Chapter 11 Anxiety and Obsessive-compulsive disorder
Anxiety is a mood state characterized by strong negative emotion and bodily symptoms
of tension in which the child apprehensively anticipates future danger or misfortune
(Barlow, 2002).
strong negative emotion
an element of fear
Children who experience excessive and debilitating anxieties are said to have anxiety
disorders.
neurotic paradox= even when someone knows there is little to be afraid of, he or she is
still terrified and does everything possible to escape or avoid the situation.
Anxiety involves an immediate reaction to perceived danger or threat—a reaction known
as the fight/flight response.
Physical effects
- Chemical effects. Adrenaline and noradrenaline are released from the adrenal
glands.
- Cardiovascular effects. Heart rate and strength of the heartbeat increase,
readying the body for action by speeding up blood flow and improving delivery of
oxygen to the tissues.
- Respiratory effects. Speed and depth of breathing increase, which brings oxygen
to the tissues and re- moves waste. This may produce feelings of breath- lessness,
choking or smothering, or chest pains.
- Sweat gland effects. Sweating increases, which cools the body and makes the skin
slippery.
- Other physical effects.
o The pupils widen to let in more light, which may lead to blurred vision or
spots in front of the eyes.
o Salivation decreases, resulting in a dry mouth.
o Decreased activity in the digestive system may lead to nausea and a heavy
feeling in the stomach.
o Muscles tense in readiness for fight or flight, leading to subjective feelings
of tension, aches and pains, and trembling.
Cognitive effects
Since the main purpose of the fight/flight system is to signal possible danger, its
activation produces an imme- diate search for a potential threat. For children with anxiety
disorders, it is difficult to focus on everyday tasks because their attention is consumed by
a con- stant search for threat or danger. When these children can’t find proof of danger,
,they may turn their search inward: “If nothing is out there to make me feel anx- ious,
then something must be wrong with me.”
Or they may distort the situation: “Even though I can’t find it, I know there’s something to
be afraid of.”
Behavioral effects
Unfortunately, avoidance perpetuates anxiety, despite the temporary feeling of relief.
Avoidance behaviors are negatively reinforced; that is, they are strengthened when they
are followed by a rapid reduction in anxiety. As a result, each time a child is confronted
with an anxiety-producing situation, the faster she or he gets out of it, the faster the
anxiety drops off—so the more the child avoids such situations. As children with anxiety
disorders engage in more and more avoidance, carrying out everyday activities becomes
exceedingly difficult.
Difference fear and anxiety and panic
Fear is an immediate alarm reaction to current danger or life-threatening emergencies.
Fear is a present-oriented emotional reaction to current danger marked by a strong
escape tendency and an all-out surge in the sympathetic nervous system
anxiety is a future- oriented emotion characterized by feelings of apprehension and lack
of control over upcoming events that might be threatening
only anxiety is frequently felt when no danger is actually present.
Panic is a group of physical symptoms of the fight/ flight response that unexpectedly
occur in the absence of any obvious threat or danger.
With no explanation for physical symptoms such as a pounding heart, the child may
invent one: “I’m dying.”
The sensations themselves can feel threatening and may trigger further fear,
apprehension, anxiety, and panic.
,Section summary
Description of Anxiety Disorders
Anxiety disorders are among the most common mental health problems in
children and adolescents, but they often go unnoticed and untreated.
Anxiety is an adaptive emotion that prepares youths to cope with potentially
threatening people, objects, or events. Strong negative emotions, physical
tension, and apprehensive anticipation of future danger or misfortune characterize
it.
The symptoms of anxiety are expressed through three interrelated response
systems: physical, cognitive, and behavioral.
Fear is a present-oriented emotional reaction to current danger. In contrast,
anxiety is a future-oriented emotion characterized by feelings of apprehension and
a lack of control over upcoming events that might be threatening.
Fears, anxieties, worries, and rituals in children are common, change with age,
and follow a predictable develop- mental pattern with respect to type.
DSM-5 specifies several types of anxiety and related disorders based on types of
reaction and avoidance.
Vormen van Anxiety Disorders
Separation anxiety disorder (SAD)
age-inappropriate, excessive, and disabling distress related to separation from their
parents or other major attachment figures and fear of being alone (Cooper-Vince et al.,
2014).
Prevalence and Comorbidity
1. SAD is one of the two most common anxiety disorders to occur during childhood
(the other is specific phobia), and it is found in about 4% to 10% of all youths
world-wide
2. It is common in both boys and girls, although it is more prevalent in girls.
3. About two-thirds of children with SAD have another anxiety disorder, and about
half develop a depressive disorder following the onset of SAD.
4. They may also display specific fears of getting lost or of the dark.
5. School reluctance or refusal is also quite common in older children with SAD
Onset, course and outcome
, 1. Of children referred for anxiety disorders, SAD has the earliest reported age at
onset (7 to 8 years) and the youngest age at referral
2. SAD generally progresses from mild to severe.
a. It may begin with harmless requests or with symptoms such as restless
sleep or nightmares, which progress to the child sleeping nightly in his or
her parents’ bed.
3. Sometimes SAD occurs after a child has experienced major stress
4. The symptoms of SAD may also fluctuate over the years as a function of stress
and transitions in the child’s life.
5. SAD persists into adulthood for more than one- third of children and adolescents,
and a number of individuals with SAD have a first onset after age 18
6. As adults, these individuals are more likely than others to experience relationship
difficulties, other anxiety disorders and mental health problems and functional
impairment in their social and personal lives
School refusal behavior is defined as the refusal to attend classes or dif- ficulty
remaining in school for an entire day.
School refusal is equally common in boys and girls, and it occurs most often between
the ages of 5 and 11 years.
Section summary
- Children with SAD display age-inappropriate, excessive, and disabling distress
related to separation from and fear of being alone without their parents or
other major attachment figures.
- SAD is one of the most common anxiety disorders of child- hood, with the
earliest reported age at onset and the youngest age at referral.
Anxiety is a mood state characterized by strong negative emotion and bodily symptoms
of tension in which the child apprehensively anticipates future danger or misfortune
(Barlow, 2002).
strong negative emotion
an element of fear
Children who experience excessive and debilitating anxieties are said to have anxiety
disorders.
neurotic paradox= even when someone knows there is little to be afraid of, he or she is
still terrified and does everything possible to escape or avoid the situation.
Anxiety involves an immediate reaction to perceived danger or threat—a reaction known
as the fight/flight response.
Physical effects
- Chemical effects. Adrenaline and noradrenaline are released from the adrenal
glands.
- Cardiovascular effects. Heart rate and strength of the heartbeat increase,
readying the body for action by speeding up blood flow and improving delivery of
oxygen to the tissues.
- Respiratory effects. Speed and depth of breathing increase, which brings oxygen
to the tissues and re- moves waste. This may produce feelings of breath- lessness,
choking or smothering, or chest pains.
- Sweat gland effects. Sweating increases, which cools the body and makes the skin
slippery.
- Other physical effects.
o The pupils widen to let in more light, which may lead to blurred vision or
spots in front of the eyes.
o Salivation decreases, resulting in a dry mouth.
o Decreased activity in the digestive system may lead to nausea and a heavy
feeling in the stomach.
o Muscles tense in readiness for fight or flight, leading to subjective feelings
of tension, aches and pains, and trembling.
Cognitive effects
Since the main purpose of the fight/flight system is to signal possible danger, its
activation produces an imme- diate search for a potential threat. For children with anxiety
disorders, it is difficult to focus on everyday tasks because their attention is consumed by
a con- stant search for threat or danger. When these children can’t find proof of danger,
,they may turn their search inward: “If nothing is out there to make me feel anx- ious,
then something must be wrong with me.”
Or they may distort the situation: “Even though I can’t find it, I know there’s something to
be afraid of.”
Behavioral effects
Unfortunately, avoidance perpetuates anxiety, despite the temporary feeling of relief.
Avoidance behaviors are negatively reinforced; that is, they are strengthened when they
are followed by a rapid reduction in anxiety. As a result, each time a child is confronted
with an anxiety-producing situation, the faster she or he gets out of it, the faster the
anxiety drops off—so the more the child avoids such situations. As children with anxiety
disorders engage in more and more avoidance, carrying out everyday activities becomes
exceedingly difficult.
Difference fear and anxiety and panic
Fear is an immediate alarm reaction to current danger or life-threatening emergencies.
Fear is a present-oriented emotional reaction to current danger marked by a strong
escape tendency and an all-out surge in the sympathetic nervous system
anxiety is a future- oriented emotion characterized by feelings of apprehension and lack
of control over upcoming events that might be threatening
only anxiety is frequently felt when no danger is actually present.
Panic is a group of physical symptoms of the fight/ flight response that unexpectedly
occur in the absence of any obvious threat or danger.
With no explanation for physical symptoms such as a pounding heart, the child may
invent one: “I’m dying.”
The sensations themselves can feel threatening and may trigger further fear,
apprehension, anxiety, and panic.
,Section summary
Description of Anxiety Disorders
Anxiety disorders are among the most common mental health problems in
children and adolescents, but they often go unnoticed and untreated.
Anxiety is an adaptive emotion that prepares youths to cope with potentially
threatening people, objects, or events. Strong negative emotions, physical
tension, and apprehensive anticipation of future danger or misfortune characterize
it.
The symptoms of anxiety are expressed through three interrelated response
systems: physical, cognitive, and behavioral.
Fear is a present-oriented emotional reaction to current danger. In contrast,
anxiety is a future-oriented emotion characterized by feelings of apprehension and
a lack of control over upcoming events that might be threatening.
Fears, anxieties, worries, and rituals in children are common, change with age,
and follow a predictable develop- mental pattern with respect to type.
DSM-5 specifies several types of anxiety and related disorders based on types of
reaction and avoidance.
Vormen van Anxiety Disorders
Separation anxiety disorder (SAD)
age-inappropriate, excessive, and disabling distress related to separation from their
parents or other major attachment figures and fear of being alone (Cooper-Vince et al.,
2014).
Prevalence and Comorbidity
1. SAD is one of the two most common anxiety disorders to occur during childhood
(the other is specific phobia), and it is found in about 4% to 10% of all youths
world-wide
2. It is common in both boys and girls, although it is more prevalent in girls.
3. About two-thirds of children with SAD have another anxiety disorder, and about
half develop a depressive disorder following the onset of SAD.
4. They may also display specific fears of getting lost or of the dark.
5. School reluctance or refusal is also quite common in older children with SAD
Onset, course and outcome
, 1. Of children referred for anxiety disorders, SAD has the earliest reported age at
onset (7 to 8 years) and the youngest age at referral
2. SAD generally progresses from mild to severe.
a. It may begin with harmless requests or with symptoms such as restless
sleep or nightmares, which progress to the child sleeping nightly in his or
her parents’ bed.
3. Sometimes SAD occurs after a child has experienced major stress
4. The symptoms of SAD may also fluctuate over the years as a function of stress
and transitions in the child’s life.
5. SAD persists into adulthood for more than one- third of children and adolescents,
and a number of individuals with SAD have a first onset after age 18
6. As adults, these individuals are more likely than others to experience relationship
difficulties, other anxiety disorders and mental health problems and functional
impairment in their social and personal lives
School refusal behavior is defined as the refusal to attend classes or dif- ficulty
remaining in school for an entire day.
School refusal is equally common in boys and girls, and it occurs most often between
the ages of 5 and 11 years.
Section summary
- Children with SAD display age-inappropriate, excessive, and disabling distress
related to separation from and fear of being alone without their parents or
other major attachment figures.
- SAD is one of the most common anxiety disorders of child- hood, with the
earliest reported age at onset and the youngest age at referral.
