Anxiety and Obsessive-Compulsive Disorders

anxiety

mood state characterized by strong negative emotions and bodily symptoms of tension in anticipation of future danger or misfortune

can anxiety be helpful?

yes, moderate amounts of anxiety help us think and act more effectively (e.g. being slightly nervous for a test)

does anxiety involve immediate responses?

yes, anxiety involves an immediate reaction to a perceived danger/threat (known as fight-or-flight response)

how are symptoms of anxiety expressed?

through three interrelated anxiety response systems (physical, cognitive, behavioral)

Symptoms of anxiety are expressed through 3 interrelated anxiety response systems. What are these three systems?

1. physical system (brain sends messages to the sympathetic NS which produces the fight-or-flight response)

2. cognitive system (feelings of apprehension, nervousness, difficulty concentrating, constant search for threat/danger, panic)

3. behavioral system (aggression, desire to escape, avoidance)

Physical System of Anxiety Responses

the brain sends messages to the sympathetic NS which produces the fight/flight response (increased HR, fatigue, increased respiration, blurred vision, blushing, numbness, sweating, etc.)

Cognitive System of Anxiety Responses

activation of the cognitive system leads to feelings of apprehension, nervousness, difficulty concentrating, constant search for threat/danger, and panic (thoughts of going crazy, self-critical thoughts, thoughts of being scared/hurt, blanking out, forgetfulness, etc.)

Behavioral System in Anxiety Response

aggression is coupled with a desire to escape the threatening situation (avoidance, nail-biting, trembling, stuttering, immobility, twitching, fidgeting, faking an illness, etc)

what happens each time a child avoids an anxiety-producing situation?

he/she is reinforced to continue avoidance in future situations

what is one of the major symptoms of anxiety disorders?

avoidance

normal fears and examples

fears that are developmentally appropriate

• separation from parents (ages 1-5)

• death/dead people (ages 4-5)

• animals and monsters (5-7)

most fears (increase/decrease) with age

decrease

while most normal fears decline with age, give an example of a fear that typically remains stable over time

school-related fears

while most normal fears decline with age, give an example of a fear that may increase over time

social fears

Give an example of a fear that is normal at one age but can be debilitating a few years later.

fear of strangers

normal anxieties

anxieties that are common during childhood and adolescence

describe how normal anxieties vary between boys and girls

girls display more anxiety than boys, but symptoms are similar

give two examples of specific normal anxieties that decrease with age

separation anxiety and school anxiety

what kinds of symptoms remain stable over time rather than showing the age-related declines observed in specific fears

nervous and anxious symptoms

___ may remain stable over time rather than showing the age-related decline observed in ___

nervous and anxious symptoms; specific fears

what are the most frequent symptoms of normal anxieties?

• separation anxieties

• test anxiety, worrying about competence

• need for reassurance

• anxiety about harm to a parent

• ritualistic, repetitive activity

do children with anxiety disorders worry more than other children?

they do not necessarily worry more, they worry more intensely

T or F: ritualistic, repetitive activity is common in young children

true (e.g. bedtime stories)

give an example of a normal ritualistic, repetitive activity common in young children

bedtime stories

how do normal routines help children?

normal routines help children gain control and mastery of their environment and make their world more predictable/safe

2 Distinct Categories of Many Childhood Routines

1. repetitive behaviors

2. doing things just right

T or F: neuropsychological mechanisms underlying compulsive, ritualistic behavior in normal development and those is OCD may be similar

true

categories of anxiety disorders

1. separation anxiety

2. generalized anxiety disorder (GAD)

3. specific phobia

4. social anxiety disorder (SAD)

5. panic disorder (PD)

6. agoraphobia

7. selective mutism

8. OCD

separation anxiety disorder (SAD)

age-inappropriate, excessive, and disabling anxiety about being apart from parents of away from home

how do you know if separation anxiety is normal or a disorder?

separation anxiety is normal in infants, but may be a disorder when it persists for 4+ weeks and is severe enough to interfere with normal daily routines such as school and recreational activities

what are some symptoms of children with SAD?

anxious when away from parents/home, withdrawn, apathetic, and depressed

what is the most common anxiety disorder in childhood?

separation anxiety disorder

what anxiety disorder has the earliest age of onset?

SAD (ages 7-8)

Separation Anxiety Disorder Age of Onset

7-8

is separation anxiety disorder (SAD) more common in boys or girls?

girls

does separation anxiety disorder (SAD) persist into adulthood?

yes, SAD persists into adulthood for more than 1/3 of affected children

which anxiety disorder is heavily associated with school refusal?

separation anxiety disorder (SAD)

school refusal

refusal to attend classes or problems staying in school for the entire day

possible reasons for school reluctance/refusal

SAD, fear of being bullied, fear of being socially evaluated, etc.

is school refusal more common in boys or girls?

equally common in boys and girls

school refusal is common in what aged individuals?

ages 5-11

how should school reluctance/refusal be handled?

immediate return to school

Generalized Anxiety Disorder (GAD)

excessive, uncontrollable anxiety and worry about many events/activities on most days accompanied by at least one somatic symptoms

in generalized anxiety disorder (GAD) are worries episodic or continuous?

can be either episodic or continuous

do those with GAD worry about minor everyday occurances or catastrophic events?

both

are somatic symptoms associated with GAD?

yes, GAD must be accompanied by at least one somatic symptom (headache, stomach ache, muscle tension, trembling, etc.)

what is the lifetime prevalence rate of GAD?

2.2%

is generalized anxiety disorder (GAD) more common in boys or girls?

equally common in boys and girls

generalized anxiety disorder (GAD) comorbitiy

has high comorbidity with other anxiety disorders and depression

Generalized Anxiety Disorder (GAD) Age of Onset

early adolescence

in generalized anxiety disorder (GAD), do older or younger children present more symptoms?

older children

in generalized anxiety disorder (GAD), do symptoms persist over time?

yes

Specific Phobia

extreme and disabling fear of objects/situations that pose little or no danger/threat but leads to avoidance and impairment in normal routines

Specific Phobia Symptoms

1. marked fear/anxiety about specific objects/situations for at least 6 months

2. child does to extreme lengths to avoid object/situation

3. children do not recognize fears as extreme and unreasonable

4. crying, tantrums, freezing, clinging

In Specific Phobias, how long must the fear/anxiety about a specific object/situation persist?

at least 6 months

how do specific phobias differ in children and adults?

children often do not recognize their fears as extreme and unreasonable like adults can

how might children with Specific Phobia express their fears?

crying, tantrums, freezing, clinging

Do those with Specific Phobia Disorder typically have one phobia or multiple phobias?

multiple phobias

is Specific Fear Disorder more common in boys or girls?

girls

Specific Phobia Disorder Comorbidity

most common co-occurring disorders are anxiety disorder and depressive disorders

Specific Phobia Age of Onset

7-9 years

Specific Phobias Age of Onset & Peak Age

• onset: 7-9

• peak: 10-13

what are the most common specific phobias in children?

fear of animals (big dogs, snakes, insects, mice)

Social Anxiety Disorder (social phobia)

a marked, persistent fear of social performance requirements that expose the child to scrutiny and possible embarrassment

what kinds of fears are associated with social anxiety disorder?

fear of performance situations and interaction situations

T or F: those with social anxiety disorder are more likely to be highly emotional, socially fearful, inhibited, sad, and lonely

true

how might those with social anxiety disorder react when pushed into social situations?

may cry, have a tantrum, freeze, or withdraw further

When children have an anxiety disorder, what is the most common secondary diagnosis?

social anxiety disorder

social anxiety disorder prevalence through the ages

• very rare under age 10

• first occurrence is in adolescence/after puberty

• prevalence increases with age

is social anxiety disorder more common in boys or girls?

2x more common in girls

why might social anxiety disorder be overlooked?

shyness is so common

Panic Disorder (PD)

disorder characterized by the presence of panic attacks followed by either at least 1 month of persistent concern/worry about having another attack or a significant change in behavior in attempt to avoid attacks

panic attack

sudden, overwhelming period of intense fear/discomfort accompanied by four or more physical symptoms of the fight/flight response

Panic Disorder Prevalence

rare in young children; common in adolecents

why might the prevalence of Panic Disorder be low in young children?

they may lack the cognitive ability to make catastrophic misinterpretations

• “my heart is beating rapidly and im sitting here watching TV like I always do—I must be going crazy”

Panic Disorder Age of Onset

15-19

what disorders have the lowest rates of remission without treatment?

panic disorder and agoraphobia

Agoraphobia

intense fear/anxiety that occurs in certain places or situations where escape may be difficult or help may not be available if panic symptoms occur (being in a crowd or being outside the home alone)

what anxiety disorder used to be considered the same as panic disorder?

agoraphobia

how is agoraphobia different from social anxiety disorder?

those with agoraphobia are not concerned about others criticizing them, they are concerned about help not being available if they are to experience panic attack symptoms

Selective Mutism

failure to talk in specific social situations, even though they may speak loudly and frequently at home or in other settings

Selective mutism Prevalence

very rare; occurs in 0.7% of children

What groups have the highest rates of selective mutism?

there is no variance between sex, race, or ethnicity

Selective Mutism Age of Onset

3-4 years old (BUT identification/referral is not common until school entry and increased social interaction tasks)

Treatment for Selective Mutism

not usually treated; child usually outgrows disorder by age 8

what anxiety disorder may be an extreme type of social phobia or lead to social phobia if left untreated?

selective mutism

Relationship between Selective Mutism and Social Phobia

selective mutism may be an extreme type of social phobia, or might lead to social phobia if left untreated

T or F: Children with Selective Mutism may have trouble in school or making friends

true

Obsessive-Compulsive Disorder (OCD)

disorder of ritual fear and doubt where child experiences recurrent, time-consuming, and disturbing obsessions and compulsions

is OCD chronic?

yes, 2/3 of children continue to have the disorder 2-14 years after being diagnosed

OCD obsessions

persistent, unwanted, intrusive thoughts, urges, or images that generally cayse significant anxiety or distress

how to differentiate obsession vs normal worry?

obsessions are more than everyday worries—they are excessive, irrational, and focused on improbable or unrealistic events

being unable to stop hearing recurring rhymes/songs, experiencing fears of having a serious disease, and fears of being attacked by an intruder are all examples of what?

OCD obsessions

what do the most common OCD obsessions focus on?

contamination, fears of harm to self or others, and concerns about symmetry/exactness

how do obsessions differ in children vs in adolescents?

vaguer in children and more specific in adolescents

OCD Compulsions

repetitive, purposeful, and intentional behaviors (hand washing) or mental acts (repeating words silently) that are performed in response to obsessions in an attempt to suppress or neutralize them

what are the most common OCD compulsions?

excessive washing/bathing, repeating, checking, touching, counting, hoarding, and ordering/rearranging

What happens if children recognize their obsessions and compulsions as excessive and unreasonable?

most children will persist in their obsessions and compulsions

does OCD occur more often in young people or adults?

about as common inyoung people as in adults

In children, is OCD more common in boys or girls?

2x more common in boys