Understanding Anxiety Disorders

Anxiety Disorders

• Most anxiety disorders result from a combination of factors
• These factors are the behavioral inhibition system, parents modeling anxiety/enabling avoidance and experiencing stressful life events.
• Anxiety disorders are based on fears, not worries

Anxiety Disorder Onset

• Separation anxiety disorder is likely to begin in childhood
• Panic disorder is likely to begin in adulthood

Specific Phobias

• Specific phobias are NOT curable within one day but are maintained by negative reinforcement, and developed entirely from environmental causes

Comorbidity of Anxiety Disorders

• Social anxiety disorder is the most common comorbid diagnosis with other anxiety disorders

Comorbidity of Generalized Anxiety Disorder

• Generalized anxiety disorder is the anxiety disorder most likely to be co-diagnosed with depressive disorders

OCD

• Obsessive compulsive disorder is preoccupies individuals with cleanliness and orderliness, but otherwise, allows individuals to function normally daily

Treatment

• Exposure therapy is a critical ingredient in treating anxiety disorders and OCD
• Combining SSRIs and CBT is a good course of care for many anxiety disorders and OCD

Panic Disorder Sensitivity

• Individuals with panic disorder have a proneness to anxiety sensitivity

Polyvictims

• Polyvictims experienced multiple forms of childhood maltreatment
• Polyvictims are more likely to experience severe trauma
• Sexual abuse is the most common form of childhood maltreatment, and the perpetrators are most likely to be males

Childhood Maltreatment

• Sexual abuse has the most severe and pervasive consequences
• Perpetrators of sexual abuse are unlikely to be strangers

PTSD

• Most victims of trauma develop post-traumatic stress disorder
• An adolescent experiencing recurrent physical abuse from a parent with symptoms lasting 3 weeks should be diagnosed with acute stress disorder
• Avoidance coping increases the risk of children developing PTSD when exposed to trauma
• Relying on avoidance to cope with stressors increases risks of PTSD

PTSD and Gender Association

• Girls are more likely to develop comorbid disruptive behavior disorders with persistent PTSD
• Boys are more likely to develop comorbid depression or anxiety disorders with persistent PTSD

PTSD Prevention

• The evidence-based approach to preventing onset of PTSD after trauma is Psychological first aid.
• Gradual re-exposure to the trauma imaginally is key in evidence-based treatment

Anxiety

• Anxiety is evolutionarily adaptive and generates the fight or flight response
• Anxiety is generated by the sympathetic nervous system
• Adaptive anxiety allows to react immediately to perceived threats to reduce potential for harm
• Anxiety helps think and act effectively and prepares for scary or dangerous events or things

Maladaptive Anxiety

• Maladaptive anxiety is intense and out of proportion to the threat
• Maladaptive anxiety is often age-inappropriate
• Maladaptive anxiety impairs functioning and interferes with daily tasks

Genetic Variability

• 30-40% of the variability in anxiety is explained by genetics
• Overactive Behavioral Inhibition receives too much input from the amygdala
• In an Overactive Behavioral Inhibition system, there is not enough input from the portion of the prefrontal cortex
• The HPA axis response is exaggerated by non-serious threats that do not habituate to recurrence of the same threat

Triple Vulnerability Model

• Parents modeling anxiety leads to over-protective, hyper-critical, and insecure attachment
• Experiencing near drowning could leads to fear of water

Fear vs Worry

• Fear anxiety is a behavioral and physiological reaction to current danger with strong escape tendency
• Worry anxiety involves cognitive preparation for future events that might be threatening

Disorder Emergence

• Separation anxiety disorder, specific phobia, and social anxiety disorder emerge in early-mid childhood
• Generalized anxiety disorder and Panic disorder are rare in childhood but can occur in adolescence/adulthood

Separation Anxiety Disorder (SAD)

• SAD involves developmentally inappropriate and excessive fear/anxiety concerning separation
• Normal separation fear emerges at 7 months and peaks at 13-18 months, then declines at 3-5 years
• Fear declines at 3-5 years except for those with a disorder
• Those with SAD have more intense, impairing fears than peers
• Separation Anxiety prevalence is 4-10%, more in girls
• 1/3 of SAD persist into adulthood
• 2/3 also have another anxiety disorder, with 1/2 developing depression

Specific Phobias

• Specific phobias include marked fear/anxiety about specific objects or situations
• 1 in 5 kids have specific phobias and tend to have multiple phobias
• Specific phobias are the most treated phobias
• Etiology of specific phobias is Classical Conditioning and Social Learning (maintained negative reinforcement/avoidance)

Social Anxiety Disorder

• Social Anxiety Disorder involves marked fear/anxiety about social situations with possible scrutiny
• Social Anxiety Disorder prevalence is 6-12%
• Girls are 2x more likely than boys to have social anxiety disorder " due to be more sensitive to evaluation especially in adolescence"
• Social Anxiety Disorder is the most common comorbid diagnosis of anxiety disorders; depression and substance use are common with SAD
• People are reluctant to seek treatment

Panic Disorder

• Panic Disorder involves recurrent, unexpected panic attacks
• Diagnosing panic disorder relies on persistent concern, worry about panic attacks, or significant maladaptive behavior
• Panic Disorder prevalence in adolescents is 16% have had at least one panic attack "especially in women"
• Panic Disorder is relatively uncommon in children as only 2.5% diagnosed are prior to age 18
• An "anxiety sensitive" individual tends to perceive anxiety as extremely upsetting/aversive with unusually high sensitivity to physiological symptoms

Agoraphobia

• Agoraphobia includes marked fear/anxiety about being somewhere and unable to get help
• Agoraphobia commonly presents with additional anxiety disorders, depression, and alcohol IUD
• Agoraphobia usually develops when individuals associate certain places with panic attacks
• Individuals either avoid these places or endure these places with intense dread

Generalized Anxiety Disorder (GAD)

• GAD is Constant, excessive anxiety/worry that is difficult to control
• Generalized Anxiety Disorder has no sex differences
• Generalized Anxiety Disorder is the least common anxiety disorder amongst those with any anxiety disorder with multiple comorbidities
• Generalized Anxiety Disorder can persist for years, with/without treatment

Cognitive Avoidance Theory

• Cognitive Avoidance Theory states worry avoids thinking about problems, "rumination, not problem-solving"
• Cognitive Distortions includes catastrophize, overgeneralize, and personalize

Obsessive Compulsive Disorder (OCD)

• OCD involves recurrent, persistent, intrusive thoughts/urges/images
• Checking, repeating rituals, and washing/grooming is statistically most common
• 1-2.5% of Children have OCD
• In Childhood, girls aren't more likely than boys to have OCD; OCD symptoms in children are more likely to change over time than adults
• OCD comorbid disorders includes anxiety, depression, SUDS, and eating pathology later
• Patients who don't come in for therapy are hard to treat and never see mental health professionals for assessment or treatment

Therapy

• Exposure Therapy is the first line treatment for pediatric anxiety disorder
• Exposure therapy involves confronting discrete stimulus causing fear/worry by providing coping skills
• Exposure is Graded and works best in real-life settings over hours/days
• Psychosocial Treatments for Phobias are Systematic desensitization, flooding, modeling and reinforcement
• Systematic Desensitization is based on classical conditioning and includes reviewing behaviors incompatible with stress responses using a fear hierarchy
• Flooding includes massed exposure and therapist demonstrating the stimulus can be handled so child is reinforced for confronting fear
• Cognitive Behavioral Therapy is a psychosocial treatment for Separation Anxiety, social anxiety and Generalized Anxiety, which includes changes in thinking to affect how a person feels and acts
• The Coping Cat is defined as Cognitive Behavioral Therapy for childanxiety which allows childrenlearn about anxiety and use individualized skills
• The Coping Cat challenges negative automatic thoughts
• By the end of the Coping Cat treatment, more than half no longer have an anxiety disorder

Childhood Maltreatment

• Childhood Maltreatment encompasses any recent act/failure to act by a parent or caretaker resulting in imminent risk, death, serious harm, sexual abuse or exploitation
• The types of childhood maltreatment are physical, sexual, psychological, and neglect with 1 in 5 most severe victims are polyvictims and most common in whites
• The FEAR plan recognizes F: feeling frightened, E: expecting bad things to happen, A: attitudes and actions that will help, R: results and rewards
• False, it’s a goodidea to involve parents in psychosocial treatments
• CBT with Panic Disorder involves -Relaxation training -Graded interoceptive exposure, -Cognitive Restructuring, and -Graded in-vivo exposure
• Graded interoceptive exposure treats fear of physiological symptoms through triggering symptoms and having clients sit through it
• Psychosocial Treatment for OCD is Exposure and Response Prevention which involves deep breathing/muscle relaxation that progresses through hierarchical stimuli

Childhood Maltreatment and Trauma

• Child and parental education in tandem with Exposure & Response Prevention can reduce rituals in the family unit
• CBT, if more severe as well as medicine, are the first line treatment for young children
• Selective serotonin re-uptake inhibitors (SSRIs) are medications for anxiety and OCD
• One or both parents are more likely to perpetrate maltreatment over nonparental figures
• Non-parents, fathers, male caregivers are those who are most likely perpetrators of sexual abuse with 2.6 to 7.8 million children affected yearly
• There are 3.5 million investigations yearly where 678,000 to 900,000 are substantiated
• .9 to 1.3% of children/adolescents are maltreated every year by means of neglect
• Not providing basic physical, education/emotional needs is failure of needs can cause failure to thrive
• No sex differences in terms of abuse with no parental access given to pre-adolescents

Consequences of Physical Abuse of Children

• Injuries such as Bruises, cuts, burns, and broken bones, can cause ptsd and disruptive patterns
• Psychological Abuse consists of threats, put-downs, and name-calling which is just as detrimental as emotional abuse with no distinction for sex
• Sexual Abuse can cause intercourse, rape, molestation or exploitation as 1/4 in are girls and 1in 20 for people generally speaking by an adolescents majority
• 1/3 do not report while suffering from the consequences such as Substance Use Disorders, anxiety disorders, eating pathology, PTSD, suicidal ideation/behavior, self-harm, and depressive disorders

Predictors of Maltreatment and Outcomes

• Sexual abuse increases the risk of school drop out, medical problems, unintended revictimization, and lack of information on trauam in sex
• Girls are falsely percieved to be less abused and boys more by non-familiar abusers
• Poor understanding a child's mental state cause more violent child abuse
• Mal coping via neglect from parental figures can result in violence
• Social relationship deficits and neurotic disorders cause children to develop problems
• Exposure to harm, threatened deaths and external events lead to cc% of adolescents in the USA experiencing this sort of trauma "25-30"percent
• Most cases lead to PSTD symptoms that fade within 6 months and 4=6% are more likely that Girls will obtain this rather than males on average