Lecture 8
Anxiety and Trauma/post-traumatic stress behavior
Fear has always been essential for humans to survive and help avoid dangerous situations.
When fear starts influencing the regular outcome of life it becomes a problematic disorder
(pathological according to the 4 D’s). There is also an adaptive/ non clinical anxiety (in
childhood) in which most children have one or two fears that are appropriate to their age.
In the pic we can see what are considered the regular fears by each age.
When it comes to the risk factors for anxiety, most of them are unknown. We do not know
exactly what brings from adaptive to clinical, we do know some of them:
Child factors:
o Genetic predisposition ( no specific gene)
o Temperament
o Cognition
Environmental factors
o Insecure attachment
o Education and parental style
o Negative life events
Some of the shared characteristics of anxiety disorders are excessive fear and anxiety in which
we define fear as an emotional response to a real/perceived threat and anxiety as an
,anticipation of a future threat. These anxiety disorders are not attributable to medications,
medical conditions or substance abuse. Usually, the difference underlies in the type of feared or
avoided objects and the thoughts. Overall anxiety:
One of the most prevalent disorders
Often early onset (young childhood)
2:1 female to male ratio
Not always present and not always intense
High comorbidity (usually with depression)
High individual impairment on occupational status and relationship
Separation anxiety disorder
It is usually typical in children, even though many outgrow it by the age of 3. It becomes an
issue when excessive or non-age appropriate. It is an excessive anxiety of going away from
home or leaving the attachment figures because of:
o Excessive worry that the caregiver may be harmed
o Refusal to go anywhere which might cause separation
o Frequent nightmares about separation
o Recurrent physical complaints when not in close proximity to attachment figure
Selective mutism
A child shows consistent failure to speak in specific social situations in which they are expected
to speak (e.g. school), despite speaking in other situations. In order to be diagnosed it needs to
be occurring at least more than a month and not during certain time frames (e.g. first month of
school). It is not to attribute to a lack of knowledge or comfort with speaking, but is often a
matter of protection ( a way with coping with anxiety).
The disturbance is not better explained by any other disorder, and It often coexists with
social anxiety disorder.
Specific phobia
Specific phobia is a marked intense fear/anxiety of a specific object or situation that interferes
with a person’s ability to function. Phobic objects/ situations always evoke immediate and
persistent fear/anxiety, they are avoided or endured with an intense and irrational fear/anxiety.
To be diagnosed it needs to be persistent (>6 months). Not better explained by any other
disorder. There are 5 main categories that can be feared:
o Animals
o Natural environments (thunderstorm)
o Blood-injection-injury
o Situational ( elevator, flying)
o Other (vomiting, clowns…)
75% > 1 phobia present
Usually:
, 7.4% cross-national life- time prevalence
Young age of onset (8 y/o)
60% has at least one comorbid disorder
Often suffered for many years
Patients usually recognize they have an excessive reaction but do not think that the danger
is excessive.
It is often difficult to recall specific reason for onset. Usually it is either developed following a
traumatic event, due informational transmission ( parents teaching not to get too close to dogs)
or observational learning.
Generalized anxiety disorder
It is an excessive anxiety and worrying occurring more days than not for at least 6 months about
a number of activities or events. GAD patients usually do not even have a valid reason to worry
about something. People usually have a difficulty controlling the worry and it is usually
associated with 3 or more symptoms as depicted :
Prevalence : 3%
Age of onset: 25-30 y/o ( when there is more responsibility ) but often report anxiety
their whole lives
66% has comorbid disorder
Social anxiety disorder
Marked fear/anxiety about one or more social situations in which individuals are exposed to
possible scrutiny by others like for example during social interactions, meanwhile being
observed or performing in front of others.
Individuals usually fear that he/she will act in a way or show anxiety symptoms that will be
negatively evaluated/considered humiliating or embarrassing or lead to rejection/ offending
others. Therefore social situations are avoided and endured with intense fear/anxiety.
Diagnosable if prevalence >6 months.
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