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5. Anxiety Disorders > DSM Anxiety Part 1 (General, Separation, Selective Mutism, Specific Phobia, Social Anxiety) > Flashcards

DSM Anxiety Part 1 (General, Separation, Selective Mutism, Specific Phobia, Social Anxiety) Flashcards

1
Q

what is “fear”

A

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

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2
Q

what is “anxiety”

A

the ANTICIPATION of FUTURE threat

more often associated with muscle tension, vigilance in preparation for future danger and cautious or avoidant behaviours

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3
Q

what are panic attacks generally? are they limited to anxiety disorders?

A

a particular type of fear response

NOT limited to anxiety disorders

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4
Q

in what ways do the anxiety disorders differ from one another

A

the types of objects or situations that induce fear, anxiety or avoidance behaviour

the associated cognitive ideation

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5
Q

how do the anxiety disorders differ from developmentally normative fear or anxiety?

how do the differ from transient fear or anxiety?

A

by being EXCESSIVE or PERSISTING beyond developmentally appropriate periods

are PERSISTENT (6 mo or more)–> though duration criterion is intended as GENERAL GUIDE

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6
Q

when do many anxiety disorders develop

A

in childhood

tend to persist if not treated

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7
Q

is there a gender bias in anxiety disorders

A

yes–> more women than men (2:1)

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8
Q

is there a specific cognitive ideation associated with specific phobias

A

no, unlike in other anxiety disorders

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9
Q

define panic attack

A

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

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10
Q

criterion A for separation anxiety disorder

A

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:

  1. recurrent excessive DISTRESS when anticipating or experiencing separation from home or from major attachment figures
  2. persistent and excessive worry about LOSING major attachment figures or about possible harm to them such as illness, injury, disasters, death
  3. persistent and excessive worry about experiencing an UNTOWARD EVENT (getting lost, kidnapped, having accident, becoming ill) that CAUSES separation from 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. reluctance/refusal to sleep away from home or go to sleep without being near a major attachment figure
  7. repeated NIGHTMARES involving theme of separation
  8. complaints of PHYSICAL SYMPTOMS when separated from major attachment figures or when separation anticipated
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11
Q

how many symptoms are required to meet criterion A of separation anxiety disorder

A

3

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12
Q

what is the time criteria for separation anxiety disorder (criterion B)

A

at least 4 weeks in kids and teens, or 6+ months in adults

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13
Q

criterion C for separation anxiety disorder

A

causes clinically significant distress/impairment

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14
Q

criterion D separation anxiety disorder

A

not better explained by other mental disorder (i.e due to autism)

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15
Q

what is the essential feature of separation anxiety disorder

A

excessive fear or anxiety concerning separation from home or attachment figures (above developmental level)

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16
Q

how might separation anxiety disorder affect bedtime

A

often have difficulty as bedtime–> may insist someone stay with them until fall asleep

may make way to parents bed in the night

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17
Q

how might children with separation anxiety disorder present when not with a major attachment figure

A

may exhibit:
social withdrawal

apathy

sadness

difficulty concentrating on work or play

may lead to school refusal

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18
Q

what are some themes of “worry thoughts” that can be present for kids with separation anxiety disorder

A

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

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19
Q

how might kids with separation anxiety disorder present when anticipating a separation

A

may become extremely upset, showing anger or occasionally aggression towards someone who is forcing separation

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20
Q

how might separation anxiety disorder affect perceptual experiences

A

when alone, especially in evenings or in the dark, young children may report unusual perceptual experiences (i.e seeing people peering into their room)

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21
Q

how might kids with separation anxiety disorder be described

A

can be “described as demanding, intrusive and in need of constant attention”

as adults–> may appear “dependent and overprotective”

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22
Q

what is the 12 month prevalence of separation anxiety disorder among US adults

A

0.9-1.9%

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23
Q

what is the 12 month prevalence of separation anxiety disorder among kids aged 6-12

A

about 4%

(in teens it is about 1.6%)

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24
Q

compared to other anxiety disorders, how prevalent is separation anxiety disorder in kids under 12

A

it is the most prevalence anxiety disorder in kids under 12

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25
Q

is there a gender bias in separation anxiety disorder?

A

in clinical samples, equal female: male

in community, more females

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26
Q

how might separation anxiety manifest in adults

A

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

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27
Q

name some environmental risk factors for separation anxiety

A

often develops after life stress, especially a LOSS

parental overprotection and intrusiveness may contribute

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28
Q

what is the estimate heritability of separation anxiety disorder

A

estimated at 73% in community sample of 6 year old twins

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29
Q

does the presence of an anxiety disorder increase risk of suicide

A

yes (but not specific to separation anxiety disorder)

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30
Q

ddx separation anxiety disorder

A

GAD

Panic disorder

agoraphobia

conduct disorder

social anxiety disorder

PTSD

illness anxiety disorder

bereavement

depressive and bipolar disorders

ODD

psychotic disorders

personality disorders

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31
Q

how does separation anxiety disorder differ from agorapgobia

A

in separation anxiety disorder there isnt that same fear of being trapped/incapacitated and unable to escape if panic sx arise

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32
Q

how do separation anxiety disorder and dependent PD differ?

A

dependent PD= “indiscriminate tendency” to rely on others rather than specific to attachment figures

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33
Q

what is commonly comorbid with separation anxiety disorder in kids

A

GAD and specific phobia

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34
Q

what is commonly comorbid with separation anxiety disorder in adults

A

specific phobia, PTSD, GAD, social anxiety disorder and panic disorder. agoraphobia. OCD. personality disorders

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35
Q

criterion A for selective mutism

A

consistent failure to speak in specific social situations in which there is an expectation for speaking ie school despite speaking in OTHER situations

36
Q

criterion B for selective mutism

A

disturbance interferes with educational or other occupational achievement or with social communication

37
Q

criterion C for selective mutism

A

duration of the disturbance is at least one month (not limited to first month of school)

38
Q

criterion D for selective mutism

A

failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation

39
Q

criterion E for selective mutism

A

disturbance not better explained by communication disorder and does not occur exclusively during course of autism spectrum disorder, schizophrenia or another psychotic disorder

40
Q

selective mutism is often marked by what kind of anxiety

A

high social anxiety

41
Q

do kids with selective mutism refuse all social interaction?

A

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)

42
Q

what other features of selective mutism might be present

A

may have excessive shyness

fear of social embarrassment

social isolation and withdrawal

clinging

compulsive traits

negativism

temper tantrums

mild oppositional behaviour

43
Q

do children with selective mutism have normal language skills

A

usually, but can also have associated communication disorder (no particular assoc. with a specific communication disorder)

44
Q

what the most common comorbidity with selective mutism

A

social anxiety disorder

45
Q

is selective mutism common

A

relatively rare

point prevalnce 0.03-1% depending on setting and ages of kids in the sample

46
Q

does the prevalence of selective mutism vary by sex or ethnicity?

A

no

47
Q

onset of selective mutism is usually before what age

A

5 years

*but may not come to clinical attention until entry into school

48
Q

what is the usual course of selective mutism

A

persistence of the disorder is usually variable

longitudinal course is unknown though may “outgrow”

49
Q

list some temperamental risk factors for selective mutism

A

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

50
Q

what are some environmental risk factors for selective mutism

A

social inhibition in parents may be a model for social reticence/mutism

overprotective parents

51
Q

ddx selective mutism

A

communication disorders

neurodevelopmental disorders

schizophrenia or other psychotic disorders

social anxiety disorder

52
Q

what are the criteria for specific phobia

A

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

53
Q

do most people with specific phobia only have one phobic stimulus

A

no–average person with specific phobia fears 3+ objects/situations

75% fear more than one

*each needs its own diagnosis and code

54
Q

what is the prevalence of specific phobia

A

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

55
Q

what is the gender bias in specific phobia

A

female:male 2:1

56
Q

when does specific phobia usually develop

A

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

57
Q

what is the typical course of specific phobia

A

if develop in childhood, tends to wax and wane during that time

if persists into adulthood, unlikely to remit for majority pf people

58
Q

which phobias may be more likely to be endorsed in older adults

A

natural environment or phobia of falling

59
Q

is there genetic susceptibility to specific phobia

A

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

60
Q

in the USA which populations have lower rates of specific phobia

A

asians and latinos

61
Q

are people with specific phobia more likely to make a suicide attempt

A

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”)

62
Q

how does impairment related to specific phobia compare to that experienced by those with other anxiety disorders, AUDs, and SUDs

A

similar patterns of impairment in psychosocial functioning and decreased QoL

distress + impairment tend to increase with the number of feared object/situations

63
Q

ddx specific phobia

A

agoraphobia

social anxiety disorder

separation anxiety disorder

panic disorder

OCD

trauma and stressor related disorders

eating disorders

schizophrenia spectrum and other psychotic disorders

64
Q

how do you distinguish between arogaphpobia and situational specific phobia

A

feared situations often overlap

if only one agoraphobic situation is feared, then can dx specific phobia–if more than one then dx agoraphobia

65
Q

those with specific phobia are particularly at risk for development of what personality d/o

A

dependent

66
Q

criterion A for social anxiety disorder

A

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

67
Q

criterion B for social anxiety disorder

A

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)

68
Q

criterion C social anxiety disorder

A

social situations almost always provoke fear or anxiety

69
Q

criterion D for social anxiety disorder

A

social situations are avoided or endured with intense fear or anxiety

70
Q

criterion E for social anxiety disorder

A

fear or anxiety is out of proportion to the threat posed by the social situation and to the sociocultural context

71
Q

criterion F for social anxiety disorder

A

persistent–> lasts 6 mo or more

72
Q

*there are a bunch of other criteria for social anxiety disorder but is the usual ones like not due to another medical/mental condition

A
73
Q

name a specifier for social anxiety disorder

A

“performance only”

74
Q

what is the 12 month prevalence estimate of social anxiety disorder in the USA

A

7%

–lower in europe (0.5-2%)

rates are similar in kids/teens as in adults

75
Q

how does prevalence of social anxiety disorder change with age

A

goes down

76
Q

how does gender affect rates of social anxiety disorder

A

generally higher in females than males (not massive difference)
–gender difference bigger in kids/teens

77
Q

what is the median age at onset for social anxiety disorder in the USA

A

13 years old

75% of people have onset between ages 8-15

first onset in adulthood = relatively rare

78
Q

is social anxiety disorder heritable

A

yes

first degree relatives have 2-6x higher chance of having social anxiety disorder

79
Q

what is “taijin kyofusho”

A

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

80
Q

what disorders are more commonly comorbid in FEMALES with social anxiety disorder

A

greater number of social fears

greater number of comorbid depressive, bipolar and anxiety disorders

81
Q

what disorders are more commonly comorbid in MALES with social anxiety disorder

A

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

82
Q

is paruresis more common in males or females with social anxiety disorder

A

males

83
Q

what is paruresis

A

“shy bladder syndrome”

(doesnt pee in public restrooms etc)

84
Q

name a strong predictor for the persistence of social anxiety disorder

A

not being employed

85
Q

ddx social anxiety disorder

A

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

86
Q

what other disorders are most commonly comorbid in social anxiety disorder

A

other anxiety disorders

MDD

SUDs

bipolar disorder

body dysmorphic disorder

avoidant PD

in kids: often comorbid with selective mutism and high functioning autism

5. Anxiety Disorders (4 decks)

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