Common Fears and Anxiety Disorders: SAD and PTSD

Common Fears at Different Ages

These are normal fears, not anxieties, and should not be pathologized. These are potential test questions.

• Infants (0 to just under 1 year of age):
  • Fear of heights: Illustrated by the visual cliff experiment, where infants appear anxious even on a solid clear surface, feeling like they are falling.
  • Fear of loud, sudden noises.
• One to Two Years of Age:
  • Strangers (stranger danger).
  • Toileting and toilet training.
  • Fear of being injured.
  • Not typically afraid of snakes or the dark; suggests these fears might be influenced by adult suggestion (e.g., offering a nightlight).
• Preschool (Approximately 3 to 4 years of age):
  • Fear of animals, often small animals.
  • Fear of the dark.
  • Fear of strangers.
  • Fear of being left alone.
  • Fear of imaginary creatures (e.g., the boogeyman).
• As Children Enter School (Elementary & Middle School):
  • Fears become more specific, realistic, and similar to those adults might have.
  • Elementary School: Small animals, dark, lightning, thunder, physical safety.
  • Middle School: Fears are very much based in reality, including academic worries, social concerns, health-related worries, parental disapproval, and receiving bad grades.

Separation Anxiety Disorder (SAD)

SAD is a relatively rare, chronic, and often relapsing-remitting disorder that can last for decades, with a tendency to recur during high-stress periods.

• Definition:
  • Excessive anxiety concerning separation from home and/or people to whom one is closely attached (e.g., parents).
  • The anxiety must be beyond what is developmentally appropriate (e.g., a $12$-year-old exhibiting the same symptoms as a kindergartner upset about leaving a parent).
• Time Course:
  • Symptoms must last for at least $4$ weeks.
  • The disorder must have begun before the age of $18$. Diagnosing it in adulthood requires a thorough developmental history to trace symptoms back to before age $18$, as it typically has roots in developmental stages rather than cropping up in young adulthood.
• Impairment:
  • Must cause significant distress or impairment in daily functioning (e.g., unwillingness to leave home or parents will easily lead to impairment).
• Prevalence and Severity:
  • Pretty rare: Less than 1 ext{%}.
  • It is rarer than Obsessive Compulsive Disorder (OCD).
  • Second to the bottom in prevalence among anxiety disorders (excluding agoraphobia without panic).
  • Severity tends to be bimodal, with severe and mild cases being more common than moderate ones.
• Case Study: $14$-Year-Old Girl (Freshman in High School):
  • Context: No prior psychiatric history, but parents recently divorced, and mother suffered from very severe depression (flat affect, no intonation, short answers, indicating profound depression).
  • Symptoms:
    • Refused to go to school (a significant problem for a $14$-year-old).
    • Complained of physical symptoms like stomachache, headache, and nausea, which are common indicators of anxiety.
    • Attempted to stay home at all times, refusing social outings with friends.
    • Exhibited pseudomature behavior, taking over her mother's role (preparing food, making grocery lists).
  • Underlying Cause: Felt she couldn't leave her mother in such a state, fearing self-harm or neglect, and felt a need to care for her.
• Associated Features of SAD:
  • A history of fear of the dark (though this is common in most children).
  • A history of depressed mood (current or past).
  • Behavioral presentation can vary: may be demanding and intrusive, needing constant attention, or conscientious, eager to please, and compliant.
  • Older children tend to exhibit more physical complaints at the time of diagnosis.
• Triggers for SAD:
  • Hospitalization of the child or a parent.
  • Death of a parent.
  • Loss of a parent through divorce.
  • Parental depression.
  • (The $14$-year-old in the case study experienced two of these: loss of father through divorce and a severely depressed mother).
• Key Characteristics:
  • Can occur as early as preschool or as late as adolescence (e.g., $14$ years old, though late onset is very rare).
  • Tendency to be a chronic disease, relapsing and remitting over many years.
  • Highly incapacitating, especially if it leads to school refusal, impacting academic progress and peer relationships.
• Sex Ratio:
  • SAD, like most internalizing disorders discussed in this unit, is predominantly female-dominant. In externalizing disorders, males typically outnumber females (e.g., $2:1$ to $4:1$).

Post-Traumatic Stress Disorder (PTSD)

PTSD is a disorder increasingly recognized and discussed in media, characterized by long-lasting psychic trauma.

• Historical Context:
  • $1918$: Sigmund Freud coined the term and provided the first descriptions of psychological trauma in children.
  • **$1930s-1940s$ (World War II -