Internalizing Disorders Study Guide .docx

**Understanding Anxiety Disorders** Anxiety is a mood state characterized by strong negative emotions and bodily symptoms of tension in anticipation of future danger or misfortune.\ \ Anxiety involves strong negative emotions, bodily symptoms of tension, anticipation of future events, and frequen...

**Understanding Anxiety Disorders** Anxiety is a mood state characterized by strong negative emotions and bodily symptoms of tension in anticipation of future danger or misfortune.\ \ Anxiety involves strong negative emotions, bodily symptoms of tension, anticipation of future events, and frequent worries and fears about things that may not have occurred yet.\ \ Anxiety disorders often involve experiencing excessive and debilitating anxieties and can occur in various forms.\ \ A certain degree of anxiety is necessary for survival as it is biologically ingrained in our DNA. However, it becomes a disorder when it interferes with daily activities and functioning.\ \ Many children with anxiety disorders suffer from more than one type of disorder and display various associated characteristics including cognitive disturbances, physical symptoms, social and emotional deficits, anxiety, and depression.\ \ Cognitive disturbances involve disruptions in how information is perceived and processed, including disruptions in the senses, intelligence, academic achievement, and school issues.\ \ Children with anxiety disorders may also have ADHD, so screening for anxiety disorders is important when considering an ADHD diagnosis. **Anxiety Disorders in Children** Anxiety symptoms in children may be accompanied by deficits in memory, attention, theory of mind, and speech and language problems.\ \ High anxiety levels can interfere with academic performance, leading to concerns from teachers. Practitioners should seek insight from teachers by using rating forms such as SNAP 4 and Vanderbilt forms.\ \ Children with generalized social anxiety may drop out of school prematurely due to difficulty with social settings and crowds.\ \ Threat-related attention biases involve selective attention to potentially threatening information as a defense mechanism.\ \ Cognitive errors and biases are perceptions of threats that may activate danger-confirming thoughts, leading to anxiety provoking situations.\ \ Children with conduct problems may respond aggressively to perceived threats, both externally and internally.\ \ Children with anxiety disorders may feel helpless and lack control over anxiety-related events, leading to the manifestation of the disorder.\ \ When anxiety interferes with daily function, it is considered a psychiatric disorder.\ \ Children with anxiety disorders may display physical symptoms such as stomachaches and headaches. **Anxiety Disorders and Adolescent Behavior** 80% of anxiety disorders are associated with sleep-related problems, such as panic attacks at night\ \ Some anxiety disorders manifest as night terrors, leading to paralysis\ \ Adolescents with high rates of anxiety have reduced accidents and accidental deaths in early adulthood\ \ Anxious children often display low social performance and high social anxiety, as well as low self-esteem and difficulty making and maintaining friendships\ \ Anxiety in children can be mistaken for autism, but may not exhibit all characteristics typical of autism spectrum disorder\ \ Children with anxiety issues may have normal intelligence and developmental progress, but struggle with social and pragmatic skills, speech and expressive language deficits, and academic challenges\ \ Symptoms can be categorized as \"positive\" (leading to a disorder) and \"negative\" (protective factors)\ \ Anxiety disorder can co-occur with other conditions, and clinical semi-structured interviews can help make differentiations\ \ Depression is diagnosed more often in children with multiple anxiety disorders\ \ Negative affectivity, positive affectivity, and physiological hyperarousal are factors associated with anxiety and depression\ \ Prevalence rate temporarily suggests a higher incidence of anxiety disorder in girls, possibly because of genetic influence and environmental influences **Theories and Interpretation of Anxiety** Anxiety is experienced differently across cultures and can be influenced by density and culture.\ \ Cultural upbringing and socialization play a role in how an individual copes with anxiety conditions or disorders.\ \ Classical psychoanalytic theory, founded by Sigmund Freud, views anxieties and phobias as defenses against unconscious conflicts rooted in early childhood upbringing, involving the ego, id, and superego. Behavior and learning theories suggest that fears and anxiety can be learned and maintained through classical and operant conditioning, resulting in triggered anxiety responses.\ \ The theory of attachment emphasizes the importance of effective attachment between child and parents for survival, as early insecure attachments can lead to development of anxiety and avoidance behaviors.\ \ No single theory fully explains anxiety in both children and adults, highlighting the complexity of anxiety interpretation and expression. **Neurobiological Factors of Anxiety Disorders** Variations in behavior reactions and novelty are partially due to inherited differences in brain neurochemistry.\ \ The amygdala is responsible for reacting to unfamiliar or unexpected events, projecting to various brain structures and the sympathetic nervous system, leading to anxiety.\ \ Behavior inhibition (BI) results in low stress responses to novelty, placing individuals at greater risk for anxiety disorders.\ \ Development of anxiety disorder in behaviorally inhibited children depends on gender, exposure to early maternal stress, and parental responses.\ \ Family and genetic risk, with about 1 third of childhood anxiety symptoms being genetic.\ \ Serotonin and dopamine systems are related to anxiety, with genes linked to anxiety-related traits such as behavioral inhibition.\ \ The HPA axis and limbic system, among other brain structures, are responsible for producing anxiety and the anxiety escape response.\ \ Neurobiological factors, including an overreactive behavior inhibition system (BIS) shaped by early life stressors, may contribute to anxiety symptoms.\ \ Brain abnormalities have also been implicated in children exhibiting anxiety symptoms. **Understanding and Addressing Childhood Anxiety** GABAergic neurotransmitter is a primary neurotransmitter implicated in anxiety disorders.\ \ Parent-child interaction can either decrease or increase anxiety in children.\ \ Parental practices can lead to anxiety in children, and training parents to recognize their impact is important.\ \ Anxious children\'s parents are often seen as overinvolved, intrusive, or limiting independence, and may be scared themselves.\ \ High levels of family dysfunction, low socioeconomic status, and insecure early attachments are factors associated with extreme anxious behaviors in children.\ \ Treatment for childhood anxiety involves exposing children to anxiety-producing situations, objects, and occasions.\ \ Excessive and uncontrollable anxiety can be debilitating, and the neurotic paradox is a self-defeating behavior pattern where there is no real threat.\ \ The anxiety response system involves the physical, cognitive, and behavioral systems, which results in feelings of apprehension, nervousness, difficulty concentrating, and panic, leading to behavioral manifestations such as aggression and a desire to escape.\ \ Symptoms of anxiety include palpitations, fatigue, increased respirations, nausea, upset stomach, blurred vision, dry mouth, muscle tension, sweating, numbness, vomiting, blushing, dizziness, and cognitive symptoms such as thoughts of harm or death. **Childhood Anxiety** Common manifestations of childhood anxiety include bodily injury, thoughts of incompetence or inadequacies, self-deprecatory and self-critical thoughts, contamination fears, feelings of appearing foolish, forgetfulness, and other irrational thoughts.\ \ Behaviors frequently associated with childhood anxiety include avoidance, crying, screaming, nail biting, trembling voices, stuttering, thumb sucking, twitching, fidgeting, and various physical symptoms.\ \ Anxiety is a future-oriented mood state that may occur in the absence of realistic danger, while fear is presently oriented and occurs in the face of current danger. Panic involves a group of physiological symptoms and an intense feeling of doom in the absence of actual danger or threat.\ \ Normal fears and anxiety are common in childhood and adolescence, but when they interfere with daily activities, they can become problematic. Various fears and anxiety symptoms can manifest at different ages and may change over time depending on the situation.\ \ Some common fears and anxiety symptoms in childhood and adolescence may include separation anxiety, test anxiety, excessive concern about competence, and excessive need for reassurance.\ \ Girls generally display more anxiety than boys, but the symptoms are similar, and specific anxiety may decrease with age. Worry serves a function in normal development and can help prepare children for adulthood. **Anxiety Disorders in Children** Children with anxiety disorders worry more intensely than other children, although they do not necessarily worry more.\ \ Normal routines help children gain control and mastery of their environment. Repetitive behaviors and the need to do things perfectly can develop as coping mechanisms and resemble OCD.\ \ There are 7 categories of anxiety disorders: separation anxiety disorder, social anxiety disorder, panic disorder, general anxiety disorder, selective mutism, agoraphobia, and specific phobia.\ \ It\'s important to be careful with abbreviations and consider the context in which they are being used.\ \ Separation anxiety is typically normal from 8 to 7 months to preschool years, and the lack of it may suggest an insecure attachment and anxiety.\ \ Separation anxiety disorder is characterized by age-inappropriate, excessive, and disabling anxiety about being apart from parents or away from home.\ \ It is one of the most common childhood anxiety disorders, affecting 4 to 10% of children, and is more prevalent in girls than in boys.\ \ More than 2 thirds of children with separation anxiety disorder have another anxiety disorder and about half have developed a depressive disorder.\ \ It has the earliest reported age of onset of anxiety disorders and can persist into adulthood for more than 1 third of affected children and adolescents. **School Refusal Behavior and Specific Phobias** School refusal behavior is the refusal to attend classes or difficulty remaining in school for an entire day, occurring often between the ages of 5 to 11 years old.\ \ The fear of school may be due to separation anxiety or other reasons.\ \ Serious long-term consequences result if school refusal behavior remains untreated.\ \ Specific phobias affect about 20% of children at some point in their lives, with onset typically at 7 to 9 years old and more common in girls.\ \ Phobias involving animals, darkness, insects, blood, and injury are common.\ \ Social anxiety disorder, or social phobia, is a marked fear of social or performance requirements exposing a child to scrutiny and possible embarrassment.\ \ Individuals with social phobia are likely to be highly emotional, socially fearful, inhibited, and lonely.\ \ The lifetime prevalence of social anxiety disorder is about 6 to 12% in children, with twice as common occurrence in girls as in boys.\ \ Two-thirds of those with social anxiety disorder also have another anxiety disorder, and 20% suffer from major depression and may self-medicate with alcohol or drugs in adolescence. **Anxiety Disorders in Children and Adolescents** Selective mutism is a type of anxiety disorder where children fail to talk in specific social situations, despite being able to speak loudly and frequently in other settings.\ \ It is estimated to occur in about 0.7% of children, with an average age of onset at 3 to 4 years old.\ \ Panic attacks are overwhelming periods of intense fear or discomfort, often accompanied by physical symptoms and engage in fight or flight responses.\ \ Panic attacks are rare in young children, but more common in adolescents, especially related to puberty.\ \ High anticipatory anxiety and situation avoidance may lead to agoraphobia, fear of being alone and avoiding certain places or situations.\ \ Bipolar disorder is less common, about 2.5% of teens between 13 to 17 years of age.\ \ Adolescents with persistent depression disorder may also experience anxiety and are at risk for suicidal behavior, alcohol, or drug use.\ \ The onset of panic disorders usually occurs between 15 to 19 years of age, with a low remission rate for any of the anxiety disorders. **Generalized Anxiety Disorder (GAD)** GAD is characterized by excessive and uncontrollable anxiety and worry, which can be episodic or almost continuous.\ \ Symptoms manifest in at least one somatic symptom, such as headaches, stomach aches, muscle tensions, and trembling.\ \ DSM-5 criteria for GAD includes excessive worry and anxiety for at least 6 months.\ \ Symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances.\ \ The anxiety and worry must cause significant distress or impairment in social, occupational, or important areas of functioning.\ \ Prevalence rate for GAD is about 2.2%, equally common in boys and girls.\ \ GAD is often accompanied by high rates of other anxiety disorders and depression.\ \ Average age of onset for GAD is early adolescence, and symptoms persist over time. **Obsessive Compulsive Disorder (OCD)** OCD is an end user disorder characterized by recurrent time consuming and disturbing obsessions and compulsions.\ \ Obsessions are persistent and intrusive thoughts, urges, or images that are experienced as intrusive and unwanted.\ \ Compulsions are repetitive, purposeful, and intentional behaviors or mental acts performed to relieve anxiety.\ \ OCD is extremely resistant to reason and can severely disrupt normal activities, family relations, and school functioning.\ \ Prevalence rate in children and adolescents for OCD is very low at about 1 to 2.5%.\ \ OCD is twice as common in boys, and comorbidity is most common with anxiety disorder, depressive disorder, and disruptive behavior disorders.\ \ Onset age of OCD is between 9 to 12 years of age, with peaks in early childhood and remission is a very hard diagnosis to achieve.\ \ Behavioral therapy, such as systematic desensitization, flooding, prolonged or repeated exposure, and response prevention, is an important treatment for OCD. **Treatment for Childhood Anxiety Disorders** Cognitive behavior therapy (CBT) is believed to trigger remission rates and is the most effective procedure for treating most anxiety disorders.\ \ CBT is frequently tested and is often used in conjunction with exposure-based treatment.\ \ CBT includes skills training and exposure combat to address problematic thinking and has been shown to be effective.\ \ Child-focused treatment may have a spillover effect into the family, resulting in more dramatic and lasting effects.\ \ Family treatment for OCD provides education about the disorder and helps families cope with their feelings.\ \ Medications, such as selective serotonin reuptake inhibitors (SSRIs), are effective in reducing symptoms, especially for OCD.\ \ Fluvoxamine, citrone, and clomipramide are some of the common medications used in childhood anxiety disorders, with specific dosages for different age groups. **Benzodiazepines and Paxil in Children** Benzodiazepines and Paxil should be avoided in children.\ \ It is important to remember that if Paxil and Benzodiazepines are prescribed for the treatment of any disorders in children, it is most likely not the correct answer in clinical practice.\ \ Review the concepts and be familiar with the clinical pearls and pitfalls, as well as the differences between some of these conditions.\ \ Part 2 of this lecture will be posted shortly. Thank you for your attention and participation.