Chapter 11 – Anxiety and Obsessive-Compulsive Disorders
Anxiety disorder is one of the most common mental health problems in young people, with
lifetime prevalence between 6-30%.
Having anxiety disorder in childhood or adolescence is one of the strongest predictors of most
other later mental disorders.
Description of anxiety disorders
Anxiety: a mood state characterized by strong negative affect, bodily symptoms of tension, and
apprehensive anticipation of future danger or misfortune.
• 2 key features: strong negative emotion and element of fear.
Anxiety disorders: a disorder in which the child experiences excessive and debilitating anxiety.
Experiencing Anxiety
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 or
excessive, find themselves unable to abandon their self-defeating behaviors.
Fight/flight response: the immediate reaction to perceived danger or threat whereby efforts are
directed towards protecting against potential harm, either by confronting the source of danger
(fight), or by escaping from the situation (flight).
Symptoms of anxiety are expressed through 3 interrelated response systems: the physical,
cognitive, and behavioral system.
• Physical system: the brain sends messages to the sympathetic nervous system to
produce fight/flight responses when danger is perceived.
o Chemical (hormones), cardiovascular, respiratory, sweat glands, other physical effects.
• Cognitive system: activation often leads to subjective feelings of apprehension,
nervousness, difficulty concentrating and panic.
• Behavioral system: avoidance behavioral are often negatively reinforces. Children with
anxiety disorders engage in more and more avoidance, carrying out everyday activities
becomes exceedingly difficult.
Anxiety vs. Fear and Panic
Fear: an alarm reaction to current danger or life-threatening emergencies; marked by strong
escape-oriented tendencies and a surge in the sympathetic nervous system.
• Fear differs psychologically and biologically from the emotion of anxiety.
• Fear is present-oriented to current danger.
• Anxiety is a future-oriented emotion and frequently felt when no danger is present.
Panic: a group of unexpected physical symptoms of the fight/flight response that occur in the
absence of any obvious threat or danger.
Normal Fears, Anxieties, Worries, and Rituals
Normal fears: if a fear has little impact on the child’s daily life or lasts only a few weeks, it is
likely a part of normal development. Girls tend to have more fears than boys.
Normal anxieties: e.g., separation anxiety, test anxiety, overconcern about competence,
excessive need for reassurance, and anxiety about harm to a parent.
Normal worries: worry is a central feature of anxiety, and anxiety is related to the number of
children’s worries and to their intensity. Older children report greater variety and complexity of
worries.
Normal rituals and repetitive behavior: e.g., bedtime ritual of saying good night.
• Rituals help young children gain control and mastery over their social and physical
environment and make their world more predictable and safer.
, Anxiety Disorders According to DSM-5
7 categories of anxiety disorders in DSM-5:
1. Separation Anxiety Disorder (SAD) – excessive worry regarding separation from home/parents.
2. Specific Phobia – severe and unreasonable fears and avoidance of a specific object/situation.
3. Social Anxiety Disorder (SOC) (Social Phobia) – severe and unreasonable fear of being embarrassed.
4. Selective Mutism – consistent failure to speak in specific social situations.
5. Panic Disorder (PD) – recurrent, unexpected and severe panic attacks.
6. Agoraphobia – fear of anxiety about 2 or more situations, e.g., public transport and open spaces.
The individual thinks that escape might be difficult.
7. Generalized Anxiety Disorder (GAD) – ongoing and excessive worry about many events and activities.
Description of Anxiety Disorder – Section Summary
- 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 3 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 developmental pattern with respect to type.
- DSM-5 specifies several types of anxiety and related disorders based on types of reaction and
avoidance.
Separation Anxiety Disorder (SAD)
This disorder is common in children from 7 months through the preschool years.
Separation Anxiety Disorder (SAD): a form of anxiety disorder in which the individual displays
age-inappropriate, excessive, and disabling anxiety about being apart from his/her parents or
away from home.
Prevalence:
• Found in 4-10% of all youths world-wide.
• Common in both girls and boys, but more prevalent in girls.
• 2/3 of children with SAD have another anxiety disorder.
• About ½ of the children with SAD develop a depressive disorder following the onset of SAD.
SAD has the earlies reported age at onset (7-8 years).
• Persists into adulthood for more than 1/3 of the children and adolescents.
• School reluctance and refusal are quite common in children and youths with SAD.
School refusal behavior: a form of anxious behavior in which the child refuses to attend classes
or has difficulty remaining in school for an entire day.
• Occurs mostly between 5-11 years.
• Academic or social problems may develop as a result of missed instruction and peer
interaction.
• Treatment emphasizes an immediate return to school.
