Anxiety Disorders

1. Anxiety Disorders By: Kayla Cameron, Kristen Helou, Jena Locke & Justine Ross

2. Definition of Anxiety Anxiety is a mood state characterized by strong negative emotions and bodily symptoms of tension in which an individual apprehensively anticipates future danger or misfortune.

3. Anxiety Children who experience excessive and debilitating anxieties are said to have anxiety disorders. Anxiety disorders are one of the most common mental health problems in young people. Many youngsters suffer from more than one type of anxiety disorder, either simultaneously or at separate times during their development.

4. Normal Fears, Worries and Rituals/Routines Normal Fears: Become abnormal only at a certain age Become debilitating the longer they last and the more intense they become Girls have more intense and debilitating fears than boys

5. Normal Fears, Worries and Rituals/Routines Normal Worries Like normal fears, worries are normal if they are not debilitating. Once debilitating, worry is a central fear of anxiety Older children tend to have more intense worries Older children are more able to explain their worries Children with anxiety disorders worry more intensely.

6. Normal Fears, Worries and Rituals/Routines Normal rituals children go through: Preferences for sameness in the environment Rigid likes and dislikes Preferences for symmetry Awareness of minute details or imperfections in toys or clothes Arranging tings so they are �just right� Normal routines include: Repetitive behaviors Doing things just right

7. Experiencing Anxiety Symptoms expressed through three interrelated response systems: Physical Brain sends messages to sympathetic nervous system, which produces fight or flight response. Cognitive Children will try to search for explanations for anxiety. Behavioral Avoidance behaviors

8. Anxiety Vs. Fear

9. Panic Group of physical symptoms of the fight/flight response. Unexpectedly occur in absence of obvious threat or danger Made up explanations of symptoms

10. Main Features of Nine DSM-IV-TR Anxiety Disorders Separation Anxiety (SAD) Generalized Anxiety (GAD) Specific Phobia Social Phobia Obsessive Compulsive Disorder (OCD) Panic Disorder Panic Disorder with Agoraphobia Post-Traumatic Stress Disorder (PTSD) Acute Stress Disorder

11. Obsessive Compulsive Disorder (OCD)

12. Definition of OCD The American Psychiatric Association describes Obsessive-compulsive disorder (OCD) as a disorder characterized by obsessions and or compulsions.

13. Obsessions Obsession is recurrent thought, image, or impulse that causes distress 90% of people have a few

14. Compulsions Compulsions are displayed in the form of ritual like behaviors such as washing hands, counting to a particular number, locking doors, etc

15. Who does OCD effect? OCD effects different races equally and people from different SES equally The only known different is found in girls and boys, with 2 boys for every girl experiencing symptoms

16. When do people develop symptoms of OCD 50-60% of adults with OCD first experienced their symptoms before the age of 18 Most early-onset cases are found between the ages of 8-11

17. Common Obsessions in people with OCD Aggression Contamination Symmetry Somatic fears Hoarding Religion Superstitions Sexual behavior

18. Common Compulsions in people with OCD Repeating Cleaning Checking Tapping Rubbing Arranging Counting Tics

19. Contributions of Family to OCD When a child has OCD parents tend to; Unintentionally support Due to this, usually therapy involves the family, rather then just the child sufferer of OCD

20. DSM IV Criteria for OCD Either an obsession or compulsion Obsessions are defined by four distinct categories Compulsions are defined by two distinct categories At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (This does not apply to children)

21. DSM IV Criteria for Obsessions Obsessions defined by: (1) recurrent and persistent thoughts, impulses or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. (2) The thoughts, impulses, or images are not simply excessive worries about real-life problems (3) The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action. (4) The person recognizes that the obsession thoughts, impulses, or images are a product of his or her own mind.

22. DSM Criteria for Compulsions Compulsions defined by (1) and (2) (1) Repetitive behavior (e.g. hand washing, ordering, counting) or mental acts ( e.g. praying, counting, repeating etc) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly. (2) The behavior or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

23. Causes of OCD Three broad main theories of the causes Biological Psychological Behavioral Cognitive Environmental

24. Biological Theories These theories believe that OCD is a result of Abnormalities in the brain, some hypothesis are Abnormalities in serotonin metabolism Oversensitivity or overractivity to specific central nervous system serotonergic pathways Abnormalities in Dopamine functioning Increase in Glucose Metabolism which indicates increased activity in the Orbital Cortex and Cingulate Cortex

25. Psychological Theories Behavioral Theories Compulsions are a form of avoidance which maintain fears by negative reinforcement (the result of less anxiety)

26. Psychological Theories Cognitive Theories Obsessions caused by how people process information, people with OCD usually interpret ordinary situations as negative and catastrophic Contribute to an exaggerated sense of responsibility as well as helplessness and self-blame

27. Environmental Theories Put most emphasis on family If a family has a lot of stress and anxiety then children will be at a greater risk for OCD Therefore they exert a great deal of caution which when increasingly exaggerated develops into compulsions and obsessions

28. Comorbidity in OCD 80% of children with OCD satisfy the criteria for having one or more other disorder Some common disorders that co-exist with OCD are; Behavioral disorders Tic disorders Depressive disorders Other anxiety disorders

29. Consequences of Comorbidity OCD is hard to detect and diagnose because of the other disorders that commonly co-exist There are a lot of behaviors that mask a child�s obsessions and compulsions such as; aggression, withdrawal, irritability, agitation, and decline in school functioning

30. Treatment for OCD Treatments for OCD include: Cognitive Behavioral psychotherapy (CBT) For mild, moderate or severe OCD Medications Should be used if CBT is ineffective More effective with CBT Family Interventions Should be used in conjunction with CBT and/or medications

31. Cognitive Behavioral Treatment for OCD Cognitive Behavioral Treatment helps children change their thoughts and feelings by first changing behaviors, and involves; A four step process to help the child and family understand what OCD is, and the best ways of treating it: Stabilization of family crisis Effective communication Effective persuasion Collaboration with parent, child and therapist Exposure and response prevention (ERP)

32. Medication for Treating OCD Medication can be used for mild, moderate or severe OCD. They should be used either along with CBT or if CBT happens to be ineffective. For children/youth, the use of the following SSRIs has proven to be effective: Flouxetine Fluvoxamine Sertraline Paroxetine Citalopram If SSRIs are ineffective, consider Clomipamine

33. Outcomes About 40% of children suffering OCD eventually outgrow their symptoms Early onset OCD is characterized by increased rates of obsession and compulsions which will increasingly effect a person as they age. Childhood OCD often predicts OCD in adulthood Medications usually only work while they are being taken, and will usually not cure the symptoms for a patient.

34. �In any social situation, I felt fear. I would be anxious before I even left the house, and it would escalate as I got closer to a college class, a party, or whatever. I would feel sick in my stomach-it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else.� �When I would walk into a room full of people, I�d turn red and it would feel like everybody�s eyes were on me. I was embarrassed to stand off in a corner by myself, but I couldn�t think of anything to say to anybody. It was humiliating. I felt so clumsy, I couldn�t wait to get out.�

35. What anxiety disorder is being described?

36. Social Anxiety Disorder - Social Phobia -

37. What is Social Anxiety Disorder? When an individual is afraid that other people will think negatively of them According to the DSM-IV-TR A marked and persistent fear of one of more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that they will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. NOTE: in children, there must be evidence of the capacity for age appropriate social relationships with familiar people, and the anxiety must occur in peer settings, not only in interactions with adults

38. According to theDSM-IV-TR Exposure to the feared social situations almost invariably provokes anxiety, which may take the form of a situationally bound, or situationally pre-disposed panic attack NOTE: in children, the anxiety must be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people The person recognizes that the fear is excessive or unreasonable NOTE: in children, this feature may be absent The feared social or performance situations are avoided or else are endured with intense anxiety or distress

39. Social Anxiety Disorder Many have a mild form Example fear of public speaking Progressively gets worse over time if not treated or controlled Most people can relate to people with this disorder because everyone has been embarrassed in social situations at some point in their lives Those with social anxiety disorder want to have social interactions but do not feel like they can, because they don�t think they can handle the results of interactions Others often think that those with social anxiety disorder are stuck up/snobs

40. Social Anxiety Disorder Varies by culture in the ways that it is portrayed Reserved cultures like Japan have similar rates to America At least one child in every class has social anxiety disorder Runs in families Strong genetic make up If parents have it, it is more likely their children will as well Evident in twin studies

41. Causes of Social Anxiety Disorder Amygdala Part of limbic system that helps control emotional regulation Alerts the brain when a negative event is going to happen Those with social anxiety disorder have an overactive Amygdala Their brain is constantly alerting them that a negative event is going to happen

42. Potential Causes Neurotransmitters � which are chemicals that nerve cells use to communicate with one another Dopamine and serotonin Low levels of dopamine � may be characterized with being antisocial Little research on the effects of serotonin levels on social anxiety disorder Need more research on the affects of neurotransmitters on social anxiety disorder Personal Experiences Negative experiences in social situations may create social anxiety disorder Being around those who have social anxiety disorder Few develop social anxiety disorder because of these factors

43. Onset and Prevalence Uncommon to diagnose a child with social anxiety disorder before the age of 10 Most diagnosed in early adolescence Occurs in 1-3 percent of children Affects slightly more girls than boys As many as 20% have social anxiety disorder as their primary diagnosis Most common secondary diagnosis for children referred to for other anxiety disorders Often overlooked 2/3 of children diagnosed with social anxiety have another anxiety disorder

44. Characteristics of those with Social Anxiety Disorder Shy and reserved No friends few close friends Makes dating and marriages complicated Date the first person that shows interest in them Once married � often stay with them even if unhappy because they don�t have self confidence to stand up and say something or to be alone Many use alcohol to reduce their anxiety because it makes them more relaxed

45. A few more characteristics Blushing Profuse sweating Trembling Nausea Rapid heartbeat Shortness of breath Dizziness Headaches Depression (about 20%) Highly emotional Socially fearful Inhibited Sad Lonely Avoid contact with others Including talking on the phone Panic attacks

46. Treatment for Social Anxiety Disorder Many do not seek help because they don�t feel comfortable speaking to anyone about the problem Once treated, often wish they had received help sooner They are afraid that the doctor might not understand the problem and think that�s it nothing Often don�t seek help because they have had it for so long that they see it as being a part of them, and no longer a problem Not a lot of awareness in medical community � over the last 10-15 years has become more prevalent

47. Treatment for Social Anxiety Disorder Cognitive-behavioural therapy (best known form of treatment for social anxiety disorder) Therapist learns about the problem the patient is experiencing Client provides therapist with an explanation of what they think the problem is, and how it effects their behaviour Therapist helps client understand the problem and ways to work through it

48. Treatment for Social Anxiety Disorder Exposure to Feared Situations (in vivo exposure) Individual is placed in feared social situations until they no longer feel fear Exposure Role Plays Social Skills Training Often included with cognitive-behavioural therapy Teaches social skills to those who have avoided social situations for an extended period of time

49. Treatment for Social Anxiety Disorder Medications Antidepressants Prozac, Paxil Antianxiety Xanax Beta blockers Play a small role Reduce increases in heart rate

50. A new way to cope with Social Anxiety Disorder Technology Helpful because people with social anxiety disorder are able to interact with others without the face to face contact However this could also be harmful as the individuals do not learn proper ways to deal with face to face interactions

51. Do you Have a Social Anxiety Disorder? Go to: http://www.adaa.org/GettingHelp/SelfHelpTests/selftest_socialpho.asp Referenced from the DSM-IV

52. Questions or Comments?

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