Download PSYCHOPATHOLOGY OF CHILDREN AND FAMILY

PSYCHOPATHOLOGY OF
CHILDREN AND FAMILY
WEEK 7:
ANXIETY DISORDERS
Anxiety disorder
 Anxiety is a generalized state of
apprehension
 The focus of anxiety is more internal than
external
 It seems to be a response to a vague or
unrecognized danger
 Anxiety is a physiological, behavioral and
psychological reaction all at once
 Therefore intervention programs in general should
focus on:
- to reduce physiological reactivity
- to eliminate avoidance behavior
- to change subjective reaction
 Free-floating anxiety
Anxiety that comes out of blue
 Situational Anxiety
anxiety arises only in response to a specific situation
but it is unrealistic
situational anxiety will eventually become phobic
when you start to avoid the situation
 Anticipatory anxiety
thinking about one particular situation
 Anticipatory anxiety is closely associated
with the way you are thinking.
 With panic disorder, thoughts are generally
focused on worrying about having a panic
attack in a situation that will result in
embarrassment, extreme discomfort, a heart
attack or even worse.
Different types of anxiety disorders defined by
DSM-IV
 Panic disorders
 Agoraphobia
 Social Phobia
 Generalized Anxiety Disorder
 Obsessive Compulsive Disorder
 Post Traumatic Stress Disorder
ANXIETY
VS
ANXIETY DISORDERS
Panic Disorder
 Characterized by sudden episodes of acute apprehension or intense fear that
occur “out of blue” without any apparent
 Symptoms of panic disorder
- Shortness of breath or a feeling of being smothered
- Heart palpitations – pounding heart or accelerated heart rate
- Dizziness, unsteadiness
- Trembling or shaking
- Feeling of choking
- Sweating
- Nausea or abdominal distress
- Feeling of unreality
- Numbness or tingling in hands and feet
- Hot and cold
- Chest pain or discomfort
- Fears of going crazy or losing control
- Fear of dying
 The panic doesn’t occur because you are
thinking about, approaching or actually
entering a phobic situation
 It happens spontaneously and unexpectedly
for no apparent reason
The causes of panic disorder
 Heredity
 chemical imbalances in the brain
 personal distress
major life changes may trigger the onset of panic
attacks
Treatment
Medication
 antidepressant drugs such as tofranil and paxil
Personal wellness program
 regular exercise
 daily practice of deep relaxation
 good nutrition
 a shift in attitude to a calmer and easy-going
approach
Generalized Anxiety Disorder
 Characterized by persistent feelings of anxiety that
are not triggered by any specific object, situation
or activity
 GAD having at least three of the following six
symptoms
- Restlessness
- Being easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Difficulties with sleep
 No specific phobias associated with GAD
but it is sustained by basic fears
- Fear of losing control
- Fear of not being able to cope
- Fear of failure
- Fear of rejection
- Fear of death and disease
Phobic Disorders
 The word phobia derives from the Greek
phobos meaning fear
 Phobic disorders are irrational fears of
objects or situations
Specific Phobias
 Persistent and excessive fears of specific objects
or situations
 The DSM-IV groups specific phobias within 5
subtypes
- Animal Type
- Natural Environment Type
- Blood Injection Injury Type
- Situational Type
- Other Type
Social Phobia
 Fear of embarrassment or humiliation in situations
where you are exposed to the scrutiny of others
 Typically your concern is that you will say or do
something that will cause others to judge you as
being anxious, weak, crazy or stupid
 The most common - Fear of Public Speaking
Agoraphobia
 The word agoraphobia means fear of open spaces /
market places
 Afraid of being in situations from which escape
might be difficult or unavailable
 Fear of embarrassment plays a key role
 The most common feature of agoraphobia is
anxiety about being far away from home or far
from a “safe person”
 Agoraphobia appears to be engendered by panic
disorder
 Different level of agoraphobia
- mild case
- moderate case
- severe case
Obsessive Compulsive Disorder
 Obsessions are recurring ideas, thoughts, images
or impulses
 Compulsions are repetitive behaviors or behaviors
or rituals that you perform to dispel the anxiety
brought up by obsessions
 Obsessions may occur by themselves without
necessarily being accompanied by compulsions
 The most common compulsions include
washing, checking and counting
 Obsessive compulsive disorder is often
accompanied by depression
Post Traumatic Stress Disorder
 The essential feature of post traumatic stress
disorder is the development of disabling
psychological symptoms following a traumatic
event
 The traumatic event involves either actual or
threatened death or serious physical injury or
threat to one’s own or another’s physical safety
Symptoms of PTSD
 Repetitive, distressing thoughts about the event
 Nightmares related to the event
 Flashbacks so intense that you feel or act as though the
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trauma were occurring all over again
An attempt to avoid thoughts or feelings associated with
the trauma
An attempt to avoid activities or external situations
associated with the trauma
Emotional numbness
Feeling of detachment or estrangement from others
Losing interest in activities that used to give you pleasure
Persistent symptoms of increased anxiety, such as
difficulty falling or staying asleep, difficulty concentrating
 To receive a diagnosis of PTSD, these symptoms
need to have persisted at least 1 month
 Less than 1 month’s duration, the appropriate
diagnosis is “acute stress disorder”
 In addition, the disturbance must be causing you
significant distress, interfering with social,
vocational or other important areas of your life
Theoretical Perspectives
 Psychodynamic perspective
- anxiety disorders are viewed as neurosis
- the anxiety experienced in neurosis
reflects;
1 – the efforts of unacceptable, repressed
impulses to break into consciousness
2 – fear as what might happen if they do
Stress on the roles of defense mechanisms
 Phobias develop through the use of defense
mechanism of projection and displacement
 A phobic reaction is believed to represent
the projection of the person’s own
threatening impulses onto the phobic object.
Learning Perspectives
 Anxiety disorders are acquired through
conditioning
 Phobia
-
Classical conditioning
Operant conditioning
Observational learning – modeling
 Generalized anxiety
-
a product of stimulus generalization
 Obsessive compulsive disorder
-
compulsive behavior are operant responses that
are negatively reinforced by relief of the anxiety
that is engendered by obsessional thoughts
 PTSD
-
classical conditioning
Cognitive Perspectives
 Overprediction of fear
 Irrational beliefs
 Oversensitivity to threats
 Anxiety sensitivity
 Misattribution for panic sensation
 Low self-efficacy expentancies
Biological Perspectives
 Genetic Factors
 Neurotransmitter
-
Gammaaminobutyric acid (GABA)