Chapter 11 – anxiety and obsessive compulsive disorders
Description of anxiety disorders
Anxiety: mood state characterized by strong negative emotion and bodily symptoms of tension in
which the child apprehensively anticipates future danger or misfortune features are strong
negative emotion and an element of fear.
There are many forms. One of the most common mental health problems often unnoticed and
untreated.
Experiencing anxiety:
We detect and react to dangers signs of anxiety. It is normal at certain ages and situations. Some
anxiety is good and you will act more effectively adaptive emotion.
Children with anxiety disorder, is it the emotion that works against them. They experience fears, but
there are no real threats or dangers.
Neurotic paradox: the pattern of self-perpetuating behavior in which children who are overly anxious
in various situations, even while being aware that the anxiety may be unnecessary, find themselves
unable to abandon their self-defeating behaviors.
Fight/flight response: effects are aimed at escaping potential harm.
Symptoms in anxiety are expressed through 3 interrelated response systems:
1. Physical system: brain sends massages to the sympathetic nervous system produces fight/
flight response. Produces chemical and physical effects ready for action
o Chemical effects adrenaline
o Cardiovascular effects hearth rate
o Respiratory effects breathing
o Sweat gland effects cool the body
2. Cognitive system: search for threat or danger. Leads to subjective feelings of apprehension,
nervousness, panic and difficulty concentrating bad thoughts.
3. Behavioral system: avoidance behaviors are negatively reinforced fighting, not showing
up avoidance
Fear: immediate alarm reaction to current danger. Present oriented emotional reaction to current
danger anxiety nog future orientated emotion characterized by feelings of apprehension.
Panic: groups of physical symptoms of the fight/flight response that unexpectedly occur in the
absence of any danger.
Fears, anxieties, worries and rituals in children are common, change with age and follow a
predictable developmental pattern with respect to type.
- Normal fears girls have more fear than boys.
- Normal anxieties during childhood and adolescence.
- Normal worries help children to prepare for the future.
- Normal rituals and repetitive behavior, children prefer sameness.
Separation anxiety disorder (SAD):
Is normal until pre-school, but some experience it longer.
, SAD: display age-inappropriate, excessive and disabling distress related to separation from their
parents of other major attachments and fear of being alone.
Diagnostic criteria SAD DSM-5:
- Developmentally inappropriate and excessive fear or anxiety concerning separation (at least
3 symptoms):
o Recurrent excessive distress when anticipating or experiencing separation form
home
o Persistent or excessive worry about losing attachment figures possible harm
(illness, injury death)
o Persistent and excessive worry about experiencing an untoward event (getting lost,
kidnapped, accident) that causes separation form attachment figures
o Persistent reluctance of refusal to go out, away from home to school/work because
of fear separation
o Persistent and excessive fear of reluctance about being alone or without attachment
figures at home or other settings
o Persistent reluctance or refusal to sleep away from home or to go to sleep without
being near an attachment figure
o Repeated nightmares involving the theme of separation
o Repeated complaints of physical symptoms when separation form attachment
figures occurs or is anticipated
- Fear, anxiety or avoidance is persisting, lasting 4 weeks in children or adolescents, 6 months
in adults
- Disturbance causes clinically significant distress or impairment in social, academic,
occupational or others areas of functioning
- Disturbance is not better explained by another mental disorder
- Criteria and specify if should be deleted in their entirety. No substitutions for either
2/3 of the children with SAD also experience another anxiety disorder or depressive disorder (1/2).
Onset around 7/8 years. Progresses from mild to severe. SAD occurs after a child has experienced
major stress. Symptoms can fluctuate over the years. School performance may suffer from SAD.
Treatment emphasizes an immediate return to school and other routines.
School refusal behavior: refusal to attend classes or difficulty remaining in school for an entire day
(5-11 years).
Specific phobia:
Specific phobia: fear occurs at an inappropriate age, persists, is irrational or exaggerated, leads to
avoidance of the object or event and causes impairment in normal routines.
Diagnostic criteria specific phobia DSM-5:
- Marked fear or anxiety about a specific object or situation
- Phobic object or situation almost always provokes immediate fear or anxiety
- Phobic object or situation is actively avoided or endured with intense fear or anxiety
- Fear or anxiety is out of proportion to the actual danger posed by the specific object or
situation and to the sociocultural context
- Lasting 6 months or more
- Fear, anxiety or avoidance causes distress or impairment in social, occupational or other
areas of functioning
- Disturbance is not better accounted for by another mental disorder
Specific animals, natural environment, blood, situational and other.
Description of anxiety disorders
Anxiety: mood state characterized by strong negative emotion and bodily symptoms of tension in
which the child apprehensively anticipates future danger or misfortune features are strong
negative emotion and an element of fear.
There are many forms. One of the most common mental health problems often unnoticed and
untreated.
Experiencing anxiety:
We detect and react to dangers signs of anxiety. It is normal at certain ages and situations. Some
anxiety is good and you will act more effectively adaptive emotion.
Children with anxiety disorder, is it the emotion that works against them. They experience fears, but
there are no real threats or dangers.
Neurotic paradox: the pattern of self-perpetuating behavior in which children who are overly anxious
in various situations, even while being aware that the anxiety may be unnecessary, find themselves
unable to abandon their self-defeating behaviors.
Fight/flight response: effects are aimed at escaping potential harm.
Symptoms in anxiety are expressed through 3 interrelated response systems:
1. Physical system: brain sends massages to the sympathetic nervous system produces fight/
flight response. Produces chemical and physical effects ready for action
o Chemical effects adrenaline
o Cardiovascular effects hearth rate
o Respiratory effects breathing
o Sweat gland effects cool the body
2. Cognitive system: search for threat or danger. Leads to subjective feelings of apprehension,
nervousness, panic and difficulty concentrating bad thoughts.
3. Behavioral system: avoidance behaviors are negatively reinforced fighting, not showing
up avoidance
Fear: immediate alarm reaction to current danger. Present oriented emotional reaction to current
danger anxiety nog future orientated emotion characterized by feelings of apprehension.
Panic: groups of physical symptoms of the fight/flight response that unexpectedly occur in the
absence of any danger.
Fears, anxieties, worries and rituals in children are common, change with age and follow a
predictable developmental pattern with respect to type.
- Normal fears girls have more fear than boys.
- Normal anxieties during childhood and adolescence.
- Normal worries help children to prepare for the future.
- Normal rituals and repetitive behavior, children prefer sameness.
Separation anxiety disorder (SAD):
Is normal until pre-school, but some experience it longer.
, SAD: display age-inappropriate, excessive and disabling distress related to separation from their
parents of other major attachments and fear of being alone.
Diagnostic criteria SAD DSM-5:
- Developmentally inappropriate and excessive fear or anxiety concerning separation (at least
3 symptoms):
o Recurrent excessive distress when anticipating or experiencing separation form
home
o Persistent or excessive worry about losing attachment figures possible harm
(illness, injury death)
o Persistent and excessive worry about experiencing an untoward event (getting lost,
kidnapped, accident) that causes separation form attachment figures
o Persistent reluctance of refusal to go out, away from home to school/work because
of fear separation
o Persistent and excessive fear of reluctance about being alone or without attachment
figures at home or other settings
o Persistent reluctance or refusal to sleep away from home or to go to sleep without
being near an attachment figure
o Repeated nightmares involving the theme of separation
o Repeated complaints of physical symptoms when separation form attachment
figures occurs or is anticipated
- Fear, anxiety or avoidance is persisting, lasting 4 weeks in children or adolescents, 6 months
in adults
- Disturbance causes clinically significant distress or impairment in social, academic,
occupational or others areas of functioning
- Disturbance is not better explained by another mental disorder
- Criteria and specify if should be deleted in their entirety. No substitutions for either
2/3 of the children with SAD also experience another anxiety disorder or depressive disorder (1/2).
Onset around 7/8 years. Progresses from mild to severe. SAD occurs after a child has experienced
major stress. Symptoms can fluctuate over the years. School performance may suffer from SAD.
Treatment emphasizes an immediate return to school and other routines.
School refusal behavior: refusal to attend classes or difficulty remaining in school for an entire day
(5-11 years).
Specific phobia:
Specific phobia: fear occurs at an inappropriate age, persists, is irrational or exaggerated, leads to
avoidance of the object or event and causes impairment in normal routines.
Diagnostic criteria specific phobia DSM-5:
- Marked fear or anxiety about a specific object or situation
- Phobic object or situation almost always provokes immediate fear or anxiety
- Phobic object or situation is actively avoided or endured with intense fear or anxiety
- Fear or anxiety is out of proportion to the actual danger posed by the specific object or
situation and to the sociocultural context
- Lasting 6 months or more
- Fear, anxiety or avoidance causes distress or impairment in social, occupational or other
areas of functioning
- Disturbance is not better accounted for by another mental disorder
Specific animals, natural environment, blood, situational and other.
