Chapter 7 Anxiety Disorders

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Chapter 7Anxiety Disorders
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Table 7.1 The Many Symptoms of Anxiety
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FAD

• Fear present (something bad is happening now)
• Anxiety future (something bad will happen in the
  future)
• Depression future continuous

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Separation Anxiety Disorder

• Age inappropriate, excessive anxiety about being
  apart from parents or away from home
• Highest occurrence of all anxiety disorder
• No gender differences
• Has the earliest onset
• Often associated with school refusal

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Generalized Anxiety Disorder

• Excessive, uncontrollable anxiety and worry about
  numerous events and activities, occurring more
  days than not
• Accompanied by physical symptoms (e.g.,
  headaches, stomachaches, muscle tension,
  trembling)
• No gender differences
• Onset in late childhood or early adolescence
• High co-morbidity with other anxiety disorders
  and depression

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Specific Phobia

• Extreme, disabling fear of specific objects or
  situations that pose little or no danger
• Often leads to avoidance or disrupted routines
• 5 DSM-IV subtypes
• Animal
• Natural environment
• Blood-injection-injury
• Situational
• Other
• More common in boys
• Peak onset between ages 10 and 13

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Social Phobia

• Marked, persistent fear of being the focus of
  attention or doing something humiliating
• more likely to be highly emotional, socially
  fearful and inhibited, sad, and lonely
• more common in girls
• age of onset often early to mid-adolescence
• Selective mutism

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Obsessive-Compulsive Disorder

• Repeated, intrusive, irrational, and anxiety
  causing thoughts (obsessions), accompanied by
  ritualized behaviors (compulsions) to relieve the
  anxiety
• Accompanied by severe disruptions functioning
• Twice as likely in boys
• Age of onset 9-12 years
• High co-morbidity
• anxiety disorders, depression, disruptive
  behavior problems

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Panic Disorder

• Panic attack sudden, overwhelming period of
  intense fear/discomfort (flight/fight response)
• Panic disorder recurrent unexpected panic
  attacks, as well as persistent concern about
  future attacks
• Associated with agoraphobia
• Age of onset 15-19 years
• Worst prognosis of all anxiety disorders

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Posttraumatic and Acute Stress Disorders

• Three core features of PTSD
• 1) persistent re-experiencing of the event,
• 2) avoidance of associated stimuli and numbing of
  general responsiveness, and
• 3) symptoms of extreme arousal
• ASD development of symptoms within one month
  lasting at least two days but not longer than a
  month

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Associated Characteristics of Anxiety Disorders

• Cognitive deficits
• Academic functioning
• Hypervigilance
• Misattribution of threat
• Somatic complaints
• Social functioning deficits

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Gender, Ethnicity, and Culture

• Gender differences may be due to genetic
  vulnerabilities
• Behavior Lens Principle also may explain
  gender, ethnic/cultural differences
• expression and developmental course of fear and
  anxiety
• Cultures that favor inhibition and compliance may
  have increased levels of fears in children

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Theories and Causes

• Early Theories
• Psychoanalytic theory
• defenses against unconscious conflicts rooted in
  the childs early upbringing
• Behavioral and learning theories
• learned though classical conditioning and
  maintained through operant conditioning (two
  factor theory)
• Attachment theory
• early insecure attachments lead children to view
  the environment as undependable, unavailable,
  hostile, and threatening

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Theories and Causes (cont.)

• Temperament
• Goodness of fit
• Genetic and Family Risk
• Genetic predisposition
• Form determined by environment
• Neurobiological Factors
• Overactive BIS
• Brain abnormalities
• Neurotransmitter abnormalities

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Theories and Causes (cont.)

• Family/Social Influences
• excessive parental control, overprotection,
  rejection, and modeling of anxious behaviors
• lower parental expectations for childrens coping
  abilities
• insecure early attachments (particularly
  ambivalent attachment)
• low SES
• exposure to community violence

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Treatment

• Behavior therapy
• Exposure/response prevention
• Counter-conditioning
• Cognitive-behavioral therapy-
• modification of maladaptive thoughts Medications
• Family Tx
• Restructuring interactions