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Anxiety Disorders
Danielle Winder
Kathia Johnson
Susie Berrin
Definition of Anxiety Disorders

Anxiety or fear is defined as a complex pattern of three
types of reactions to a perceived threat. (Lang,1984)

What are the three types of reactions? Give an example
of each.
1. Overt Behavioral Responses
-Running away, trembling voice, closing eyes
2. Physiological Responses
- Changes in heart rate and respiration, muscle tension,
stomach upset
3. Subjective Responses
- Thoughts of being scared, images of bodily harm
Classification of Anxiety Disorders
1.) DSM Approach
-The DSM IV describes several types of anxiety disorders.
-Match the disorder to the respective definition:
1.Separation
Anxiety
Disorder
a) -is characterized by sudden attacks of intense anxiety.
-these attacks do not occur only in response to a particular phobic
stimulus or threatening situation.
- symptoms peak within 10 minutes, and often subside within 20-30
minutes.
d
2. Phobic
Disorder
b) –is characterized by frequent and excessive anxiety or worry
about a number of activities of events rather than anxiety being
focused on particular objects or situations.
-anxiety occurring most days for a period of 6 months or more
c
3. Panic
Disorder
c.) -characterized by fear or avoidance of specific objects or
situations other than separation or involvement with strangers.
a
d.) –is characterized by the child’s excessive distress when
separated from persons to whom there is a strong attachment and
by the avoidance of situations that require separation.
b
4.Generalized
Anxiety
Disorder
Classification of Anxiety Disorders
2.) _________ Approach
-The empirical approach to classification describes
subcategories of internalizing disorders.
EX: Achenbach (1991a)
-The existence of a single anxious/depressed
syndrome suggests that these problems tend to cooccur.
*Other internalizing syndromes, such as:
-somatic complaints (dizzy, stomach ache)
-withdrawn (refusing to talk)
TABLE 6-1
Behavior Problems
included in
Anxious/Depressed
Syndrome
Lonely
Cries a lot
Fears impulses
Needs to be perfect
Feels unloved
Feels persecute
Feels worthless
Nervous, tense
Fearful, anxious
Feels too guilty
Self-conscious…
Developmental Characteristics of Children’s Fears

General Prevalence
(1)
Jersild and
Holmes(1935)
MacFarlane, Allen, &
Honzik(1954)
Bell-Dolan, Last, &
Strauss(1990)
(2)
(3)

Sex and Age Diff.
(1)
King(1989);
Kilpatrick(1984)
(1)
King(1989);
MacFarlane(1954)
Reported that children aged 2-6 had between four and
five fears and exhibited fearful reactions once every 4 ½
days.
In their longitudinal study of children from 2-14, found
that specific fears were reported in 90% of their sample.
Use of semi structured interviews with nonreferred children
indicates that between 10.7 and 22.6% of children endorsed
symptoms of phobias.
Most research suggests that girls exhibit a greater number of
fears than boys.
It is most commonly reported that both the number and the
intensity of fears experienced by children decline with age.
Also, certain fears appear to be more common at particular
ages.
ARTICLE

Relationship Between Specific Adverse Life Events and Psychiatric
Disorders (Weems, Silverman, La Greca)
Hypothesis:
1)
2)
Depressive disorders (MDD and Dysthymia) and disruptive disorders (CD and
ODD) would be highly associated with many adverse life events.
Some life events are associated with a specific group of psychiatric disorders.
Results:
1)
2)
3)
4)
5)
6)
Both disruptive disorders and depressive disorders were closely associated with a
broad range of adverse life events (17-22 /25)
ADHD and phobias were associated with fewer of the events (3 or less)
It showed that being a victim of crime, violence, or assault was strongly related to
CD and ODD in both boys and girls.
A parent being jailed was strongly associated with CD and Dysthymia in boys, and
CD and Overanxious Disorder in girls.
Getting a new stepparent had a strong impact on CD and Dysthymia in boys and
Overanxious Disorder in girls.
*Strong association between school change and several psychiatric disorders in
boys. Boys who started a new school had more than a threefold increase in
Separation Anxiety Disorder and Social Phobia, and more than a fivefold increase
in ADHD, ODD, Depression, and Agoraphobia.
Specific Phobias- Epidemiology and Developmental Course

Most commonly diagnosed anxiety disorders in children and
adolescents.

Specific phobias appear to have the earliest age of onset and to
occur during childhood.
 Specific phobias are likely to begin during childhood and that for
at least some individuals, they may persist over time.

Youngsters with specific phobias are also likely to meet criteria of
other diagnoses.
(other anxiety disorders, depression, mood disorders)
 Also, many experience co-occurring disorders.
Specific Phobias

DSM-IV Criteria
Specific Phobias
1.
2.
3.
4.
5.
Animal Type
Natural Environmental
Type
Blood-Injection-Injury
Type
Situational Type:
Other:
animals or insects
storms, heights, water, etc.
getting injections, seeing blood, seeing
injuries, watching invasive medical procedures
elevators, flying, driving, bridges, escalators,
trains, tunnels, closets, etc
avoidance of loud sounds or costumed
characters
Specific Phobias

Treatment Options
1.
Systematic desensitization and exposure
Beta-blockers may be effective in treating performance-anxiety symptoms.
Drugs used in generalized social phobias include SSRIs or an MAOI (such as
phenelzine).
2.
3.

Associated Features
1.
2.
Depressed Mood
Anxious or Fearful or Dependent Personality

Differential Diagnosis
1.
Panic Disorder With Agoraphobia
Social Phobia
Posttraumatic Stress Disorder
Obsessive-Compulsive Disorder
Separation Anxiety Disorder
Social Phobia
•
DSM IV- Criteria
Social Phobia

Treatment Options
1.
2.
cognitive behavioral therapy
Drugs used in generalized social phobias include SSRIs or an MAOI (such as
phenelzine).

Associated Features
1.
4.
Depressed Mood
Somatic or Sexual Dysfunction
Addiction
Anxious or Fearful or Dependent Personality

Differential Diagnosis
1.
Panic Disorder With Agoraphobia or Agoraphobia Without History of Panic Disorder
Separation Anxiety Disorder
Generalized Anxiety Disorder
Specific Phobia
Schizoid Personality Disorder
Avoidant Personality Disorder
Performance anxiety, stage fright, and shyness…
2.
3.
Separation Anxiety & School Refusal
DSM IV Criteria
Separation Anxiety

Associated Features
1.
3.
Depressed Mood
Somatic or Sexual Dysfunction
Anxious or Fearful or Dependent Personality

Differential Diagnoses
1.
Pervasive Developmental Disorders
Schizophrenia, or other Psychotic Disorders
Generalized Anxiety Disorder
Panic Disorder with Agoraphobia
Agoraphobia Without History of Panic Disorder
Conduct Disorder
Developmentally appropriate levels of separation anxiety
2.
Generalized Anxiety Disorder
DSM IV- Criteria
Generalized Anxiety Disorder

Treatment Options
1.
3.
Therapy
Psychotherapy: Most patients with mild symptoms can be treated with supportive
counseling and education without need for medication.
Other therapies: Relaxation training and cognitive therapy
General measures: Regular exercise and avoidance of caffeine and alcohol.
Medications: Selective Serotonin Reuptake Inhibitors (SSRIs).

Assoiciated Features
1.
3.
Depressed Mood
Somatic or Sexual Dysfunction
Anxious or Fearful or Dependent Personality

Differential Diagnosis
1.
Anxiety Disorder Due to a General Medical Condition
Substance-Induced Anxiety Disorder
Panic Disorder
Social Phobia
Obsessive-Compulsive Disorder
Anorexia Nervosa
Somatization Disorder
Separation Anxiety Disorder
Obsessional thoughts…
2.
2.
Any Questions?