Anxiety Disorders

Question 1

core characteristics of anxiety

Answer 1

strong negative emotion, tension, apprehension, a sense of fear/dread
- anticipating future danger
- anxiety is expected in situations that may affect safety or wellbeing (it’s normal)
- but excessive, persistent, debilitating anxiety signals dysregulation of the anxiety response system (too much anxiety is bad)
- it may occur in response to specific stimuli or as a generalized state of worry

Question 2

symptoms of anxiety

Answer 2

physical: abdominal pain, nausea, vomiting, sweating, dizzy, inc. heartrate, dry mouth, blushing

cognitive: worrying, poor concentration, blanking out, self-critical thoughts, thoughts of being scared/hurt, etc

behavioral: avoidance (most common), crying, screaming, trembling voice, nail biting, shaking, avoidance of eye contact, twitching, etc

Question 3

anxiety

Answer 3

future-oriented emotional state, feelings of apprehension and lack of control; no danger present

Question 4

fear

Answer 4

present-oriented, immediate emotional reaction to current danger

Question 5

panic

Answer 5

unexpected physical symptoms in the absence of threat/danger

Question 6

associated characteristics of anxiety

Answer 6

cognitive - avg intelligence, probs w/ attention, memory, concentration, cognitive biases, less adaptive coping strategies

physical/health - sleep problems and less risk-taking behaviors

social - lower social competence, problematic peer and sibling interactions, more loneliness (lower self report of self esteem, more shy)

Question 7

sex and age differences in anxiety

Answer 7

• 10-15% of school-aged children have at least 1 anxiety disorder
• specific phobia, social anxiety, and separation anxiety are more common during childhood and adolescence
• no sex diff in preschool
• for school-aged and older, most anxiety disorders are common in girls (persists into adulthood)

Question 8

comorbidity

Answer 8

• comorbidity among anxiety disorders and between anxiety disorders and other disorders (depression) makes diagnosis hard
• combos usually persist into adulthood
• anxiety also co-occurs w/ ADHD, eating disorders, and substance use disorders

Question 9

what factors cause anxiety (just list)

Answer 9

biological
individual
environmental

Question 10

biological factors

Answer 10

• heritability is moderate (.35) and nonspecific (parent has social anxiety, you are now on path to anxiety, but could be diff type)
• over/underactivity of neural circuits, structural abnormalities, right-left asymmetries
• altered serotonin and norepinephrine functioning

Question 11

individual factors

Answer 11

• tend to focus on temperament in childhood an personality in adulthood
• behavioral inhibition is a risk factor only (children afraid to try new things)

Question 12

environmental factors

Answer 12

overprotective parenting, critical parenting, parent modeling of anxious behavior and avoidant coping increases risk
- children learn from modeled behavior
- some parents reinforce child’s anxiety by allowing avoidance behaviors (stay home from school and miss test)

Question 13

4 types of interventions for anxiety

Answer 13

behavior therapy
CBT
family interventions
medications

• exposure to source of anxiety is main approach

Question 14

behavior therapy

Answer 14

• graded exposure to fear (make list least feared to most and start talking it through, rate distress SUDS)
• flooding: prevent avoidance behaviors, exposure in prolonged and repeated doses

Question 15

CBT

Answer 15

• modify maladaptive thoughts to decrease symptoms (if scared of panic attack - spin in circle and tell self i’m okay)
• coping cat ages 7-13: decrease negative thinking, increase active problem solving

Question 16

family interventions

Answer 16

• children view selves as less competent, parent’s perspective of child may change
• greater parental involvement in modeling and reinforcing coping techniques

Question 17

medications

Answer 17

• SSRIs can be used
• not first pick, try CBT first
• for some CBT doesn’t work, or anxiety is too severe and need medication to be able to do therapy

Question 18

core characteristics of separation anxiety

Answer 18

• excessive, prolonged anxiety about being away from home/parents (when developmentally inappropriate)
• reluctance/refusal to attend school or sleep alone, clingy, physical complaints
• typical at 7/8 mos of age; declines after 2yrs old, but expected during transition to school or after major stressor

Question 19

sex and age differences of separation anxiety

Answer 19

sex: community samples more girls; clinical boys and girls same

age: avg age of onset = 7-8yrs (but 70% or more who develop disorder do so before age 4)

Question 20

comorbidity of separation anxiety

Answer 20

majority of children have another disorder, usually anxiety, but 1/2 develop comorbid depression. substance use disorder may be found in adolescents

Question 21

etiology of separation anxiety

Answer 21

biological factors: genetics, neurological factors, inhibited temperament

environmental factors: highly involved parents (overprotective), occurrence of major life stressor is important (moving, death/illness in family, new school)

Question 22

outcomes of separation anxiety

Answer 22

• SAD may develop suddenly or gradually
• course: some have brief probs, symptoms come/go, for others symptoms are chronic
• chronic course is more likely when older age at onset, parental psychopathology, marital distress, comorbid diagnoses in childhood

Question 23

core characteristics of social anxiety

Answer 23

• intense fear of social situations thar involve possible scrutiny by others and risk of evaluation or embarrassment
• individuals tend to be unassertive, make less eye contact, seem shy, may find it hard to go to school or activities
• many cases overlooked because shyness common

Question 24

sex and age differences in social anxiety

Answer 24

sex: community 2X more girls; clinical no diff

age: onset is often in late childhood or early adolescence (80% who develop do so by age 18)

Question 25

comorbidity of social anxiety

Answer 25

co-occurrence of another disorder is common; 1/5 have comorbid depression, substance use probs may also develop - in boys/men - higher rates of ODD, CD, and substance use disorders - girls/women - higher rates of another anxiety or depression

Question 26

etiology of social anxiety

Answer 26

often develops after a highly stressful event, but may develop gradually - biological predispositions likely interact w/ individual and/or environmental factors

Question 27

outcomes of social anxiety

Answer 27

- course is variable; some have remission, some have symptoms come/go, for others symptoms are chronic - adults may experience impairments in education, employment, social, and relationship domains - rates of long-lasting remission is very low

Question 28

anxiety in preschoolers (5 points)

Answer 28

- most prevalent diagnosis in preschoolers, they cause impairment in young children and their families - the most significant barrier to ID and intervention: widespread belief among adults that children will outgrow symptoms (not true!!!) - anxiety in young children presents as specific disorders as it does for other ages (separation, social, specific phobia, GAD, etc) - less able to describe internal experiences, so it is shown through behavior - some symptoms are misinterpreted as irritability and/or defiance

Question 29

prevalence of anxiety in preschoolerrs

Answer 29

about 20% have an anxiety disorder - very high rates - no sex diff in this age group

Question 30

etiology in preschoolers

Answer 30

bio and environ. factors contribute, but environment makes stronger contribution - more likely to a) have parent w/ anxiety or depression; b) have parent who is younger and less education/income; c) have experienced recent stressor

Question 31

interventions for preschoolers

Answer 31

- parent who is empathic, firm, and encourages exposure to fear is good - CBT w/ more parent involvement is first used, meds only considered really if no access to CBT, or if child doesn't respond to it

Question 32

selective mutism core characteristics

Answer 32

children don't speak in some situations and speak normally in others. not speaking is a way to avoid intense anxiety associated w/ social interactions - also shows little/no eye contact, tantrums, sleep problems, stomach aches, nausea

Question 33

comorbidity in selective mutism

Answer 33

most common comorbid diagnosis is social anxiety disorder; higher rates of other anxiety disorders, depression, OCD also occur, may have speech/language problems