ABNORMAL

PSYCHOLOGY

JOYCE C. LARDIZABAL-PADILLA
KEY FACTS:
• Nine to 15 percent of children and adolescents have
anxiety symptoms that interfere with their day to- day
functioning.

• Shy children are at increased risk for developing

anxiety disorders.

• Children and adolescents with anxiety disorders are at

risk for underachievement in school, low self-esteem,
and psychiatric problems in adulthood, especially
depression and anxiety
Anxiety disorder include disorders that
share features of excessive fear and
anxiety and related behavioral
disturbances.
What is the essential feature of anxiety disorder?
 ANXIETY

Anxiety is a normal and sometimes lifesaving response to

threat.

• When usual coping strategies fail and a child’s or

adolescent’s anxiety becomes severe enough to cause
significant distress or to interfere with her schoolwork,
fun, or relationships, the child or adolescent may be
experiencing an anxiety problem or disorder.
• “When anxiety significantly affects a child’s or
adolescent’s functioning, it is classified as a disorder
rather than a problem.

• There are various forms of anxiety disorders, including

generalized anxiety disorder (GAD), panic disorder,
specific phobias, social phobia, separation anxiety,
acute stress disorder, posttraumatic stress disorder
(PTSD), and obsessive compulsive disorder (OCD).
1. Panic disorder and adult panic anxiety
syndrome, in which a person experiences
episodes of a crippling sense of terror and panic
called panic attacks.

2. Obsessive compulsive disorder, which is marked

by obsessive thoughts that cause anxiety. People
with obsessive compulsive disorder try to reduce
their anxieties through ritual and repeated
behaviors.
3. Post traumatic stress disorder is an anxiety
disorder that occurs after a traumatizing event
and is characterized by flashbacks of the
terrifying event.

4. Social Anxiety disorder- A persistent fear of

social situations.
5. Generalized anxiety disorder manifests as
excessive worry and anxiety that is out of
proportion to the actual situation.

6. Phobias are anxiety disorders that are due to an

excessive, irrational fear of certain objects or
situations.
SEPARATION ANXIETY DISORDER
• is defined by the primary expression of excessive
anxiety that occurs upon the actual or anticipated
separation of the child from adult caregivers—
most often the parents.
• most frequently from the ages of five to seven
and from 11 to 14.

• Disrupted sleep, difficulty falling asleep alone,

fear of monsters, or nightmares are also
commonly experienced by children with
separation anxiety disorder.
CAUSE
• Environmental change
• Genetic influence
• Parent/child attachment
• Cognitive factors
• Behavioral factors
• Stress factors and influence
PREVALENCE
• Prevalence estimates of separation anxiety
disorder are 4–5% of the population
• girls do present more often with anxiety
disorders in general
DIAGNOSIS
• The mental health professional will usually make
the diagnosis of separation anxiety disorder
based on information gathered during an
interview process involving the parent(s) and the
child
• Duration of disturbance prior to diagnosis is a
minimum of four weeks, occurring prior to the
age of 18 years.
A. Developmentally inappropriate and excessive anxiety
concerning separation from home or from those to whom
the individual is attached, as evidenced by three (or more)
of the following: 

1. recurrent excessive distress when separation from home or

major attachment figures occurs or is anticipated .

2. persistent and excessive worry about losing, or about

possible harm befalling, major attachment figures 

3. persistent and excessive worry that an untoward event will
lead to separation from a major attachment figure (e.g.,
getting lost or being kidnapped) 

4. persistent reluctance or refusal to go to school or elsewhere
because of fear of separation 

5. persistently and excessively fearful or reluctant to be alone
or without major attachment figures at home or without
significant adults in other settings 
(6) persistent reluctance or refusal to go to sleep without
being near a major attachment figure or to sleep away
from home 

(7) repeated nightmares involving the theme of
separation 

(8) repeated complaints of physical symptoms (such as
headaches, stomachaches, nausea, or vomiting) when
separation from major attachment figures occurs or is
anticipated 
B. The duration of the disturbance is at least 4 weeks. 
C. The onset is before age 18 years. 
B. The fear, anxiety, or avoidance is persistent,
lasting at least 4 weeks in children and
adolescents and typically 6 months or more in
adults.
SELECTIVE MUTISM
• characterized by a child's inability to speak in one
or more types of social situation.

• It was called as "aphasia voluntaria."

SYMPTOMS
• The child does not talk in one or more social
situations in which speech is commonly expected
and would facilitate understanding
• is also often associated with crying, clinging to
the parent, and other signs of social anxiety.
• Other children with the disorder, however, may
smile, gesture, nod, and even giggle, although
they do not talk.
CAUSES
• Consensus regarding the most common causes of
selective mutism has changed significantly over
time:

• caused by severe trauma in early childhood

• Some of these causative traumas were thought to

include rape, molestation, incest, severe physical
or emotional abuse , and similar experiences
• many researchers attributed selective mutism to
family dynamics.
• frequently attributed at present
to high levels of social anxiety in
children and not to traumatic
events in their early years

• Children with selective mutism

have been found to be more
timid and shy than most
children in social situations, and
to exhibit signs of depression
and anxiety disorders.
• Some children have been reported to dislike
speaking because they are uncomfortable with
the sound of their own voice or because they
think their voice sounds abnormal.
DIAGNOSTIC CRITERIA
A. 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. 

B. The disturbance interferes with educational or occupational

achievement or with social communication. 

C. The duration of the disturbance is at least 1 month (not limited

to the first month of school). 

D. The failure to speak is not due to a lack of knowledge of, or

comfort with, the spoken language required in the social
situation. 

E. The disturbance is not better accounted for by a Communication

Disorder (e.g., Stuttering) and does not occur exclusively during
the course of a Pervasive Developmental Disorder,
Schizophrenia, or other Psychotic Disorder.
PROGNOSIS
• Selective mutism is frequently treatable, in that
many cases of the disorder are thought to resolve
on their own. Sometimes reported cases do
resolve with time, although treatment can be very
effective.
PROGNOSIS
• Over 60% of children participating with their
parents in cognitive-behavioral treatment are
successful in managing their symptoms without
medication.
• Existence of other conditions, such as autism ,
decrease the likelihood of a positive prognosis.
GAD-GENERALIZED ANXIETY DISORDER
• is a pattern of frequent, constant worry and anxiety over many
different activities and events


Causes, Incidence, And Risk Factors

• Common condition.
• Genes may play a role.
• Stressful life situations or learned behavior may also contribute to
the development of GAD.
• The disorder may start at any time in life, including childhood
• Common in women than in men


Symptoms:

➢ The main symptom is the almost constant presence of worry or tension,

even when there is little or no cause.
➢ Worries seem to float from one problem to another.
➢ Difficulty concentrating
➢ Fatigue
➢ Irritability
➢ Problems falling or staying asleep, and sleep that is often restless and
unsatisfying
➢ Restlessness or feeling keyed up or "on the edge," often becoming
startled very easily



Examination

• Physical
• Psychological Examination
TREATMENT:

• The goal of treatment is to help you function well

during day-to-day life. 


• CBT
Prognosis

• The success of treatment usually depends on the

severity of the generalized anxiety disorder. The
disorder may continue and be difficult to treat,
but most patients see great improvement with
medications or behavioral therapy.

PANIC DISORDER

• Causes episodes of irrational fear and panic

called "panic attacks". In addition to the mental
symptoms of fear, panic, and terror, these attacks
often lead to physical symptoms.
A. Recurrent unexpected panic attacks. A
panic attack is an abrupt surge of intense
fear or intense discomfort that reaches a
peak within minutes, and during which
time four (or more) of the following
symptoms occur;
Symptoms
• Intense fear Chest discomfort
• Terror Breathlessness
• Racing heartbeat Choking sensation
• Pounding heartbeat Lump in your throat
• Skipping heartbeat Throat tightness
• Heart palpitations Excessive sweating
• Chest pain Fear of losing control
• Chest pressure Fear of dying
• Social problems
Isolation
Work problems

• Mental problems
Depression
Difficulty concentrating
Difficulty thinking
B. At least one of the attacks has been followed
by 1 month (or more) of one or both of the
following:

1. Persistent concern or worry about additional

panic attacks or their consequences (e.g.,
losing control, having a heart attack, “going
crazy”).

2. A significant maladaptive change in behavior

related to the attacks (e.g., behaviors designed
to avoid having panic attacks, such as
avoidance of exercise or unfamiliar situations).
TREATMENT

Panic attacks and panic disorder are treatable

conditions. They can usually be treated
successfully with self-help strategies or a series of
therapy sessions.

1. CBT
2. EXPOSURE THERAPY
Agoraphobia

A. Marked fear or anxiety about two (or

more) of the following five situations:

1. Using public transportation (e.g.,

automobiles, buses, trains, ships,
planes).
2. Being in open spaces (e.g., parking lots,
marketplaces, bridges)
3. Being in enclosed places (e.g., shops,
theaters, cinemas).

4. Standing in line or being in a crowd.

5. Being outside of the home alone

PHOBIA
PHOBIA-refers to an excessive fear of specific
object, circumstance, or situation.

SPECIFIC PHOBIA- strong, persisting fear of an

object.

SOCIAL PHOBIA-is a strong, persisting fear of

situations in which embarrassment can occur.
• Specific phobia is more common than social
phobia.

• Most common disorder for women and 2nd

among men.
Specific Phobia
A. Marked fear or anxiety about a specific
object or situation (e.g., flying, heights,
animals, receiving an injection, seeing
blood).

Note: In children, the fear or anxiety may

be expressed by crying, tantrums,
freezing, or clinging.
B. The phobic object or situation almost always
provokes immediate fear or anxiety.

C. The phobic object or situation is actively

avoided or endured with intense fear or
anxiety.

D. The fear or anxiety is out of proportion to the

actual danger posed by the specific object or
situation and to the sociocultural context.
E. The fear, anxiety, or avoidance is
persistent, typically lasting for 6 months
or more.

F. The fear, anxiety, or avoidance causes

clinically significant distress or
impairment in social, occupational, or
other important areas of functioning.
• Specify if:
Code based on the phobic stimulus:

Animal (e.g., spiders, insects, dogs).

Natural environment (e.g., heights, storms,
water)
Blood-injection-injury (e.g., needles,
invasive medical procedures)
Situational (e.g., airplanes, elevators,
enclosed places).

Other (e.g., situations that may lead to

choking or vomiting: in children,
e.g., loud sounds or costumed characters).
Social Anxiety Disorder (Social Phobia)
A. 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 (e.g., having a

conversation, meeting unfamiliar people), being
observed (e.g., eating or drinking), and
performing in front of others (e.g., giving a
speech).

Note: In children, the anxiety must occur in peer

settings and not just during interactions with
adults.
B. The individual fears that he or she will act in a way
or show anxiety symptoms that will be negatively
evaluated (i.e., will be humiliating or
embarrassing: will lead to rejection or offend
others).

C. The social situations almost always provoke fear

or anxiety.

Note: In children, the fear or anxiety may be

expressed by crying, tantrums, freezing, clinging,
shrinking, or failing to speak in social situations.
• D. The social situations are avoided or endured
with intense fear or anxiety.

• E. The fear or anxiety is out of proportion to the

actual threat posed by the social situation and to
the sociocultural context.

• F. The fear, anxiety, or avoidance is persistent,

typically lasting for 6 months or more.

• G. The fear, anxiety, or avoidance causes clinically

significant distress or impairment in social,
occupational, or other important areas of
functioning.
• H. The fear, anxiety, or avoidance is not
attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or
another medical condition.

• I. The fear, anxiety, or avoidance is not better

explained by the symptoms of another mental
disorder, such as panic disorder, body
dysmoφhic disorder, or autism spectrum
disorder.

• J. If another medical condition (e.g., Parkinson’s

disease, obesity, disfigurement from bums or
injury) is present, the fear, anxiety, or avoidance
is clearly unrelated or is excessive.
COURSE AND PROGNOSIS

➢Depends on age onset.

➢ Research suggests that most specific phobias

that begin in childhood and persists into
adulthood continue to persists for many years.
TREATMENT

➢BT- is the most effective (systematic

desensitization

➢Supportive therapy/Family therapy

• ANXIETY DISORDER NOT OTHERWISE
SPECIFIED
Thank you! ☺