1.9%
what is the 12 month prevalence of separation anxiety disorder among kids aged 6-12
about 4%
(in teens it is about 1.6%)
compared to other anxiety disorders, how prevalent is separation anxiety disorder in kids under 12
it is the most prevalence anxiety disorder in kids under 12
is there a gender bias in separation anxiety disorder?
in clinical samples, equal female: male
in community, more females
how might separation anxiety manifest in adults
may limit ability to cope with changes in circumstances (i.e moving, getting married)
typically overconcerned about their offspring and spouses and experience marked discomfort when separated from them
name some environmental risk factors for separation anxiety
often develops after life stress, especially a LOSS
parental overprotection and intrusiveness may contribute
what is the estimate heritability of separation anxiety disorder
estimated at 73% in community sample of 6 year old twins
does the presence of an anxiety disorder increase risk of suicide
yes (but not specific to separation anxiety disorder)
ddx separation anxiety disorder
GAD
Panic disorder
agoraphobia
conduct disorder
social anxiety disorder
PTSD
illness anxiety disorder
bereavement
depressive and bipolar disorders
ODD
psychotic disorders
personality disorders
how does separation anxiety disorder differ from agorapgobia
in separation anxiety disorder there isnt that same fear of being trapped/incapacitated and unable to escape if panic sx arise
how do separation anxiety disorder and dependent PD differ?
dependent PD= “indiscriminate tendency” to rely on others rather than specific to attachment figures
what is commonly comorbid with separation anxiety disorder in kids
GAD and specific phobia
what is commonly comorbid with separation anxiety disorder in adults
specific phobia, PTSD, GAD, social anxiety disorder and panic disorder. agoraphobia. OCD. personality disorders
criterion A for selective mutism
consistent failure to speak in specific social situations in which there is an expectation for speaking ie school despite speaking in OTHER situations
criterion B for selective mutism
disturbance interferes with educational or other occupational achievement or with social communication
criterion C for selective mutism
duration of the disturbance is at least one month (not limited to first month of school)
criterion D for selective mutism
failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation
criterion E for selective mutism
disturbance not better explained by communication disorder and does not occur exclusively during course of autism spectrum disorder, schizophrenia or another psychotic disorder
selective mutism is often marked by what kind of anxiety
high social anxiety
do kids with selective mutism refuse all social interaction?
no–> sometimes use nonspoken/nonverbal means of communicating (grunting, pointing, writing) and may be willing or eager to perform or engage in social encounters when speech is not requried (i.e non verbal parts in school plays)
what other features of selective mutism might be present
may have excessive shyness
fear of social embarrassment
social isolation and withdrawal
clinging
compulsive traits
negativism
temper tantrums
mild oppositional behaviour
do children with selective mutism have normal language skills
usually, but can also have associated communication disorder (no particular assoc. with a specific communication disorder)
what the most common comorbidity with selective mutism
social anxiety disorder
is selective mutism common
relatively rare
point prevalnce 0.03-1% depending on setting and ages of kids in the sample
does the prevalence of selective mutism vary by sex or ethnicity?
no
onset of selective mutism is usually before what age
5 years
*but may not come to clinical attention until entry into school
what is the usual course of selective mutism
persistence of the disorder is usually variable
longitudinal course is unknown though may “outgrow”
list some temperamental risk factors for selective mutism
not well identified
neuroticism/negative affectivity may play a role
behavioural inhibition
parental hx shyness/social isolation / social anxiety
may have SUBTLE RECEPTIVE LANGUAGE DIFFICULTIES compared to peers although receptive language still within NORMAL range
what are some environmental risk factors for selective mutism
social inhibition in parents may be a model for social reticence/mutism
overprotective parents
ddx selective mutism
communication disorders
neurodevelopmental disorders
schizophrenia or other psychotic disorders
social anxiety disorder
what are the criteria for specific phobia
A–marked fear or anxiety about a SPECIFIC object or situation
B–phobic object or situation almost ALWAYS provokes immediate fear or anxiety
C–phobic object or situation is actively AVOIDED or ENDURED with intense fear or anxiety
D–fear or anxiety is OUT OF PROPORTION to the actual danger posed by the specific thing and to sociocultural context
E–fear, anxiety and avoidance is PERSISTENT, typically 6+ months or more
F–fear, anxiety avoidance causes clinically sig. distress or impairment
G–not better explained by another mental disorder
do most people with specific phobia only have one phobic stimulus
no–average person with specific phobia fears 3+ objects/situations
75% fear more than one
*each needs its own diagnosis and code
what is the prevalence of specific phobia
7-9% in USA
–5% in kids
–16% in 13-17 year olds
–lower in older individuals
similar in europe
rates lower in asian, african, latin american countries
what is the gender bias in specific phobia
female:male 2:1
when does specific phobia usually develop
early childhood
majority develop before age 10 (median btw 7-11)
*situation specific phobias tend to have later onset than natural environment, animal, or blood-injection-injury phobias
what is the typical course of specific phobia
if develop in childhood, tends to wax and wane during that time
if persists into adulthood, unlikely to remit for majority pf people
which phobias may be more likely to be endorsed in older adults
natural environment or phobia of falling
is there genetic susceptibility to specific phobia
may be when it comes to certain categories of phobia
ie someone w first degree relative with specific phobia of animals sig. more likely to have same specific phobia than any other category of phobia
in the USA which populations have lower rates of specific phobia
asians and latinos
are people with specific phobia more likely to make a suicide attempt
yes–up to 60% more likely than those without a diagnosis (**but this is “likely due to comorbidity with personality disorders and other anxiety disorders”)
how does impairment related to specific phobia compare to that experienced by those with other anxiety disorders, AUDs, and SUDs
similar patterns of impairment in psychosocial functioning and decreased QoL
distress + impairment tend to increase with the number of feared object/situations
ddx specific phobia
agoraphobia
social anxiety disorder
separation anxiety disorder
panic disorder
OCD
trauma and stressor related disorders
eating disorders
schizophrenia spectrum and other psychotic disorders
how do you distinguish between arogaphpobia and situational specific phobia
feared situations often overlap
if only one agoraphobic situation is feared, then can dx specific phobia–if more than one then dx agoraphobia
those with specific phobia are particularly at risk for development of what personality d/o
dependent
criterion A for social anxiety disorder
marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others (i.e social interactions, performing, being observed)
*in kids, anxiety must occur in PEER settings and not just in interactions with adults
criterion B for social anxiety disorder
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)
criterion C social anxiety disorder
social situations almost always provoke fear or anxiety
criterion D for social anxiety disorder
social situations are avoided or endured with intense fear or anxiety
criterion E for social anxiety disorder
fear or anxiety is out of proportion to the threat posed by the social situation and to the sociocultural context
criterion F for social anxiety disorder
persistent–> lasts 6 mo or more
*there are a bunch of other criteria for social anxiety disorder but is the usual ones like not due to another medical/mental condition
name a specifier for social anxiety disorder
“performance only”
what is the 12 month prevalence estimate of social anxiety disorder in the USA
7%
–lower in europe (0.5-2%)
rates are similar in kids/teens as in adults
how does prevalence of social anxiety disorder change with age
goes down
how does gender affect rates of social anxiety disorder
generally higher in females than males (not massive difference)
–gender difference bigger in kids/teens
what is the median age at onset for social anxiety disorder in the USA
13 years old
75% of people have onset between ages 8-15
first onset in adulthood = relatively rare
is social anxiety disorder heritable
yes
first degree relatives have 2-6x higher chance of having social anxiety disorder
what is “taijin kyofusho”
syndrome often characterized by social evaluative concerns, fulfilling criteira for social anxiety disorder that are associated with the fear that the individual makes OTHER people uncomfortable –> can be experienced with delusional intensity
i.e in Japan, Korea, but also in non-asian settings
other presentations of tajin kyofusho may meet criteria for BDD or delusional disorder
what disorders are more commonly comorbid in FEMALES with social anxiety disorder
greater number of social fears
greater number of comorbid depressive, bipolar and anxiety disorders
what disorders are more commonly comorbid in MALES with social anxiety disorder
more likely to fear dating
more likely to have ODD or conduct disorder and use alcohol and illicit drugs to relieve symptoms of the disorder
is paruresis more common in males or females with social anxiety disorder
males
what is paruresis
“shy bladder syndrome”
(doesnt pee in public restrooms etc)
name a strong predictor for the persistence of social anxiety disorder
not being employed
ddx social anxiety disorder
normative shyness
agoraphobia
panic disorder
GAD
separation anxiety disorder
specific phobias
selective mutism
BDD
delusional d/o
ASD
personality d/os
ODD
other mental or medical disorders
what other disorders are most commonly comorbid in social anxiety disorder
other anxiety disorders
MDD
SUDs
bipolar disorder
body dysmorphic disorder
avoidant PD
in kids: often comorbid with selective mutism and high functioning autism
