Internalising disorders Flashcards
developmental psychopathology
The study of the onset and maintenance of psychological disorder across the lifespan
It takes into account: o Changes in symptomatology o Deviations from normal development o Early precursors of mental health problems o The influence of multiple pathways
Children may outgrow the disorder
Classification system important to test effectiveness of treatments and when collecting information about the prevalence of the disorder
Classification systems important for differential diagnosis
internalising disorders
“Inward-looking and withdrawn behaviours, which in children may represent the experience of depression, anxiety and active attempts to socially withdraw” (Davey, 2008)
Common factor in anxiety and depression – e.g. negative affect (feel sad, worried etc.)
There are also differences between disorders
The focus is inward
depression and anxiety over the life course
see notes
Problems can be quite stable
changes in anxiety disorder presentation across the lifespan
Some only prevalent at certain ages (e.g. fear of falling)
How can we differentiate fear v anxiety?
Walk away – adaptive response – fear
Anxiety – maladaptive – causes significant impairment in the indv
see notes
perceived family impact of preschool anxiety disorders
see notes
Some disorders can cause a lot of problems
Separation anxiety
Obsessive Compulsive Disorder (OCD)
Specific phobias
(Problems with specific situation or object)
DSM-IV diagnostic criteria for Generalised Anxiety Disorder (GAD)
- Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events/activities (such as work or school perf)
- Indv finds it difficult to control worry
- Anx and worry associated with 3 (/+) of following symptoms (with at least some symptoms having been present for more days than not for past 6 months) – only 1 item required in children:
• Restlessness/feeling keyed up/on edge
• Easily fatigued
• Difficulty concentrating/mind going blank
• Irritability
• Muscle tension
• Sleep disturbance (difficulty falling/staying asleep/restless, unsatisfying sleep) - Anx, worry/physical symptoms cause clinically sig distress/impairment in social, occupational/other imp areas of functioning
- Disturbance not attributable to phys effects
vulnerability risk factors for anxiety
(personal attributes that can lead to maladjustment under stress/adversity)
Genetics
Behav inhibition
Info processing
env risk factors for anx
Life events
Info transfer
Modelling
Parenting
genetic factors
“Genetic factors play an imp role in most, if not all, psychiatric disorders
Few common single gene psychiatric disorders exist, and genetic influence is more commonly the result of a no. of genes, each having small effects
Genetic contribution to psychiatric disorder variable, being higher in bipolar disorder and autism, and lower in anx disorders”
Genetic factors only explain 1/3 of variance in anx problems
Higher in MZ twins as they share more DNA
behavioural inhibition
Refers to temperamental pattern of responding characterised by fearfulness, reticence or restrain when faced with unfam people/situs
Strong association between BI and anx disorder in children – not all BI children develop anx disorders suggesting other factors also at play – only 50%
interactions between child’s and parent characteristics in predicting child’s behaviour
(Aktar, Majdandžić, de Vente and Bögnels, 2013)
N = 122 12-month-old infants
Took part in social referencing paradigm in lab – met stranger and saw mechanical dinosaur
Looked at mothers body posture and behav
Sig interaction between infants with moderate to high levels BI and parents’ anx in predicting infants’ avoidance – effects didn’t differ by parent’s gender
see notes
BI in adolescence
N = 968 adolescents aged 12-18
Completed a questionnaire about BI,
interpretation of ambiguity
27 children with anx disorder and mothers and 33 children from community and mothers – 7-15
Mothers and children completed measure of anx and indicated most likely interp of ambiguous scenarios
Sig pos links between child’s and mother’s anx
After treatment, decrease in threat interp in both mothers and children
Anx interp can be changed with treatment
cognitive biases can maintain/cause anxiety
(Steinman & Teachman, 2010)
N = 75 Ps who scored high on anx allocated to pos training condition (resolved ambiguous scenario pos)/one of 2 control conditions (neutral/no training)
Pos training resulted in more pos and less neg interps and was associated with lower levels of anx
Neg biases changed with treatment
Better when trained to give pos interp in ambiguous scenario
see notes
environment risk factors for anxiety disorder (summary)
Neg life events
Info transfer
Modelling
negative life events
Can lead to development and maintenance of anx in children
May be bi-directional influences – anx can predict subsequent neg life events
Why?
o Anx indvs focus more on negative aspects
o Might have more physical health problems leading to more neg experiences
o Attract neg experiences
o Anx adolescents avoid fears and so experience depression and loneliness – criticised by others
information transfer (Field)
Examined if transfer/threat info influence children’s fears/avoidance
Results indicated that children who received neg info reported greater fear beliefs about fictitious monster
Info received from adult had greater influence
parental modelling of anxiety
Study examined effect of parenting modelling on fear acquisition and avoidance of novel stim
Sample = 30 toddlers and mothers
Toddler presented with rubber snake and spider, paired with maternal pos and neg facial expressions
Results showed toddler more fearful and avoidant when mothers expressed neg facial expressions
Effects greater in girls – mothers may have greater effect on girls
examining the association between parenting and childhood anxiety: a meta-analysis
(McLeod, Wood and Weisz, 2007)
Analyses revealed that parental control was more strongly associated with child anx than parental rejection
The modest association between parenting and child anx suggests that understanding the origins of children’s anx will require identifying factors other than parenting that account for the bulk of the variance
Don’t allow children to develop problem-solving skills – develop some habitual avoidance
Rejected how to deal with situ – prompted child until proposed avoidance strat
treatments
VR (e.g. fear of flying)
o Exposure to stim will help them over time
Mindfulness
o Mindful of behaviours
Cog modification bias
o Optimistic/pessimistic etc.
o Depression – focus on threats – feel unable to deal with stressors
o Try and change maladaptive beliefs
DMS diagnostic criteria for Major Depressive Disorder
Depressed mood/irritable most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad/empty) or observation made by others (e.g. appears tearful)
Decreased interest/pleasure in most activities, most of each day
Sig weight change (5%)/change in appetite
Change in sleep: insomnia/hypersomnia
screen for cognitions that may mimic/coexist with MDD
Substance abuse causing depressed mood
Medical illness causing depressed mood
Other disorders: o Mania o Hypermania o Bipolar o Schizoaffective, Sz, etc.
bereavement
see notes
Delays in developmental accomplishments in infancy predict depression later in life (e.g. sleeping problems, toilet training problems, delays in intellectual growth)
Preschool children have difficulty verbalising issues – instead looked at how they play – play is very sad/neg
Separation anx is risk factor
Don’t take pride in accomplishments is risk factor for later depression
Older children
o Low self-esteem and confidence, self-criticism, destructive behavs
o Mood swings
o Neg
o Experience problems at school – academic achievement, truancy
o Sleep problems
o Changes in weight
probability of experiencing an episode of MDD as a function of age and gender
see notes
Higher depression in females – why?
o More emotional
o More self-reflective
o Negative events – neg events in fam env
o Females more likely to report how they feel – methodological issue
- Changes in hormones – changes in physical characteristics – cause distress
o Differences in daily lives – sexual harassment
o More likely to be sensitive to stress – more emphasis on social r’ships
Depression increases during adolescence
o Bio changes – brain maturation, hormone changes – use of higher order thinking – think in abstract way – make generalisations and make evaluations
o Changes in emotionality – experience intense sadness and over extended periods
o Become more independent
prevalence of depression by gender and age group
see notes
risk factors for childhood depression
Abuse and neglect
Parental marital partner changes
Physical health
Parental mental health
Parenting and caregiving
o Unresponsive parenting
risk factors for depression in adolescence
Cognition (neg cognitions and attribution style)
Dispositional factors (e.g. low self-esteem, self-consciousness)
Stress (stress and neg events)
Social skills (poor social skills, parent-child conflict)
Social support (low social support from fam and friends)
Physical health
Academic dissatisfaction (e.g. grades, school absenteeism)
key brain regions involved in affect and mood disorders
see noteS
ntms
Serotonin is a brain neurotransmitter involved in several processes (e.g. mood, sleep appetite) – low levels of serotonin associated with depression
Norepinephrine is a hormone that acts as a ntm – responsible for preparing the mind and body for action – ev shows its associated with depression and mania
Beck’s cognitive triad
Depressed indvs tend to have neg thoughts about:
o The self (e.g. I am worthless)
o The world (e.g. the world is not fair)
o The future (e.g. there is no hope)
Cog biases in way depressed people think – think will fail or experience of loss – predispose to feel depressed
a unified model of depression: integrating clinical, cognitive, biological and evolutionary perspectives
see notes
attributions
Depressed indvs are more likely to attribute neg events to factors that are: o Internal (e.g. it’s because of my personality) o Stable (e.g. I will always fail) o Global (e.g. my whole life is a failure)
5-year-old children of depressed mothers were more likely to express depressive cognitions about their self-worth, perf and outcome of comp game compared to children of non-depressed mothers (Murray, Woolgar, Cooper & Hipwell, 2001)
emotion-regulation strategies across psychopathology: a meta-analytic review
see notes
mood repair mechanisms in depressed and non-depressed youths
see notes
the family context
see notes
R’ship may not be linear
interventions
Drug treatments (aim to increase serotonin, e.g., selective serotonin reuptake inhibitors; SSRIs)
Behav therapy (e.g., time-out, exposure, behav management techniques)
Fam interventions (e.g., boundaries, communication) and parent training programmes
CBT (e.g. focus on problematic thoughts and feelings)
Play therapy (suitable for younger children)
separation anxiety
characterised by excessive anxiety about separation from caregivers/home
often associated with somatic complaints (e.g. stomach aches, nausea)
affects 2-5% of children and adolescents
e.g. refuse to go to school, worry about the parents, need parents to stay awake while sleeping
OCD
characterised by intrusive, repetitive thoughts, obsessions and compulsions (e.g. checking, washing, touching, ordering)
often comorbid with Tourette’s syndrome and tic disorders
thoughts and behaviours are difficult to resist and control
irrational
but not aware of behaviour
specific phobias
e.g. social phobia is characterised by avoidance of social situations
specific phobias affect 7% of school-aged children
can lead to low self-esteem and confidence
