Hoorcolleges (8 tm 12) van deel 2 Ontwikkelingspsychologie en psychopathologie

College 8 Trauma and anxiety

Overview




Part 1

Anxiety
Fear has a function!
 Essential to survival
 Helps in avoidance of dangerous situations

Adaptive  Problematic  Pathological
 Intensity, duration and pervasiveness
 4 Ds: Dysfunction, Distress, Deviance, Danger

Adaptive/nonclinical: most children have one or two fears appropriate to their age.

Problematic: interference with daily life and development

Anxiety disorders – shared characteristics
 Excessive fear and anxiety
 Related behavioral disturbances

Fear: emotional response to real/perceived imminent threat. Fear is related to
autonomic arousal that is necessary for fight or flight, escape behaviour.
Anxiety: anticipation of future threat. Anxiety is related to muscle tension and
vigilance. It is much longer lasting and maybe the treat isn’t present.

Not attributable to physiological effects of: (you always have to ask about what types
of medication someone is using and if someone is diagnosed with a medical
condition)
 Medication/substance
 Medical condition

Anxiety disorders – differences

,  Types of feared or avoided objects/situations
 Content of associated thoughts or believes

Anxiety disorders facts and figures
 Most prevalent
 Often early onset
 2:1 female to male ratio
 Wax and wane over time but they are chronic if not threated properly
 High comorbidity
 High individual impairment

DSM-5: Anxiety Disorders
 Separation Anxiety Disorder (e.g., parents leaving)
 Selective Mutism
 Specific Phobia
 Generalized Anxiety Disorders
 Social Anxiety Disorder
 Panic Disorder
 Agoraphobia

No longer considered anxiety disorders:
 OCD
 Acute stress disorder
 PTSD

Separation Anxiety Disorder
Non age-appropriate and excessive anxiety (or anticipation) of going away from
home or leaving attachment figures
 Excessive worry that caregivers may be harmed
 Persistent refusal to go anywhere which may cause separation
 Frequent nightmares about separation
 Recurrent physical complaints when not in close proximity to attachment
figures

Selective Mutism
 A child shows consistent failure to speak in specific social situations in which
there is an expectation for speaking (e.g., at school), despite speaking in other
situations.
 The disturbance interferes with educational, occupational and social
achievement and interaction
 Duration: at least 1 month (not limited to the first month of school)
 not attributable to a lack of knowledge of, or comfort with, speaking
 The disturbance is not better explained by other disorders
 Often co-exist with social anxiety disorder

,These behaviours are a method of self-protection during an experience of intense
anxiety. The age of onset is most often between two to four years of age. However
you don’t really identify it until kids go to school.

Specific phobia: DSM-5
 A marked, intense fear/anxiety of a specific object or situation that
substantially interferes with the person’s ability to function
 Phobic object almost always evokes immediate fear/anxiety
 Phobic object is actively avoided or endured with intense fear/anxiety
 Fear/anxiety is out of proportion (irrational)
 Persistent: >6months
 Not better explained by another disorder

Specific Phobia
 7.4% cross-national life-time prevalence
 Young age of onset (8 y/o)
 60% has at least 1 comorbid disorder
 Often suffered for many years
o Not always overt anxiety in daily life
 Recognize excessiveness of their fear reaction
o But not of actual danger

Generalized Anxiety Disorder – DSM-5
People worry about all sort of things (everyday things)
 Excessive anxiety and worry, occurring more days than not for at least 6
months about a number of events or activities
 Difficulty controlling the worry
 Associated with 3 or more other symptoms:
 Clinically significant distress or impairment
 Not attributable to medication, substance or other medical or mental disorder
 GAD vs. normal worry

Generalized Anxiety Disorders – Facts
 Prevalence: ~3%
 Age of onset: 25-30 y/o
o But often, anxiety reported all their lives
 66% has comorbid disorder

Social Anxiety Disorder – DSM-5
They are still able to speak (whereas someone with selective mutism does not
speak)

 Marked fear/anxiety about one or more social situations in which the individual
is exposed to possible scrutiny by others:
o Social interactions
o Being observed

, o Performing in front of others (children have to display these social fears
also around peers and not just with adults)
 Individual fears he/she will act in a way or show anxiety symptoms that will be
negatively evaluated
o humiliating or embarrassing
o leading to rejection or offending others
 Social situations (and behaviors) are avoided or endured with intense
fear/anxiety

Possible scrutiny: they are potentially critically observed.

Continued:
 Social situations almost always provoke fear or anxiety
 Fear/anxiety is out of proportion
 Persistent: > 6 months
 Clinically significant distress or impairment
 Not attributable to substance, medication, or other disorder/condition

Social Anxiety Disorder
 Prevalence: 2-5%
 Age of onset: adolescence (10-15 y/o)
 Panic attacks may occur

Panic Disorder – DSM-5
 Recurrent unexpected panic attacks
 Attacks are followed by one month period or more of (either/or):
o Persistent worry about having additional attacks or their consequences
o Significant change in behavior because of the attacks
 Not attributable to substance, medicine or other disorder

Panic attack: Abrupt surge of intense fear or discomfort that reaches a peak within 10
minutes and during which time 4 or more of the following symptoms occur:
 Pounding or accelerated HR
 Sweating  Trembling or Shaking
 Shortness or breath
 Feelings of choking
 Nausea
 Feeling dizzy, unsteady, light-headed or faint
 Chills or heat sensations
 Numbness or tingling sensations
 Derealization or depersonalization
 Fear of losing control or going crazy
 Fear of dying


Panic Disorder