PSYCHOPATHOLOGY OF CHILDREN AND FAMILY

WEEK 6:

ANXIETY DISORDERS

Anxiety disorder

Anxiety is a generalized state of apprehension

The focus of anxiety is more internal than external

It seems to be a response to a vague or unrecognized danger

Anxiety is a physiological, behavioral and psychological reaction all at once

Therefore intervention programs in general should focus on:

- to reduce physiological reactivity- to eliminate avoidance behavior - to change subjective reaction

Free-floating anxietyAnxiety that comes out of blue

Situational Anxietyanxiety arises only in response to a specific situation but it is unrealisticsituational anxiety will eventually become phobic when you start to avoid the situation

Anticipatory anxietythinking about one particular situation

Anticipatory anxiety is closely associated with the way you are thinking.

With panic disorder, thoughts are generally focused on worrying about having a panic attack in a situation that will result in embarrassment, extreme discomfort, a heart attack or even worse.

Different types of anxiety disorders defined by DSM-IV-TR

Panic disorders Agoraphobia Social Phobia Generalized Anxiety Disorder Obsessive Compulsive Disorder Post Traumatic Stress Disorder

ANXIETY

VS

ANXIETY DISORDERS

Panic Disorder Characterized by sudden episodes of acute apprehension or intense fear

that occur “out of blue” without any apparent

Symptoms of panic disorder- Shortness of breath or a feeling of being smothered - Heart palpitations – pounding heart or accelerated heart rate - Dizziness, unsteadiness- Trembling or shaking- Feeling of choking - Sweating - Nausea or abdominal distress- Feeling of unreality- Numbness or tingling in hands and feet- Hot and cold- Chest pain or discomfort - Fears of going crazy or losing control - Fear of dying

Your symptoms would be diagnosed as panic disorders if:

You have had two or more panic attacks

At least one of these attacks has been followed by one month (or more) of persistent concern about having another panic attack.

The panic doesn’t occur because you are thinking about, approaching or actually entering a phobic situation

It happens spontaneously and unexpectedly for no apparent reason

The causes of panic disorder

Heredity

chemical imbalances in the brain

personal distress

major life changes may trigger the onset of panic attacks

Treatment

Medication antidepressant drugs such as tofranil and paxil

Personal wellness program regular exercise daily practice of deep relaxation good nutrition a shift in attitude to a calmer and easy-going

approach

Generalized Anxiety Disorder Characterized by persistent feelings of anxiety that

are not triggered by any specific object, situation or activity

GAD having at least three of the following six symptoms - Restlessness- Being easily fatigued- Difficulty concentrating - Irritability- Muscle tension - Difficulties with sleep

No specific phobias associated with GAD but it is sustained by basic fears

- Fear of losing control

- Fear of not being able to cope

- Fear of failure

- Fear of rejection

- Fear of death and disease

Phobic Disorders

The word phobia derives from the Greek phobos meaning fear

Phobic disorders are irrational fears of objects or situations

Specific Phobias Persistent and excessive fears of specific objects

or situations

The DSM-IV groups specific phobias within 5 subtypes

- Animal Type- Natural Environment Type - Blood Injection Injury Type- Situational Type - Other Type

Social Phobia

Fear of embarrassment or humiliation in situations where you are exposed to the scrutiny of others

Typically your concern is that you will say or do something that will cause others to judge you as being anxious, weak, crazy or stupid

The most common - Fear of Public Speaking

Agoraphobia

The word agoraphobia means fear of open spaces / market places

Afraid of being in situations from which escape might be difficult or unavailable

Fear of embarrassment plays a key role

The most common feature of agoraphobia is anxiety about being far away from home or far from a “safe person”

Agoraphobia appears to be engendered by panic disorder

Different level of agoraphobia

- mild case- moderate case- severe case

Obsessive Compulsive Disorder

Obsessions are recurring ideas, thoughts, images or impulses

Compulsions are repetitive behaviors or behaviors or rituals that you perform to dispel the anxiety brought up by obsessions

Obsessions may occur by themselves without necessarily being accompanied by compulsions

The most common compulsions include washing, checking and counting

Obsessive compulsive disorder is often accompanied by depression

Post Traumatic Stress Disorder

The essential feature of post traumatic stress disorder is the development of disabling psychological symptoms following a traumatic event

The traumatic event involves either actual or threatened death or serious physical injury or threat to one’s own or another’s physical safety

Symptoms of PTSD

Repetitive, distressing thoughts about the event Nightmares related to the event Flashbacks so intense that you feel or act as though the

trauma were occurring all over again An attempt to avoid thoughts or feelings associated with

the trauma An attempt to avoid activities or external situations

associated with the trauma Emotional numbness Feeling of detachment or estrangement from others Losing interest in activities that used to give you pleasure Persistent symptoms of increased anxiety, such as

difficulty falling or staying asleep, difficulty concentrating

To receive a diagnosis of PTSD, these symptoms need to have persisted at least 1 month

Less than 1 month’s duration, the appropriate diagnosis is “acute stress disorder”

In addition, the disturbance must be causing you significant distress, interfering with social, vocational or other important areas of your life

PSYCHOPATHOLOGY OF CHILDREN AND FAMILY

WEEK 7:

ANXIETY DISORDERS

Theoretical PerspectivesPsychodynamic perspective

- anxiety disorders are viewed as neurosis

- the anxiety experienced in neurosis reflects;

1 – the efforts of unacceptable, repressed impulses to break into consciousness

2 – fear as what might happen if they do

Stress on the roles of defense mechanisms

Phobias develop through the use of defense mechanism of projection and displacement

A phobic reaction is believed to represent the projection of the person’s own threatening impulses onto the phobic object.

Learning Perspectives

Anxiety disorders are acquired through conditioning

Phobia

- Classical conditioning

- Operant conditioning

- Observational learning – modeling

Generalized anxiety

- a product of stimulus generalization

Obsessive compulsive disorder

- compulsive behavior are operant responses that are negatively reinforced by relief of the anxiety that is engendered by obsessional thoughts

PTSD - classical conditioning

Cognitive Perspectives

Overprediction of fear Irrational beliefsOversensitivity to threatsAnxiety sensitivityMisattribution for panic sensationLow self-efficacy expentancies

Biological Perspectives

Genetic Factors

Neurotransmitter

- Gammaaminobutyric acid (GABA)