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5. Anxiety Disorders > DSM Anxiety Part 1 (General, Separation, Selective Mutism, Specific Phobia, Social Anxiety) > Flashcards

DSM Anxiety Part 1 (General, Separation, Selective Mutism, Specific Phobia, Social Anxiety) Flashcards

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1
Q

what is “fear”

A

the EMOTIONAL response to real or perceived imminent threat

more often associated with surges of autonomic arousal necessary for FIGHT or FLIGHT, thoughts of immediate danger, and escape behaviours

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2
Q

what is “anxiety”

A

the ANTICIPATION of FUTURE threat

more often associated with muscle tension, vigilance in preparation for future danger and cautious or avoidant behaviours

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3
Q

what are panic attacks generally? are they limited to anxiety disorders?

A

a particular type of fear response

NOT limited to anxiety disorders

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4
Q

in what ways do the anxiety disorders differ from one another

A

the types of objects or situations that induce fear, anxiety or avoidance behaviour

the associated cognitive ideation

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5
Q

how do the anxiety disorders differ from developmentally normative fear or anxiety?

how do the differ from transient fear or anxiety?

A

by being EXCESSIVE or PERSISTING beyond developmentally appropriate periods

are PERSISTENT (6 mo or more)–> though duration criterion is intended as GENERAL GUIDE

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6
Q

when do many anxiety disorders develop

A

in childhood

tend to persist if not treated

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7
Q

is there a gender bias in anxiety disorders

A

yes–> more women than men (2:1)

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8
Q

is there a specific cognitive ideation associated with specific phobias

A

no, unlike in other anxiety disorders

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9
Q

define panic attack

A

abrupt surges of intense fear or intense discomfort that reach a peak within minutes, accompanied by physical and/or cognitive symptoms

may be expected or unexpected

*function as a marker and PROGNOSTIC factor for severity of diagnosis, course and comorbidity across an array of disorders

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10
Q

criterion A for separation anxiety disorder

A

developmentally INAPPROPRIATE and excessive fear or anxiety concerning the separation from those to whom the individual is attached as evidenced by at least THREE of the following:

  1. recurrent excessive DISTRESS when anticipating or experiencing separation from home or from major attachment figures
  2. persistent and excessive worry about LOSING major attachment figures or about possible harm to them such as illness, injury, disasters, death
  3. persistent and excessive worry about experiencing an UNTOWARD EVENT (getting lost, kidnapped, having accident, becoming ill) that CAUSES separation from major attachment figure
  4. persistent RELUCTANCE OR REFUSAL to go out, away from home, to school, to work or elsewhere because of fear of separation
  5. persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
  6. reluctance/refusal to sleep away from home or go to sleep without being near a major attachment figure
  7. repeated NIGHTMARES involving theme of separation
  8. complaints of PHYSICAL SYMPTOMS when separated from major attachment figures or when separation anticipated
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11
Q

how many symptoms are required to meet criterion A of separation anxiety disorder

A

3

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12
Q

what is the time criteria for separation anxiety disorder (criterion B)

A

at least 4 weeks in kids and teens, or 6+ months in adults

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13
Q

criterion C for separation anxiety disorder

A

causes clinically significant distress/impairment

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14
Q

criterion D separation anxiety disorder

A

not better explained by other mental disorder (i.e due to autism)

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15
Q

what is the essential feature of separation anxiety disorder

A

excessive fear or anxiety concerning separation from home or attachment figures (above developmental level)

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16
Q

how might separation anxiety disorder affect bedtime

A

often have difficulty as bedtime–> may insist someone stay with them until fall asleep

may make way to parents bed in the night

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17
Q

how might children with separation anxiety disorder present when not with a major attachment figure

A

may exhibit:
social withdrawal

apathy

sadness

difficulty concentrating on work or play

may lead to school refusal

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18
Q

what are some themes of “worry thoughts” that can be present for kids with separation anxiety disorder

A

may have fear of animals, monsters, the dark, muggers, burglars, kidnappers, car accidents, pane travel and other situations perceived as danger to family or themselves

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19
Q

how might kids with separation anxiety disorder present when anticipating a separation

A

may become extremely upset, showing anger or occasionally aggression towards someone who is forcing separation

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20
Q

how might separation anxiety disorder affect perceptual experiences

A

when alone, especially in evenings or in the dark, young children may report unusual perceptual experiences (i.e seeing people peering into their room)

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21
Q

how might kids with separation anxiety disorder be described

A

can be “described as demanding, intrusive and in need of constant attention”

as adults–> may appear “dependent and overprotective”

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22
Q

what is the 12 month prevalence of separation anxiety disorder among US adults

A

0.9-1.9%

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23
Q

what is the 12 month prevalence of separation anxiety disorder among kids aged 6-12

A

about 4%

(in teens it is about 1.6%)

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24
Q

compared to other anxiety disorders, how prevalent is separation anxiety disorder in kids under 12

A

it is the most prevalence anxiety disorder in kids under 12

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25
is there a gender bias in separation anxiety disorder?
in clinical samples, equal female: male in community, more females
26
how might separation anxiety manifest in adults
may limit ability to cope with changes in circumstances (i.e moving, getting married) typically overconcerned about their offspring and spouses and experience marked discomfort when separated from them
27
name some environmental risk factors for separation anxiety
often develops after life stress, especially a LOSS parental overprotection and intrusiveness may contribute
28
what is the estimate heritability of separation anxiety disorder
estimated at 73% in community sample of 6 year old twins
29
does the presence of an anxiety disorder increase risk of suicide
yes (but not specific to separation anxiety disorder)
30
ddx separation anxiety disorder
GAD Panic disorder agoraphobia conduct disorder social anxiety disorder PTSD illness anxiety disorder bereavement depressive and bipolar disorders ODD psychotic disorders personality disorders
31
how does separation anxiety disorder differ from agorapgobia
in separation anxiety disorder there isnt that same fear of being trapped/incapacitated and unable to escape if panic sx arise
32
how do separation anxiety disorder and dependent PD differ?
dependent PD= "indiscriminate tendency" to rely on others rather than specific to attachment figures
33
what is commonly comorbid with separation anxiety disorder in kids
GAD and specific phobia
34
what is commonly comorbid with separation anxiety disorder in adults
specific phobia, PTSD, GAD, social anxiety disorder and panic disorder. agoraphobia. OCD. personality disorders
35
criterion A for selective mutism
consistent failure to speak in specific social situations in which there is an expectation for speaking ie school despite speaking in OTHER situations
36
criterion B for selective mutism
disturbance interferes with educational or other occupational achievement or with social communication
37
criterion C for selective mutism
duration of the disturbance is at least one month (not limited to first month of school)
38
criterion D for selective mutism
failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation
39
criterion E for selective mutism
disturbance not better explained by communication disorder and does not occur exclusively during course of autism spectrum disorder, schizophrenia or another psychotic disorder
40
selective mutism is often marked by what kind of anxiety
high social anxiety
41
do kids with selective mutism refuse all social interaction?
no--> sometimes use nonspoken/nonverbal means of communicating (grunting, pointing, writing) and may be willing or eager to perform or engage in social encounters when speech is not requried (i.e non verbal parts in school plays)
42
what other features of selective mutism might be present
may have excessive shyness fear of social embarrassment social isolation and withdrawal clinging compulsive traits negativism temper tantrums mild oppositional behaviour
43
do children with selective mutism have normal language skills
usually, but can also have associated communication disorder (no particular assoc. with a specific communication disorder)
44
what the most common comorbidity with selective mutism
social anxiety disorder
45
is selective mutism common
relatively rare point prevalnce 0.03-1% depending on setting and ages of kids in the sample
46
does the prevalence of selective mutism vary by sex or ethnicity?
no
47
onset of selective mutism is usually before what age
5 years *but may not come to clinical attention until entry into school
48
what is the usual course of selective mutism
persistence of the disorder is usually variable longitudinal course is unknown though may "outgrow"
49
list some temperamental risk factors for selective mutism
not well identified neuroticism/negative affectivity may play a role behavioural inhibition parental hx shyness/social isolation / social anxiety may have SUBTLE RECEPTIVE LANGUAGE DIFFICULTIES compared to peers although receptive language still within NORMAL range
50
what are some environmental risk factors for selective mutism
social inhibition in parents may be a model for social reticence/mutism overprotective parents
51
ddx selective mutism
communication disorders neurodevelopmental disorders schizophrenia or other psychotic disorders social anxiety disorder
52
what are the criteria for specific phobia
A--marked fear or anxiety about a SPECIFIC object or situation B--phobic object or situation almost ALWAYS provokes immediate fear or anxiety C--phobic object or situation is actively AVOIDED or ENDURED with intense fear or anxiety D--fear or anxiety is OUT OF PROPORTION to the actual danger posed by the specific thing and to sociocultural context E--fear, anxiety and avoidance is PERSISTENT, typically 6+ months or more F--fear, anxiety avoidance causes clinically sig. distress or impairment G--not better explained by another mental disorder
53
do most people with specific phobia only have one phobic stimulus
no--average person with specific phobia fears 3+ objects/situations 75% fear more than one *each needs its own diagnosis and code
54
what is the prevalence of specific phobia
7-9% in USA --5% in kids --16% in 13-17 year olds --lower in older individuals similar in europe rates lower in asian, african, latin american countries
55
what is the gender bias in specific phobia
female:male 2:1
56
when does specific phobia usually develop
early childhood majority develop before age 10 (median btw 7-11) *situation specific phobias tend to have later onset than natural environment, animal, or blood-injection-injury phobias
57
what is the typical course of specific phobia
if develop in childhood, tends to wax and wane during that time if persists into adulthood, unlikely to remit for majority pf people
58
which phobias may be more likely to be endorsed in older adults
natural environment or phobia of falling
59
is there genetic susceptibility to specific phobia
may be when it comes to certain categories of phobia ie someone w first degree relative with specific phobia of animals sig. more likely to have same specific phobia than any other category of phobia
60
in the USA which populations have lower rates of specific phobia
asians and latinos
61
are people with specific phobia more likely to make a suicide attempt
yes--up to 60% more likely than those without a diagnosis (**but this is "likely due to comorbidity with personality disorders and other anxiety disorders")
62
how does impairment related to specific phobia compare to that experienced by those with other anxiety disorders, AUDs, and SUDs
similar patterns of impairment in psychosocial functioning and decreased QoL distress + impairment tend to increase with the number of feared object/situations
63
ddx specific phobia
agoraphobia social anxiety disorder separation anxiety disorder panic disorder OCD trauma and stressor related disorders eating disorders schizophrenia spectrum and other psychotic disorders
64
how do you distinguish between arogaphpobia and situational specific phobia
feared situations often overlap if only one agoraphobic situation is feared, then can dx specific phobia--if more than one then dx agoraphobia
65
those with specific phobia are particularly at risk for development of what personality d/o
dependent
66
criterion A for social anxiety disorder
marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others (i.e social interactions, performing, being observed) *in kids, anxiety must occur in PEER settings and not just in interactions with adults
67
criterion B for social anxiety disorder
individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e will be humiliating or embarrassing, will lead to rejection or offend others)
68
criterion C social anxiety disorder
social situations almost always provoke fear or anxiety
69
criterion D for social anxiety disorder
social situations are avoided or endured with intense fear or anxiety
70
criterion E for social anxiety disorder
fear or anxiety is out of proportion to the threat posed by the social situation and to the sociocultural context
71
criterion F for social anxiety disorder
persistent--> lasts 6 mo or more
72
*there are a bunch of other criteria for social anxiety disorder but is the usual ones like not due to another medical/mental condition
73
name a specifier for social anxiety disorder
"performance only"
74
what is the 12 month prevalence estimate of social anxiety disorder in the USA
7% --lower in europe (0.5-2%) rates are similar in kids/teens as in adults
75
how does prevalence of social anxiety disorder change with age
goes down
76
how does gender affect rates of social anxiety disorder
generally higher in females than males (not massive difference) --gender difference bigger in kids/teens
77
what is the median age at onset for social anxiety disorder in the USA
13 years old 75% of people have onset between ages 8-15 first onset in adulthood = relatively rare
78
is social anxiety disorder heritable
yes first degree relatives have 2-6x higher chance of having social anxiety disorder
79
what is "taijin kyofusho"
syndrome often characterized by social evaluative concerns, fulfilling criteira for social anxiety disorder that are associated with the fear that the individual makes OTHER people uncomfortable --> can be experienced with delusional intensity i.e in Japan, Korea, but also in non-asian settings other presentations of tajin kyofusho may meet criteria for BDD or delusional disorder
80
what disorders are more commonly comorbid in FEMALES with social anxiety disorder
greater number of social fears greater number of comorbid depressive, bipolar and anxiety disorders
81
what disorders are more commonly comorbid in MALES with social anxiety disorder
more likely to fear dating more likely to have ODD or conduct disorder and use alcohol and illicit drugs to relieve symptoms of the disorder
82
is paruresis more common in males or females with social anxiety disorder
males
83
what is paruresis
"shy bladder syndrome" (doesnt pee in public restrooms etc)
84
name a strong predictor for the persistence of social anxiety disorder
not being employed
85
ddx social anxiety disorder
normative shyness agoraphobia panic disorder GAD separation anxiety disorder specific phobias selective mutism BDD delusional d/o ASD personality d/os ODD other mental or medical disorders
86
what other disorders are most commonly comorbid in social anxiety disorder
other anxiety disorders MDD SUDs bipolar disorder body dysmorphic disorder avoidant PD in kids: often comorbid with selective mutism and high functioning autism

5. Anxiety Disorders (4 decks)

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