Anxiety Disorders

Anxiety Disorders

Anxiety Disorders share features of excessive fear and anxiety, and related behavioral disturbances.

What kinds of behaviors do you think these are?

Definitions

Fear-The emotional response to a real or perceived threat, usually responded with “fight or flight”

Anxiety-anticipation of a future threat, often associated with muscle tension and cautious and avoidant behaviors

Panic Attacks-type of fear response, also found in other types of disorders

Anxiety is Normal

However, anxiety can become a disorder when:› Anxiety is excessive› Anxiety is persistent (lasts 6 months or

more)

Facts

More prominent in women (2:1) People overestimate the dangers that

they are facing, which the clinician will decide, based on the cultural context

Many anxiety disorders develop in childhood and can get worse if left untreated

There are different anxiety disorders for different developmental ages

Anxiety Disorders 1. Separation Anxiety Disorder 2. Selective Mutism 3. Specific Phobia 4. Social Anxiety Disorder 5.Panic Disorder 6.Agoraphobia 7.Generalized Anxiety Disorder 8. Substance/Medication Induced Anxiety

Disorder 9. Anxiety Disorder Due to a Medical Condition 10. Other Specified Anxiety Disorder 11. Unspecified Anxiety Disorder

1. Separation Anxiety Disorder Diagnostic Criteria:

› Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least 3 of the following:

Recurrent distress when anticipation or experiencing separation

Persistent worry about losing major attachment figures to harm, illness or death

Persistent worry about experiencing an event that would cause separation (ie. Being kidnapped)

Persistent reluctance or refusal to go anywhere without the person

Persistent fear about being alone at home or other settings without the person

Persistent reluctance or refusal to sleep without the person Repeated nightmares involving separation Repeated complaints of physical pain and symptoms when

separated from the person

1. Separation Anxiety Disorder Continued...

The disturbance must last for at least 4 weeks in children and teens, and 6 months in adults

Children with this disorder may get angry when separated, need constant attention, may be demanding and intrusive, and are often “homesick”

Remember that having some separation anxiety in children is normal!!!

1. Separation Anxiety Disorder Continued...

Prevalence: 0.9- 1.9% of adults Prevalence: 4% of children Often develops after a life stress,

especially a big loss (pet, grandparent, etc.) but also after a move, divorce, etc.

Parental overprotection and intrusiveness is often associated with it

Heritability has been estimated as high as 73%

Often comorbid with Generalized Anxiety Disorder and Specific Phobia Disorder

1. Separation Anxiety Disorder Differential Diagnosis (it looks a lot like...)

› Generalized Anxiety Disorder› Panic Disorder› Agoraphobia› Conduct Disorder› Social Anxiety Disorder› Post Traumatic Stress Disorder› Illness Anxiety Disorder› Bereavement› Depressive Disorders› Oppositional Defiance Disorders› Psychotic Disorders› Personality Disorders

2. Selective Mutism This disorder is a consistent failure to speak in

specific social situations in which there is an expectation for speaking (ie. School), despite being able to speak in other situations.

It interferes with educational or occupational achievement

Duration must be at least 1 month Can not be explained by the individual having

a lack of knowledge, or by a Communication Disorder (which is a Neurodevelopmental Disorder)

Occurs before age 5, and is found in 0.03-1.0% of children

3. Specific Phobia Diagnostic Criteria:

› Marked fear or anxiety about a specific object or situation

› The phobic object or situation always provokes immediate fear

› The phobic object is avoided always› The fear is out of proportion to the actual

threat› The fear is persistent, lasts more than 6

months› The fear causes signficant distress or

impairment in social, occupational, or other important areas of functioning

3. Specific Phobia-Specifiers

Several Specifiers for Specific Phobia Disorder:

A. Animals B. Natural Environment C. Blood-Injection-Injury D. Situational E. Other

Can you name an example of each?

3. Specific Phobia

Most prevalent in North America (7-9%) Usually develops in early childhood Children’s symptoms are usually

crying, tantrums, freezing, and clinging Environmental risk factors include

overprotective parents, parental loss and separation, physical and sexual abuse, and traumatic experience with the phobia before it started

4. Social Anxiety Disorder This is having marked fear or anxiety about one

or more social situations in which the individual is exposed to possible scrutiny by others.

Examples include social interactions (ie. Having a conversation), being observed (ie. Eating or drinking), and performing in front of others.

Impairs their professional life Occurs in about 7% of the population, highest in

North American countries, and in women Usually starts around 8-15 years old. Why? Differential Diagnosis is huge! It looks like

several other disorders. Can you think of any?

5. Panic Disorder

Panic Attacks must be recurrent!!! (A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time, the person experiences a lot of symptoms).

The person must have 4 symptoms in order for it to be called a Panic Attack

What do you think the symptoms of a panic attack are?

Panic Attack Symptoms Heart palpitations Sweating Trembling or shaking Shortness or breath Feelings of choking Chest pain Nausea or abdominal

distress Feeling dizzy or faint Chills or heat sensations Numbess or tingling Delrealization or

depersonalization Fear of losing control or

going crazy Fear of dying

After panic attack, for at least 1 month, you must have persistent worry that you are going to have another one

Your behavior has to negatively change because of the panic attack

5. Panic Disorder Prevalence: 2-3% adults Age of onset is around 20-24 years old Rare in children Negative emotions and anxiety sensitivity are

risk factors Reports of childhood physical and sexual abuse

are more common in panic disorder than other anxiety disorders

Most people report identifiable stressors in the months before their first panic attack

Several genes confer vulnerability to panic disorder

6.Agoraphobia Marked fear or anxiety about two (or more) of

the following situations:› Using public transportation› Being in open spaces› Being in enclosed spaces› Standing inline or being in a crowd› Being outside of the home alone

The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms

6. Agoraphobia Prevalence: 1.7% of adolescents and

adults have it Females are twice as likely as males to

have it Negative events in childhood and other

stressful events, such as being attacked or mugged, are associated with the onset of agoraphobia

The family climate is characterized by reduced warmth and overprotective

7. Generalized Anxiety Disorder (GAD)

Excessive anxiety and worry, occurring more days than not, for at least 6 months, about any and all events and activities, which causes significant distress and impairment to the individual’s daily life.

The individual can not control the worry Must have 3 of the following six symptoms:

› Restlessness or feeling on edge› Being easily fatigued› Difficulty concentrating› Irritability› Muscle tension› Sleep disturbances

7. GAD Prevalence: 0.9% in teens Prevalence: 2.9% in adults What do teens and adults worry about? Accounts for 110,000,000 sick days per year in

the USA Females are twice as likely as males to get

GAD Many report feeling nervous and anxious their

entire life No environmental factors specific to GAD 1/3 of the risk is genetic, and these genetic

factors overlap with the risk of neuroticism and mood disorders, and depression

7. GAD Differential Diagnosis

GAD looks a lot like...› Anxiety disorder due to a medical condition› Substance/medication induced anxiety

disorder› Social anxiety disorder› Obsessive-compulsive disorder› Posttraumatic stress disorder› Depressive disorders

8. Substance/Medication Induced Anxiety Disorders

Substance Intoxication can produce anxiety

Substance Withdrawl can produce anxiety. So why not just diagnose these people

with an substance use disorder? Their anxiety and panic attacks are so

bad, it predominates, and they require clinical intervention

What kinds of substances do you think can cause this anxiety disorder?