Internalising Disorders

Question 1

Internalising disorders include

Answer 1

anxiety and depressive disorders

Question 2

List the three reasons why it is difficult to differentiate anxiety disorders in children

Answer 2

1. valid assessment is often not possible in children
2. lots of overlap in symptoms of the disorders generally
3. disorders not quite differentiated in children

Question 3

Which disorders can be easily differentiated in children?

Answer 3

OCD and PTSD

Question 4

List all anxiety disorders according to the DSM in order of appearance

Answer 4

separation anxiety disorder
selective mutism
specific phobia
social anxiety disorder
panic >20 years
agoraphobia
GAD

Question 5

Criterion A: Separation Anxiety Disorder (part a): Developmentally inappropriate and ________ ____ or _______ concerning ________ from those whom the individual is _______

Answer 5

excessive fear
anxiety
separation
attached

Question 6

Criterion A: Separation Anxiety Disorder … at least 3 of the following …(part b)

Answer 6

1. fear of being alone
2. recurrent, excessive distress when anticipating separation
3. persistent refusal to go out, go to school, etc
4. persistent worry about losing attachment figure, or possible harm to them
5. persistent worry about experiencing an untoward event that causes separation (e.g: kidnapping, getting lost)
6. refusal to sleep without attachment figure
7. nightmares involving theme of separation
8. physical symptoms - headaches, stomachaches, nausea, when separated or anticipating separation

Question 7

Criterion B: Separation Anxiety Disorder

Answer 7

The fear, anxiety or avoidance is persistent, lasting 4 weeks in children

Question 8

Separation AD is strongly associated with school ______, and the child ultimately cares about the ____, and what will happen if something happens to the ________.

Answer 8

refusal, self, caregiver

Question 9

Separation anxiety is normal around the ages of

Answer 9

6 months - 5 years. If it continues into school age it starts interfering with milestones. Also, it’s normal for us to go to school, etc. Some cultures do not.

Question 10

Aetiology of Separation Anxiety Disorder involves three factors, which are

Answer 10

1. Trauma - divorce, or sickness in caregiver. Insecure environment
2. Genetic Component - pre-disposition, temperament inherited (shy, anxious temperament, not open to exploring, dislikes novelty)
3. Parenting - parents could be already anxious, model anxious behavior (verbal information about worries “be careful), and generally display overprotective parenting. Or the parents could just be overprotective. Or the child’s temperament may entice anxiety.

Question 11

Selective mutism is characteristic of

Answer 11

Child is incapable of talking. Not considered a choice. It’s a failure to speak when there is an expectation to (eg school).

Question 12

Marianna’s “Worrying in Youth” study showed

Answer 12

That children 7-9 yrs and 10-12 years, worry more about physical outcomes. They know physical outcomes carry a much higher cost than social outcomes. However, they know social outcomes are more likely to occur. Hence, their worries are based on cost judgements rather than likelihood.

Young adults also know that physical outcomes are a higher cost than social outcomes and that social outcomes are more likely than physical ones. Their worry is based on both cost and likelihood outcomes.

Question 13

It is believed children start worrying around the age of…

Answer 13

6-7 years

Question 14

In order for a child to worry they need to be able to imagine _____ of ______ outcomes. And switch from ______ to ______ worry. This theory is the ________ ________ ________ (Borkovec).

Answer 14

chains of catastrophic outcomes
imagery to verbal
Cognitive Avoidance Theory

Question 15

There is ____ evidence for SSRIs in the treatment of childhood anxiety, except for ____

Answer 15

no, OCD

Question 16

There is good evidence for the use of __________ treatment in childhood anxiety disorders, especially ________ therapy

Answer 16

psychological, family

Question 17

Children don’t want to be exposed to what they fear, so we often use ______.

Answer 17

bribes

Question 18

In treatment of anxiety disorders, ______ _______ is used increasingly in younger children.

Answer 18

behavioural therapy

Question 19

It is also important that we teach parents to not _______ anxious behaviour, or act in an ___________ manner

Answer 19

model, overprotective

Question 20

The strong increase in prevalence of MDD in adolescence is said to be attributed to the consolidation of ________ _________ (aka ________) and an increase in _______ ________ ________. This is known as the ______ ________ _______.

Answer 20

thinking styles, schemas (personality is more settled)
negative life events (new stressors - independence, romantic relationships, etc)
cognitive diathesis model

Question 21

Why is there such a large gender difference which emerges in adolescence and stays till ~50 yrs?

1. Small differences a result of…
2. Larger differences a result of…

Answer 21

Smaller differences attributed to

• reporting differences
• self-medication in males more common
• hormonal differences.

Larger differences due to

• higher stress exposure in females
• higher negative cognitive styles
• different coping functions.

Question 22

What are some stressors experienced by females in adolescence?

Answer 22

• rape and sexual assault,
• body image concerns - physical attractiveness strongly valued by women, and their self-worth related to that. Also, men can get bigger, but women can’t get thinner. They cannot achieve the societal ideal
• interpersonal negative events (more weighting placed on peer group, women take on each others problems, and can be nasty to each other - social aggression)

Question 23

What coping factors are more common in women? How does this affect depression?

Answer 23

Rumination very common (as opposed to distraction which is used in men). Rumination interferes with problem-solving.

Question 24

In children with MDD, _____ _____ ______ usually precede _______ _______ _________.

Answer 24

negative life events

negative cognitive schemas

Question 25

Name four ways parenting is affected if the parent has MDD and how this increases risk for the child

Answer 25

1. Genetic loading
2. Attachment theory - lack of security contingency that if the child cries the parent will respond. Child doesn’t learn world is a safe place and that they are lovable. Hence, a more negative schema develops
3. Parents model depressive behaviour - helplessness, not coping, poor problem-solving
4. Increased hostility from parents - overly negative and critical generally; rejective.

Question 26

For childhood MDD, there is little evidence that SSRIs are ______ and ________.

Answer 26

safe and effective

Question 27

________ should be the first line of treatment in childhood MDD

Answer 27

Psychotherapy

Question 28

How can we prevent MDD in children?

Answer 28

1. Universal - whole school approach - low effectiveness as not targeted to “at-risk” kids
2. Indicated Prevention - elevated scores - targeted to “at-risk” children
3. Selective Prevention - scores not elevated but have trauma or are children of depressed parents

Question 29

What does the DSM say about how MDD can be deferentially expressed in children?

Answer 29

Depressed mood can be expressed as irritability

Weight loss/gain in children is more about a failure to make an expected weight gain for their development

Question 30

Disruptive Mood Dysregulation disorder is in the same chapter as which other disorders? What is it characterised by?

Answer 30

Same chapter as MDD and PDD

Characterised by severe, recurrent temper outbursts that are out of proportion to the provocation. The child’s mood between outbursts is also quite irritable and angry.