Emotional Disorders in Children
, CHAPTER I
INTRODUCTION
Mental health problems in children are a common problem in children. This
problem includes several types of emotional disorders which include depression,
anxiety, obsessive-compulsive disorder, and trauma which is characterized by the
internalization of the problem. Emotional problems in children such as anxiety,
depression, and post-traumatic stress disorder tend to appear in late childhood. The
disorder is often difficult for parents or caregivers to recognize because many
children have different speech developments to express their emotions clearly. Many
clinicians have difficulty distinguishing between normal emotional development (eg,
crying, fear) and severe and prolonged emotional distress, which is called
disturbance.1
Emotional disturbances (internalization) can be grouped into several
syndromes, although there is often overlap among these symptoms: depression,
withdrawal, anxiety and feelings of loneliness. Some additional features of
internalizing disorder are low self-esteem, suicidal behavior, poor academic
performance, and social withdrawal. Grief can cause bigger problems, such as social
withdrawal, suicidal behavior or thoughts, and other unexplained physical
symptoms.2
2
, CHAPTER II
LITERATURE REVIEW
A. Definition
According to the Diagnostic and Statistical Manual of Mental Disorders fifth
edition (DSM-5) emotional disorders in children are characterized by high levels
of negativity, which include:3,4
1. Anxiety disorder
2. Depressive disorder
3. Obsessive-compulsive disorder and others
4. Disorders related to trauma and stressors
B. Anxiety Disorders
Anxiety disorders(anxiety disorders) are the most common disorders in
young people, affecting an estimated 10% to 20% of young children and
adolescents. The hallmark of all anxiety disorders is the recurrent emotional and
physiological arousal in response to the perception of excessive threat or danger.
The anxiety disorders commonly found in children are separation anxiety disorder,
generalized anxiety disorder, social phobia and selective mutism.4,5
Separation anxiety is a normal stage of human development, starting at less
than one year of age, increasing around the ages of 9 and 18 months and
decreasing then disappearing at the age of 2 and a half years, which allows
children to still feel comfortable when separated from their parents while at
3
, school. About 15% of children show fear, embarrassment, and withdraw from
intense and persistent social situations when encountering new people or
environments. Children with this pattern have a higher risk of developing
separation anxiety disorder, generalized anxiety disorder and social phobia. These
children exhibit physiological traits such as increased resting heart rates and higher
morning cortisol levels. Separation anxiety disorder is a level of fear or anxiety
that occurs due to separation from parents or caregivers that exceeds normal
development. Diagnostic criteria for separation anxiety disorder according to the
Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5),
namely:3–5
1. Fear or anxiety caused by separation from the individual's primary attachment,
which is developmentally inappropriate and manifested by at least three of the
following symptoms:
a. Recurrent excessive distress in anticipation of or experiencing separation
from home or attachment figures.
b. Excessive and persistent feelings of anxiety about losing a major
attachment figure or about possible harm to them such as illness, trauma,
disaster or death.
c. Excessive and persistent feelings of anxiety that you will have an
unwanted experience that will result in separation from your primary
attachment figure.
d. Persistent reluctance or refusal to go outside, away from home, to school,
work, or other places caused by fear of separation.
4
, CHAPTER I
INTRODUCTION
Mental health problems in children are a common problem in children. This
problem includes several types of emotional disorders which include depression,
anxiety, obsessive-compulsive disorder, and trauma which is characterized by the
internalization of the problem. Emotional problems in children such as anxiety,
depression, and post-traumatic stress disorder tend to appear in late childhood. The
disorder is often difficult for parents or caregivers to recognize because many
children have different speech developments to express their emotions clearly. Many
clinicians have difficulty distinguishing between normal emotional development (eg,
crying, fear) and severe and prolonged emotional distress, which is called
disturbance.1
Emotional disturbances (internalization) can be grouped into several
syndromes, although there is often overlap among these symptoms: depression,
withdrawal, anxiety and feelings of loneliness. Some additional features of
internalizing disorder are low self-esteem, suicidal behavior, poor academic
performance, and social withdrawal. Grief can cause bigger problems, such as social
withdrawal, suicidal behavior or thoughts, and other unexplained physical
symptoms.2
2
, CHAPTER II
LITERATURE REVIEW
A. Definition
According to the Diagnostic and Statistical Manual of Mental Disorders fifth
edition (DSM-5) emotional disorders in children are characterized by high levels
of negativity, which include:3,4
1. Anxiety disorder
2. Depressive disorder
3. Obsessive-compulsive disorder and others
4. Disorders related to trauma and stressors
B. Anxiety Disorders
Anxiety disorders(anxiety disorders) are the most common disorders in
young people, affecting an estimated 10% to 20% of young children and
adolescents. The hallmark of all anxiety disorders is the recurrent emotional and
physiological arousal in response to the perception of excessive threat or danger.
The anxiety disorders commonly found in children are separation anxiety disorder,
generalized anxiety disorder, social phobia and selective mutism.4,5
Separation anxiety is a normal stage of human development, starting at less
than one year of age, increasing around the ages of 9 and 18 months and
decreasing then disappearing at the age of 2 and a half years, which allows
children to still feel comfortable when separated from their parents while at
3
, school. About 15% of children show fear, embarrassment, and withdraw from
intense and persistent social situations when encountering new people or
environments. Children with this pattern have a higher risk of developing
separation anxiety disorder, generalized anxiety disorder and social phobia. These
children exhibit physiological traits such as increased resting heart rates and higher
morning cortisol levels. Separation anxiety disorder is a level of fear or anxiety
that occurs due to separation from parents or caregivers that exceeds normal
development. Diagnostic criteria for separation anxiety disorder according to the
Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5),
namely:3–5
1. Fear or anxiety caused by separation from the individual's primary attachment,
which is developmentally inappropriate and manifested by at least three of the
following symptoms:
a. Recurrent excessive distress in anticipation of or experiencing separation
from home or attachment figures.
b. Excessive and persistent feelings of anxiety about losing a major
attachment figure or about possible harm to them such as illness, trauma,
disaster or death.
c. Excessive and persistent feelings of anxiety that you will have an
unwanted experience that will result in separation from your primary
attachment figure.
d. Persistent reluctance or refusal to go outside, away from home, to school,
work, or other places caused by fear of separation.
4
