Psikologi Anak
Pertemuan 10
Emotional Disorders
Anxiety
• Viewed as a multi-dimensional response to
the expectation of threat
• Anxiety is common
• Anxiety can be adaptive
• Symptoms include trembling, palpitations,
sweating, gastro-intestinal discomfort,
diarrhea, muscle tension, blushing, confusion
Commonly used terms
• Fear – an emotional reaction to present
danger (real or imagined)
– Autonomic nervous system
– Flight/fight response
• Panic – sudden extreme fear/terror
– Physical symptoms
• Anxiety – more persistent and often about
things that may happen in the future
Developmental progression
• Infancy - strangers, loud noises
• 1-2 yrs - separation, animals, dark, loud
noises, the toilet
• 4-6 yrs - kidnappers, robbers, ghosts
• 6-early adol.- bodily injury, death,
achievement
• 10+ - social comparison, appearance, personal
conduct, exams
Separation anxiety
• Developmentally inappropriate and excessive
anxiety re separation from home or an
individual
• May develop after some life stress
• Onset may be as young as pre-school
• Prevalence about 4%
Generalized Anxiety Disorder
• Excessive anxiety/worry (apprehensive
expectation) about a number of
events/activities.
• Accompanied by symptoms - restlessness,
easily fatigued, difficulty concentrating,
irritability, muscle tension, disturbed sleep
• Intensity and duration out of proportion to
likelihood or impact of feared event
Obsessive-Compulsive Disorder
• Recurrent obsessions or compulsions that are
severe enough to be time-consuming or cause
marked impairment or distress
• Obsessions - persistent thoughts, ideas that
are experienced as intrusive and inappropriate
• Compulsions - repetitive behaviours or mental
acts the goal of which is to reduce anxiety or
distress
Specific Phobia
• A marked and persistent fear of clearly
discernible, circumscribed objects or
situations.
• Exposure - immediate anxiety response
• Feared stimulus frequently avoided
• Commonly - animals, insects, environmental
fears, situational fears
Social Phobia
• Marked and persistent fear of social or
performance situations in which
embarrassment may occur
• Exposure - immediate anxiety response
• Often situation is avoided
• Common features - hypersensitivity to
criticism, negative evaluation, low
assertiveness, low self-esteem
Post Traumatic Stress Disorder
• Characteristic symptoms following exposure to
an extreme stressor.
• Response to the event must include intense
fear, feelings of helplessness or horror – in
children disorganized or agitated behaviour
• Persistent re-experiencing of trauma,
avoidance of stimuli associated with event,
symptoms of increased arousal
Aetiology
• Genetics and neurobiology
– family studies & twin studies
• Behavioural inhibition
– early manifestation of predisposition
• Psychosocial factors
– stressful life events
• Psychoanalytic theory
– anxiety central to theory of neurosis
Treatment
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Most promising treatment CBT using a combination of behavioural and cognitive
techniques
– Relaxation training (BT)
– In vivo exposure (BT)
– Contingency management (BT)
– Self-instructional training (CBT)
– Positive self-statements (CBT)
Recent studies show increased benefits from combining group CBT with family therapy
10-16 sessions target behavioural and cognitive sequelae of the anxiety disorder
– awareness of physical symptoms
– recognition of cognitions
– problem-solving skills
– self-evaluation and rewards
All of this is done slowly and using role play, rehearsal and feedback
second 8 sessions employ imaginal and in vivo exposure to anxiety provoking situations
– child practices skills learned earlier in the feared situations
– a hierarchy is used to take the child step by step towards the feared situation
Mood Disorders
Types of mood disorders
• Major depressive episode
– Meets DSM criteria
• Major depressive disorder
– Two or more episodes
• Bipolar disorder
– Switches between normal mood, depressed mood and
manic states
• Dysthymic disorder
– Persistent mild depression
Age related symptomatology
• Children do not complain of feeling depressed
and may present as irritable, anxious or
hyperactive.
• Adults note behavioural indicators
• More likely to be referred for and diagnosed
with oppositional behaviour, anxiety, ADHD
than with depression
Diagnosis of Depression
• Definition is the same as for adult diagnosis
• DSM-IV criteria
• Onset in childhood/adolescence constitutes
early onset
• Early onset impacts on prognosis
Risk Factors for Depression
• Genetic factors – predisposition
• Child factors – temperament
• Early adverse environment
– Maternal depression
• Neglect
• Modelling
– Marital conflict
– Domestic violence
Precipitants for Depression
• Major Loss
– Death of a loved one
– Interpersonal loss (relationship)
• Negative life event
– Failure (school or work)
• Disciplinary crisis
– Arrest
Theories of Depression
Psychoanalytic theory
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Unresolved oral conflict
Perceived rejection during oral stage
Failure to develop strong sense of self
Overly dependent on opinions of others
Want to punish those who reject them
Turn anger inward
Loss/rejection leads to depression
Cognitive theory
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Early rejection, criticism by or loss of a parent
Unrealistic expectations of self
Cognitive Triad (self, events, the future)
Major loss/disappointment will trigger a depressive reaction
Maintained by distorted thinking patterns
Treatment of Depression
• Treatment depends on your conceptualization
of the cause of the depression
– Biological
– Psychoanalytic
– Cognitive
– A combination
Suicide
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Suicide is rare in children but does occur
Rates increase through adolescence
3rd leading cause of death 15-24 year olds
Rates tripled from 1945 to 1995
Increase in depression
Access to means (guns, drugs)
Attempts also increase through adolescence
1 in 10 girls; 1 in 25 boys
Suicide
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Risk Factors
Depression
Family history of suicide
Family discord
Substance abuse (alcohol,
marijuana etc)
Relationship problems
Peer problems
Physical or sexual abuse
School problems
Other emotional
problems
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Protective Factors
Having someone to talk
to a friend, school
counsellor, teacher
Having a close/
supportive family
Having had positive life
events
Emotional stability
Being connected to
school or community
Belonging to a group