Week 6: Anxiety; definition, core features & assessment Flashcards
Internalizing Spectrum Basics
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
-short lived fears are normal
Service Utilization
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
Service Utilization
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
-Even for ADHD there were 18% with severe ADHD that did not get help
-
For depression only 41% of SEVERE cases got help
For anxiety, even worse - 30%
Who is more likely to receive services for anxiety?
Girls
Older youth - could be because internalizing disorders do not bother adults so much and so it is down to the child to get help. They cannot do this until later in life.
Some fear is adaptive
We WANT people to be scared of some things
- strangers
- crossing streets
- midterms!
But can spiral out of control and lead to excessive checking of homework etc.
This can make it very hard to change an anxiety as
Some fear is adaptive
We WANT people to be scared of some things
- strangers
- crossing streets
- midterms!
But can spiral out of control and lead to excessive checking of homework etc.
This can make it very hard to change an anxiety as people will argue what they are doing is good and might not want the consequences that come with lessening this problems
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 favorable characteristics
- e.g. less aggression & better performance at school
Core features of anxiety
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
Fight or flight
When you feel DANGER, your body jumps in to protect you.
Every part of your body gears up for action.
Here are
some of the changes that happen in your body…
HEART: Your heart starts pumping faster.
Why: To get more oxygen in your blood to your big
muscles. This gives you the energy to fight or run.
Feeling: Racing heart, pounding in ears.
STOMACH: Your body stops digesting food.
Why: Digesting food isn’t so important if you
are in the middle of fighting or running away.
Feeling: A big heavy lump of undigested food in your
stomach, nausea, or stomach cramps.
DSM V diagnoses for internalizing disorders
- Anxiety Disorders
- Obsessive Compulsive and Related Disorders
- Trauma and Stressor Related Disorders
- Post Traumatic Stress Disorder
Anxiety disorders: Specific phobia
Specific phobia
- Specific situations or things
- e.g. Needles, dogs, water
Anxiety disorders: GAD and the worry spin cycle
Generalized anxiety disorder
- Worry about multiple threats
- School, friends, sports, bad things happening
Every time you fix one thing
Another thing to worry about pops into your head
Anxiety disorders: Separation anxiety
Separation anxiety
- Separation from or harm coming to loved ones
- Do not want to be separated from parents
- Worrying about events that might separate them from parents
Anxiety disorders: 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)
- NOT JUST WITH PARENTS
Anxiety disorders: Selective Mutism
Selective Mutism
-Failure to speak in specific situations and contexts in which speaking is
expected, even though they may speak in other settings
-Reclassified as an anxiety disorder in DSM 5, but not clear that all5, but not clear that all children with selective mutism are anxious
