Anxiety Disorders
Anxiety Disorders - Terms
• Fear = emotional rxn to danger
• Anxiety
– Future orientation
– Feelings of apprehension
– No danger may be present
• Panic – physiological rxn; fight or flight
• Phobias = pathological fears
Fears vs. Phobias
1.
2.
3.
4.
5.
6.
Out of proportion
Cannot be explained away
Leads to avoidance
Not adaptive
Persists over time
Not age or stage specific
Fears
• Common and normal
• 90% of children have at least one specific
fear
• 50% have numerous fears
• Generally decline with age; peak around
11
• Phobias only 1%
Common fears
• Fears of physical injury or personal loss
• Fears of natural or supernatural danger
• Fears reflecting psychic distress
• animals
Developmental changes in fears
• 1st year: loud noises, separation from
parent
• Preschoolers – animals, the dark,
imaginary creatures
• school age – school, injury, social fears
• Adolescence – interpersonal fears,
appearance, school, safety
Difficulties in assessment of anxiety
disorders in children
1. Differentiate normal fears from pathological anxiety
•
impairment
•
•
•
Verbal
Behavioral
Physiological
2. domains may not correspond
3. Problems operationalizing behavioral manifestations of
anxiety
•
•
•
Physiological measures limited
Verbal report - ??
Rating scales good but don’t distinguish
DSM-IV Anxiety Disorders
• 9 disorders
– Same as adult except for separation anxiety
disorder
– OCD, PTSD, GAD, Panic Disorder, phobia,
social phobia, agoraphobia, acute stress
disorder
Separation Anxiety Disorder
• Excessive anxiety concerning separation
from home or caregivers beyond that
expected for developmental level
• Lasts 4 weeks or more
• Often early age of onset
• Often precipitated by major stressor
Social Phobia
• Extreme shyness
• Children may not recognize why they feel
anxious
• Must have capacity for social relationships
with familiar people
• Must occur in peer setting, not just with
adults
Components of Treatment
1. Avoidance/escape – exposure
2. Physiological reactions – relaxation
training and/or meds
3. Cognitive – alter distorted thinking
4. Cognitive – sense of control, self-efficacy