anxiety disorders- developmental psychopathology
OCD prevalence
- 1-2.3% in children (increases in adults) - More stable when onset is in adulthood, but still fairly stable in childhood - Overall relatively equal gender rations - Slightly higher in males in childhood - Slightly higher in females in adulthood - Females more likely to have contamination/cleaning symptoms - Males more likely to have sexual-religious or aggressive symptoms - Similar across cultures
social anxiety disorder
- Fear or anxiety about one or more social situations that involves evaluation/scrutiny - In children can include peer settings - Fears that they will be negatively evaluated - Social situations almost always provokes anxiety or fear - In children, may be expressed behaviorially - Situation avoided or endured with intense distress -Anxiety out of proportion to actual threat or danger - Persistent for 6 or more months - Specifier: performance only - Tends to be more common in older children and adolescents - Most common after specific phobia
developmental course
- Fears common in children - Fears decrease with age - Content of fears changes with age - Females report more fears than males - Anxiety is an internal experience and in adults primarily based on patient report - In children, we integrate behavior observations - Fear may present as crying, clinging to caregiver - May present as somatic symptoms - Headaches, stomachaches -Anxiety can manifest differently in children
separation anxiety disorder
- Symptoms (3 or more) - Excessive distress when anticipating or separating from caregivers/attachment figures - Worrying about something bad happening to caregiver - Worrying about experiencing something bad that results in separation - Reluctance or refusal to go places because of fear of separation - Reluctance or refusal to sleep away from home - Nightmare about separation - Physical symptoms (somatic) - Persistent: 4 weeks in children and 6 months in adults - Can occur at any age but typically before puberty, with average age around 7
tic treatment
- Tics are neurological but sensitive to environment in which they occur - Comprehensive behavioral intervention for tics (CBIT) - Trains patient to be more aware of tics - trains patients to do competing behaviors when they feel the urge to tic - Making changes to day to day activities to reduce tic triggers - Habit-reversal therapy - Teaching competing response - Medications that decrease dopamine (atypical antipsychotics like haloperidol and risperidone) - Botox injections - ADHD medications (can increase concentration, but for some make tics worse) - Anxiety medicines like clonidine and guanfacine can control behavioral symptoms - Antidepressants: control anxiety and OCD - Antiseizure medications like topiramate for Tourette's
specifier for phobias
-animal (common in young kids) -natural environment (common in young kids) -blood-injection injury -situational -other (choking, vomiting, sounds, costumed characters)
criteria for most anxiety disorders
-cause clinically significant distress or impairment in functioning -not better explained by another disorder (psych, medical) or substance us
specific phobias
-fear or anxiety about something specific -this almost always results in immediate fear or anxiety -out of proportion to actual danger -persistent and lasts 6 months or more
panic disorder
-recurrent unexpected panic attacks, fear and discomfort which reaches peak within minutes and includes four symptoms in picture. -At least one attack followed by 1 month of one or both 1. persistent concern or worry about panic attacks 2. maladaptive change in behavior related to attacks
Tourette's prevalence
0.1-1%
Tics prevalence
1-2%
prevalence of anxiety
1/3 of teens by age 18, general estimates above 30%, Tourette's and OCD are highly comorbid and bidirectional with anxiety disorders, often chronic across lifespan
anxiety medications
Benzodiazepines, SSRIS, SNRIS, MAOIS
anxiety treatment
CBT, exposure therapy, relaxation skills, medication
extra credit
Walter, 15 year old spaniel
medications for tics
atypical antipsychotic, tics and ADHD use clonidine
3 components
behavioral, physiological, cognitive
etiology of tics
complex neurobiological underpinnings but associated with cortical-subcortical circuit dysregulation, dopamine activity
obsession/ OCD
constant thoughts about whether or not oven was turned off even after checking once
relaxation skills and anxiety
deep breathing, progressive muscle relaxation, and mindfulness provide immediate relief from the symptoms of anxiety
agoraphobia
fear in 2 of the 5 of the following: -using public transportation -being in open spaces -being in enclosed places -standing in line or being in crowds -being outside of home
core features of anxiety
fear, nervousness, avoidance (can increase anxiety when avoiding things)
agoraphobia general information
fears or avoid these situations because it might be hard to leave or get help, situations almost always produce anxiety or fear. Actively avoided, need another person with them or are endured with distress. -6 months or longer and fear is out of proportion to situation
gender/ anxiety
females more likely
medication and anxiety
helps control uncomfortable symptoms of anxiety
internalizing disorders
internal experiences, tricky in children, mood/anxiety, lived experience, not always observable -hard to diagnose in children since they do not have the language to describe internal emotions
socioeconomic status/anxiety
lower income families lead to children with more worries
rates of panic attacks
lower rates in children and starts increasing in adolescents, with average age of onset usually in adults
phobias continued
most often emerge before age 7, remission rates higher in children than adults, despite high rates few seek treatments, one of the most common anxiety disorders
anxiety/ OCD
obsessions cause strong, uncomfortable feelings of anxiety, the person feels compelled to act and remove the discomfort
OCD cycle
obsessions, anxiety, relief, compulsions
DBT
often used in adults, accept skills, TIPS skills
somatic
physical symptoms associated with distress
factors that influence GAD
race and ethnicity, socioeconomic status, gender, age
Selective Mutism
rarest anxiety disorder - Consistent failure to speak in social situations in which there is an expectation for speaking - Despite speaking in other situations - Disturbance interferes with educational, occupational, or social functioning - Persists for at least 1 month o Does not include first month of school - Not attributable to communication disorder or lack of knowledge of verbal communication - Rarest anxiety disorder (0.3-2%) - Usually emerges around time when child starts school
compulsion/ OCD
repeatedly checking to confirm that the oven is turned off, possibly going to great lengths to do so such as traveling home from work
DSM criteria for generalized anxiety disorder
see picture
OCD symptoms
see picture
Tic disorders
see picture
etiology of OCD
see picture
genetics and anxiety
see picture
tic
sudden, rapid, recurrent, nonrhythmic motor movement or vocalization
relief/ OCD
the individual experiences relief from their anxiety however the obsessive response has been strengthened for the future
Exposure therapy and anxiety
therapist and client create a plan to gradually face anxiety-producing situations, thus breaking the cycle of avoidance. With enough exposure, the anxiety loses power and symptoms diminish. Exposure therapy relies on an exposure hierarchy
CBT
thoughts, emotions, behaviors -Thoughts (what we think affects how we feel and act) - Emotions (what we feel affects how we think and act) - Behaviors (what we do affects how we think and feel)
prevalence of tic disorders
used to be considered rare but now some evidence that up to 20% of children have transient tics
race and ethnicity/anxiety
white females are more likely to have social anxiety and black adolescents more likely to have symptoms of OCD
externalizing disorders
you can see traits, observable
