Anxiety Disorders Notes

Anxiety Disorders

Introduction to Anxiety Disorders

  • Anxiety disorders are a category of mental health conditions characterized by excessive fear and anxiety.

  • They include behavioral disturbances that impede daily functioning.

Distinction Between Fear and Anxiety

  • Fear: An emotional response to real or perceived imminent threats.

  • Anxiety: The anticipation of future threats.

  • Anxiety disorders are characterized by fear or anxiety that persists beyond developmentally appropriate periods.

Developmentally Appropriate Fears

Age-Related Normal Fears

  • Birth to 6 Months:
      - Loud noises
      - Loss of physical support
      - Rapid position changes
      - Rapidly approaching objects

  • 7 to 12 Months:
      - Strangers
      - Looming objects
      - Unexpected objects or unfamiliar people

  • 1 to 5 Years:
      - Strangers
      - Storms
      - Animals
      - The dark
      - Separation from parents
      - Objects
      - Loud noises
      - Machines
      - The toilet

  • 6 to 12 Years:
      - Supernatural fears
      - Bodily injury
      - Disease
      - Burglars
      - Failure
      - Criticism
      - Punishment

  • 12 to 18 Years:
      - Performance in school
      - Peer scrutiny
      - Personal appearance
      - Performance anxieties

Types of Anxiety Disorders

  1. Separation Anxiety Disorder

  2. Selective Mutism

  3. Specific Phobia

  4. Social Anxiety Disorder (Social Phobia)

  5. Panic Disorder

  6. Panic Attack (specifier)

  7. Agoraphobia

  8. Generalized Anxiety Disorder

  9. Substance/Medication-Induced Anxiety Disorder

  10. Anxiety Disorder Due to Another Medical Condition

  11. Other Specified Anxiety Disorder

  12. Unspecified Anxiety Disorder

Separation Anxiety Disorder

Overview

  • Involves excessive fear or anxiety related to separation from home or attachment figures.

DSM Criteria for Separation Anxiety Disorder

  • Requires 3 or more of the following symptoms:
      - Excessive distress when separation from attachment figures occurs
      - Excessive fear or reluctance to be alone or without attachment figures
      - Excessive worry about losing attachment figures or possible harm to them
      - Excessive worry that an event will lead to separation
      - Reluctance or refusal to go to school due to fear of separation
      - Reluctance or refusal to sleep without being near attachment figures
      - Nightmares involving separation themes
      - Physical symptoms when separation occurs (e.g., stomachaches, headaches)

Duration and Impact

  • Symptoms must last for at least 4 weeks in children and adolescents, and 6 months or more in adults.

  • Causes clinically significant distress or impairment in functioning.

  • Not attributed to autism, delusions/hallucinations, agoraphobia, generalized anxiety disorder, or illness anxiety disorder.

Selective Mutism

Overview

  • Characterized by lack of speech in specific social interactions despite speaking in other situations.

DSM-5 Criteria for Selective Mutism

  • Consistent failure to speak in social situations where speaking is expected, lasting for at least one month.

  • Speech disturbance interferes with educational or occupational functioning or social communication.

  • Failure to speak is not due to lack of knowledge or comfort with the language.

  • Disturbance not better explained by a communication disorder (e.g., stuttering).

Specific Phobia

Overview

  • Fear or anxiety related to the presence of a specific object or situation known as a phobic stimulus.

DSM-5 Diagnostic Criteria for Specific Phobia

  1. Marked fear or anxiety about specific objects or situations, with visible reactions (e.g., crying, tantrums in children).

  2. Phobic object or situation typically provokes immediate fear or anxiety.

  3. The fear is disproportionate to the actual danger posed.

  4. Fear/anxiety/avoidance persists for 6 months or more.

  5. Causes clinically significant distress or impairment in functioning.

Types of Specific Phobias

  • Animal: Animals such as snakes or insects; generally begins in childhood.

  • Natural Environment: Fears involving natural events like storms or heights; also begins in childhood.

  • Blood, Injection, Injury Phobia: Fear of blood, injury, or injections.

  • Situational Phobia: Fear of specific situations like public transport or closed spaces; may arise in childhood or mid-20s.

  • Other Phobias: Fear of choking, contracting illnesses, etc.

Common Phobias

  • Agoraphobia: Fear of open spaces.

  • Claustrophobia: Fear of confined spaces.

  • Acrophobia: Fear of heights.

  • Mysophobia: Fear of being contaminated.

  • Xenophobia: Fear of strangers.

  • Necrophobia: Fear of death or dead things.

  • Brontophobia: Fear of thunder or lightning.

  • Carcinophobia: Fear of cancer.

  • Aviophobia: Fear of flying.

  • Arachnophobia: Fear of spiders.

Social Anxiety Disorder (Social Phobia)

Overview

  • Marked or intense fear of social situations where scrutiny by others may occur.

Diagnostic Criteria for Social Anxiety Disorder

  • A: Fear or anxiety about one or more social situations involving potential scrutiny.
      - Examples: having a conversation, being observed eating, performing in front of others.

  • B: Fear of acting in a way that will lead to negative evaluation (humiliation/embarrassment).

  • C: Social situations almost always provoke fear/anxiety.
      - In children, this may be expressed through crying, tantrums, or failure to speak.

  • D: Social situations are avoided or faced with intense anxiety.

  • E: The fear/anxiety is disproportionate to the actual threat.

  • F: Lasting at least 6 months.

  • G: Causes clinically significant distress/impairment in important areas of functioning.

  • H: Not due to the effects of a substance or another medical condition.

  • I: Not better explained by another disorder (e.g., panic disorder, autism spectrum disorder).

Albert Ellis

  • Born in Pittsburgh, Pennsylvania in 1913.

  • Eldest of three children, raised with a distant relationship with parents.

  • Father was frequently away; mother struggled with bipolar disorder.

  • Experienced significant illness during childhood, resulting in multiple hospitalizations.

  • Assisted in raising siblings until leaving home for studies in New York.

  • Achieved a business degree and pursued a writing career alongside.

  • 1942: Obtained a doctorate in clinical psychology.

  • Development of Rational Emotive Behavior Therapy (REBT) was influenced by his own struggles with public speaking.

Panic Disorder

Overview

  • Characterized by recurrent unexpected panic attacks.
      - A panic attack is an abrupt surge of intense fear or discomfort.

Symptoms of Panic Attack

  • Peaks within minutes and includes 4 or more of the following:
      - Feeling of imminent danger and the need to escape
      - Palpitations
      - Excessive sweating
      - Trembling
      - Shortness of breath
      - Feelings of choking
      - Chest pain or discomfort
      - Nausea or abdominal discomfort
      - Dizziness or lightheadedness
      - A sense of unreality or depersonalization
      - Fear of losing control or