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Child Psychopath
Final Exam: Anxiety and Phobias
| Question | Answer |
|---|---|
| Anxiety: Background | anxiety d/o among most common d/o of youth yet often not identified; 13% of children and adol btwn 9 -17 yrs have anxiety d/o; 20-30% of anxiety d/o are stable over time |
| Anxiety: History | DSM-I: psychoneurotic reactions; DSM-II: phobic neurosis (overanxious reaction of childhood); DSM-III/R: SAD, Avoidant & overanxious d/o of child/adult anx d/o; DSM-IV: eliminated avoidant d/o of childhood, overanxious d/o subsumed under GAD |
| Anxiety: Definitions: Fear | a normal emotion; an adaptive, discrete response to a real or perceived, specific threat; "fight or flight" response |
| Anxiety: Definitions: Anxiety | chronic, repeated, or pathological experience of fear; perceived inability to control; can occur w/o a real threat ("false" alarm), anxious apprehension |
| Anxiety: Definitions: Phobia | fear involving a severe or exaggerated response to specific stimuli and a persistent behavioral pattern of avoidance; cannot be explained away |
| Anxiety: Components of fear: list | physical, cogntive, behavioral |
| Anxiety: Components of fear: physical | inc heart rate, muscle tension, sweating, dry mouth ("fight-or-flight" syndrome) |
| Anxiety: Components of fear: cognitive | fearful thoughts: "something bad is going to happen", "it's going to hurt me" |
| Anxiety: components of fear: behavioral | avoidance of things associated with the feared stimulus or situation |
| Anxiety: developmental context | "fear" is normal; at certain ages, some kinds of fears are expected (ex. separation anxiety) |
| Anxiety: common age-appropriate fears in children: Infants | loss of support, loud noises, height, strangers, sudden and unexpected objects |
| Anxiety: common age-appropriate fears in children: 1-2 years | separation from parent, strangers, toilet injury, loud noises, large animals |
| Anxiety: common age-appropriate fears in children: preschool | animals, the dark, masks, being left alone, insects, separation from parent |
| Anxiety: common age-appropriate fears in children: elementary school | animals, the dark, thunder & lightning, supernatural beings, current events |
| Anxiety: common age-appropriate fears in children: middle school | academic, social, and health-related fears (ex. tests, medical procedures) |
| Anxiety: when is child "too" fearful? | intensity (more fear than expected given age/gender/etc); duration (continues beyond "normal" age); impairment (fear that interferes w/ normal activities) |
| Anxiety: types of d/o (DSM-IV) | anxiety d/o: separation anxiety, specific phobia, social phobia, GAD, panic d/o (w/ or w/o agoraphobia), other anxiety d/o; OCD; PTSD (or acute) |
| Anxiety: types of d/o (DSM-5 changes) | social phobia changed to social anxiety d/o, include selective mutism; separate panic d/o and agoraphobia d/o, obsessive-compulsive and related d/o (new category), trauma & stress-related (new category) |
| Anxiety: Separation Anxiety | developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached (3+ of 8 symptoms) |
| Anxiety: Separation Anxiety: general criteria (DSM-IV) | present 4+ weeks, onset < 18 yrs, clinically sig distress/impair, specifier: early onset (< 6 yrs), most common in children 5 - 11 |
| Anxiety: Separation Anxiety: DSM-5 changes | present 6+ months (rather than 4+), removal of specifier (early onset) |
| Anxiety: Specific Phobia | marked and persistent fear that is excessive or unreasonable, cued by presence or anticipation of a specific object or event (e.g., flying, heights, animals, etc) |
| Anxiety: Specific Phobia: general criteria (DSM-IV) | exposure to stimulus provokes immediate anxiety response; recog fear excessive/unreasonable (except kids); avoidance or severe distress in presence; interferes w/ functioning/marked distress; if <18 yrs present 6+ mo, avg age 7.8 - 8.4 yrs |
| Anxiety: Specific Phobia: DSM-5 changes | no age, typically 6+ mo (compared to <18 yrs, present 6+ mo), minor wording changes for specifying type |
| Anxiety: Social Phobia | marked and persistent fear of social or performance situations, exposed to unfamiliar pple or to possible scrutiny by others. fear they will act in ways that are humiliating or embarassing |
| Anxiety: Social Phobia: general criteria (DSM-IV) | recognize fear as excessive/unreasonable (except kids); avoid social/performance situations; interferes w/ functioning or marked distress; if <18 yrs present 6+ mo, specifier: generalized; avg age of onset 11.3 - 12.3 yrs |
| Anxiety: Social Phobia: DSM-5 changes | social phobia changed to social anxiety d/o, no age; typically 6+ mo (compared to <18 yrs), specifier (generalized changed to "performance only" or "selective mutism" |
| Generalized Anxiety Disorder: DSM-IV | excessive anxiety and worry occurring more days or not about a number of events or activities; worry difficult to control; 1 or more physical symptoms (restlessness, fatigue, irritable); present 6+ mo; avg age onset 8.8 yrs; avg age seek tx 10.8-13.4 yrs |
| GAD: DSM-5 changes | excessive anxiety and worry 2+ domains; anxiety/worry more days than not, 3+ mo; associated w/ 1+ symptoms (restless, on edge, muscle tension), associated w/ 1+ bx (avoid, procrast, seek reassurance); clinically sig distress/impairment |
| Panic Disorder (w/ or w/o Agoraphobia): DSM-IV general description | discrete periods of intense fear including trembling, shaking, palpitations, dizziness/faintness, shortness of breath, etc (see criteria for panic attack) |
| Panic Disorder (w/ or w/o Agoraphobia): DSM-IV general criteria | month or more of (1+) - persistent concern about future attacks; worry about implications of the attack or its consequences; sig change in bx related to attacks also: not due to substance, GMC or other mental d/o |
| Panic Disorder (w/ or w/o Agoraphobia): DSM-5 changes | Panic Disorder standalone dx, criteria wording changed: add in worry about future attacks or their consequences and significant maladaptive change in bx related to attacks (bx designed to avoid PA) |
| Panic Disorder and children | controversial in children and adolescents b/c capacity for "catastrophic misinterpretation" of physical symptoms disputed; good evidence that panic symptoms occur, but that current criteria may not be approp for kids |
| Agoraphobia: DSM-5 proposes standalone diagnosis | marked fear or anxiety about 1+ situation from 2+ of 5 groups (public transport; open spaces; shops/theaters/cinemas; standing in line/crowd; outside of home); fear these situations due to thinking escape is difficult or help not available |
| Agoraphobia: DSM-5 proposes standalone diagnosis: duration and additional description | situations always provoke fear/anxiety, actively avoided, require companion; fear/anxiety out of proportion to actual danger; persistent (typically 6+ mo); clin sig distress/impair; not due to substance, GMC, or mental d/o |
| Anxiety: DSM-IV: other anxiety disorders | anxiety d/o due to GMC; substance-induced anxiety d/o; anxiety d/o NOS |
| Anxiety: DSM-5: other anxiety disorders | anxiety d/o due to a GMC (attributable to another med condition); Anxiety d/o NEC (rather than NOS) |
| OCD: DSM-IV: obsessions: general description | recurrent/persistent thoughts/impulses/images experiences as intrusive/inappropriate, cause marked anxiety/distress; not excessive worries about real-life probs; attempts to ignore/suppress/neutralize; recog obsessions as product of mind |
| OCD: DSM-IV: compulsions: general description | repetitive, purposeful bx or mental acts driven to perform in response to rules that must be applied rigidly; aimed at preventing/reducing distress/event; recognize excessive/unreasonable; time consuming (>1hr/day) or sig interf w/ funct |
| OCD: DSM-5: changes | specifier: with poor insight (change - broaden range from Good to Absent; add Tic-related OCD) |
| PTSD: DSM-IV general description | exposure to traumatic event involving actual/threatened death/serious injury followed by intense fear/helplessness/horror; persistent reexperience of event; avoid stimuli associated w/ trauma and numbing of responsiveness; inc physical arousal |
| PTSD: DSM-IV general criteria | present more than 1 mo; acute stress d/o - same except present 2 days - 4 wks w/ onsent w/in 4 wks of event (clinging, assurance seeking) |
| PTSD and children | -children rarely have flashbacks, but often relive trauma during play and thru nightmares - children may experience disorganized or agitated bx instead of appearing fearful |
| Selective Mutism: DSM-5 changes | specified under Social Anxiety d/o |
| Selective Mutism: DSM-IV | consistent failure to speak in specific social situations despite speaking in others; interferes w/ social/acad funct; lasts 1+ mo; not due to lack of knowledge of lang |
| School Refusal (not in DSM): description | -refusal to attend school and/or dif remaining in class all day which is initiated by child; 5-28% exhibit some aspect of school refusal |
| School Refusal: functions (R-) | negative affectivity avoidance (avoid of school b/c it promotes negative affectivity); esc from anxiety/social phobia (esc from aversive social evaluative situations) |
| School Refusal: functions (R+) | attn (inc sep. anx.) - wants parental attn; positive tangible reinforcement (prob w/ attn, delinquency and/or agg; specific activities outside of school - friends, drugs, shopping) |
| Anxiety: epidemiology: prevalence and age | prevalence (1-17% DSM, 12-20% text); 15-20% lifetime prevalence, varies by disorder: age - younger tend to have more fears; # of fears dec w/ age; sympt expression/focus of fears changes w/ age |
| Anxiety: epidemiology: risk factors | gender (all anxiety d/o more common in girls; dif foci - animals, injury/illness in girls, failure in boys); lower education; lower income; ethnicity/culture (AA fewer diagnosed anxiety d/os; urbanization not correlated) |
| Anxiety: epidemiology: course | onset often age 5-10; very stable, often continue into adulthood in some form if severe; most fears not based on actual experience are outgrown; "conditioned" fears more persistent |
| Anxiety: epidemiology: comorbidity/developmental course | vary by disorder; SAD (depression, social phobia, panic d/o); OCD (anxiety or depression); Social Phobia (substance use d/o); differential diagnosis varies by disorder |
| Anxiety: etiology of anxiety: triple-vulnerability model of anxiety | heritable diathesis, generalized psychological vulnerability, specific psychological vulnerability |
| Anxiety: etiology of anxiety: biological: genetic/familial | family aggregation - parents = children (2-5x); twin studies (few child studies), heritability varies 29% - 59%, differs by age, type of anxiety and informant, debate about if pure anxiety or mixed anx/depr inherited |
| Anxiety: etiology of anxiety: biological: neurobiological (temperament) | behavioral inhibition theory (Kagan): 10-15% infants inhibited - inc sympathetic activation and low arousal thresholds; Gray's behavioral inhibition system |
| Anxiety: etiology of anxiety: biological: neurochemical | GABA, serotonin, noradrenalin; animal and adult models mainly |
| Anxiety: etiology of anxiety: biological: psychophysiological | respiration and CO2 levels |
| Anxiety: etiology of anxiety: biological: neuroscience | amygdala, hippocampus; also biased info processing, selective attention |
| Anxiety: etiology of anxiety: psychological: psychoanalytic | anxiety signals underlying conflict; results from: unsuccessful progression thru psychosexual stages, conflict btwn id/ego/superego, defense mechanisms exceeded (ex. Little Hans' fear of horses) |
| Anxiety: etiology of anxiety: psychological: behavioral (anxiety results from conditioned response) | pavlovian/classical conditioning - little albert; Mowrer's Two-Factor theory (fear classically conditioned, maintained thru operant avoidance) |
| Anxiety: Mowrer's 2 Factor Theory | factor 1: fear and anxiety conditioned thru classical conditioning; conditioned fear motivates escape from CS; factor 2: removal of cue eliciting fear reinforces avoidance |
| Anxiety: etiology of anxiety: psychological: Rachman | "indirect" fear acquisition - indirect vicarious learning, transmission of information |
| Anxiety: etiology of anxiety: psychological: social learning theory expanded | modeling and self efficacy |
| Anxiety: etiology of anxiety: psychological: cognitive | anxiety influenced by expectations and interpretations of events, anxiety sensitivity (not clear if cognitions in anxious children are causes or consequences) |
| Anxiety: etiology of anxiety: psychosocial | family/parenting (parenting style - overcontrolling, overprotective, lack of affection; insecure attachment; modeling/vicarious learning); social prob w/ peers (unclear if cause or result) |
Created by:
ironchiet
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