Wee 6 L11 Anx. Flashcards
Internalizing Spectrum
Cluster of interrelated problems anxiety disorders
mood disorders
cross-sectional and lifetime comorbidity extremely high
Developmental psychopathology framework
Remember that we evaluate what is abnormal in the context of
what is typical for children of that age
fear and sadness are important emotions
“normal” fears come and GO over development
Shift of focus from externalizimg is orders to
Internalizing.
Anx disorders, and epidemiology today.
Anxiety Disorders are:
Though we often discount or forget about them…
Associated with significant impairment
Social impairment
Excluded, unliked
Academic impairment
Service Utilization for anx,
Good help from psych, what they are probably best at, but?
Anxiety problems often go untreated
Most youth with mental health problems do not receive treatment
This gap is very pronounced for anxiety
National Comorbidity Survey – Adolescent (Merikangas et al.)
10, 123 adolescents aged 13 to 18 years
Nationally representative (US) sample
Interviewed about psychiatric diagnoses
Asked whether they had ever received services for each disorder
depression was just 50% only 14% to 30 %
Percentage of Adolescents Who Report Using Mental Health Services
ADHD
ODD
CD
Nonsevere
Depression 39% 41%
55%
35%
26%
Severe
78%
54%
82%
v
Look at table again!
Who is more likely to receive services for anxiety?
Girls
Older youth
Reason no treat anx.
1) Some Fear and Anxiety is Normal
Nearly all 1-year-olds become distressed when separated from Mom
Most children have very short lived specific fears About half of children aged 6 to 12 have 7 or more fears
Is it causing disability, distress, or risk?
Only 5% of children report excessive fear in response to a given fear stimulus (e.g., needles, dogs)
Reason no treat anx.
2) Some Anxiety is Adaptive
Stranger anxiety in young children
Test anxiety
Excessive checking of homework
Reason not treat anx.
3) It may not be as upsetting to adults
Remember that children and adolescents do not generally refer themselves for treatment
Anxiety may not be causing disruption
May be associated with favourable characteristics
Less aggression
But saw videos of impairing anx,
Core Features of anx
Focus on threat or danger
Anxiety is future oriented
“anxious apprehension”
Note that this differs from fear, which is present-oriented
Strong negative emotion or tension, displayed as: cognitive shifts, keeps worrying.
Behavioural pattern, phobia (avoid object)
physical sensations
Focus on threat or danger
Anxiety is future oriented “anxious apprehension”
Note that this differs from fear, which is present-oriented
Strong negative emotion or tension, displayed as: physical sensations
Cognitive shifts
Images
Worry
behavioral patterns
Avoidance Crying
Clinging
Diagnoses of anx
Many specific diagnoses
vary on content of threat
vary on balance of symptoms (e.g., worry versus physical)
Specific phobia
(Content of anx disorder)
Specific situations or things
Needles, dogs, water
Separation anxiety
Not limited to children, can see in adults.
Separation from or harm coming to loved ones
Do not want to be separated from parents
Worrying about events that might separate them from paren
Social anxiety
Fear of negative evaluation by others
Fear of social situations in which person will be evaluated
For children, must occur in peer settings (not just with adults)
Generalized anxiety disorder
Worry about multiple threats
School, friends, sports, bad things happening
Post-traumatic stress disorder
Fear of trauma cues
Panic Disorder
and dsm criteria
Fear of panic attacks
Panic attack: period of intense fear or discomfort that develops abruptly and is accompanied by at least four symptoms (e.g., sweating, shortness of breath, feeling like you are choking, chest pain, nausea)
DSM-5 Criteria for Panic Disorder
Recurrent, unexpected panic attacks
At least one of the attacks has been followed by one month (or more) of one of the following
(a) persistent concern about having additional attacks
(b) worry about the implications of the attack or its consequences (e.g., losing
control, having a heart attack, “going crazy”)
(c) a significant change in behavior related to the attacks
Panic attacks are not better explained by another disorder, including another anxiety disorder
Obsessive-Compulsive Disorder (OCD)
obsessions
Obsessions
Recurrent, persistent thoughts, impulses, or images that are experienced as intrusive, inappropriate, and that cause marked anxiety or distress
These thoughts are not simply excessive worries about real life problems
The person attempts to ignore or suppress the thoughts or to neutralize them with another thought or action
The person recognizes that the thoughts are a product of their own mind
Common obsessions
Contamination
Harm to self or others
Symmetry
OCD
Compulsions
Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded events or situations; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or they are clearly excessive
Common compulsions
Counting
Checking
Washing
To meet criteria for OCD, note odd has been taken out of anxiety section of dsm-v different biological mechanisms.
a person must be experiencing either obsessions or compulsions
Obsessions or compulsions are time consuming or causing clinically significant distress or impairment
Prevalence of anxiety disorder
NCS-A
Lower levels of parental education associated with
increased rates of anxiety disorder
Also higher rates of anxiety disorders among youth whose parents were divorced or separated, and among minority youth
Lifetime prevalence of any anxiety disorder during childhood and adolescence is 32%
Specific phobia: 19% (most do not get treatment)
Separation anxiety: 8%
Social Phobia: 9%
Generalized anxiety disorder: 2%
Panic Disorder: 2%
OCD 1%-2% (data from a different survey)
Gender differences
2:1 female to male ratio
Except for OCD, which is 2:1 male to female
-Present across development
Course of anx disorder.
Some fears, worries, and rituals developmentally
appropriate, shoes, desert, cute things… But trying in the moment.
Different “typical” age of onset for each fear
2 years of age: Loud noises, animals, the dark, separation from
parents
5 years of age: Animals, dark, separation from parents, bodily injuries, “bad” people
7 to 8 years of age: Dark, supernatural beings, staying alone, bodily injuries
Worries more complex as youth age
Young children may not realize that their fears or behaviors are excessive or abnormal
Young children may not realize that their fears or behaviors are excessive or abnormal
As children become older, they may become more embarrassed Young children may not be able to tell you how they are feeling
Defiance, acting out
Ages of onset of anxiety disorders?
Anxiety disorders typically show earlier age of onset than other disorders
Different Anxiety Disorders Show Different Ages of Onset
Separation Anxiety Disorder (7 to 8 years)
OCD (9 to 12 years) prognosis worse younger you are at onset.
Some children will show it very early – 6 to 10 years
Generalized Anxiety Disorder (10 to 14 years) Social Phobia – adolescence
Panic Disorder – adolescence
Prognosis of anx dis.
Research is ongoing to determine what the long-term outcomes of anxiety disorders are
Homotypic continuity: have same anx. In the future
-Anxiety disorders predict subsequent anxiety disorders
Heterotypic continuity
–An anxiety disorder predicts other types of disorders
There was a table looking at this, a proxy
Showed that accounting for many variables,
Homotypic, 17.4 , 41,
Strong homotypic continuity.
Strong hetero topic continutioy esp. With depression. 60% had.
More anx, less likely to go to uni.
Clinical Correlates of anx.
Academic difficulties
Anxious children typically have IQs in the normal range
BUT . ..
Impact of worry on concentration
School refusal
Refusal to go to school
Difficulty remaining in school
Separation anxiety
Social anxiety
Selective mutism:
–Will not talk in specific social settings
Clinical Correlates of anx. Dis.
Social Difficulties
Shy/withdrawn children become increasingly rejected by the
peer group with age
More likely to experience peer victimization
Shy/withdrawn children are as likely as peers to have friends, but they perceive these relationships to be of lower quality
Anxiety and Mood Disorders link?
Links between anxiety and depression
Anxiety and depression are highly co-morbid
Diagnostic co-morbidity rates can be as high as 75% in some clinical samples
Symptom overlap
GAD and MDD – fatigue, sleep disturbance, irritability,
concentration difficulties
Negativity affectivity
Underlying dimension
Extent to which person feels distress
Occurs in both anxiety and depression
Anxiety symptoms/disorders often precede depression
Anxiety as a risk factor
Dysfunctional social behaviors (avoidance)
Social-cognitive processing
