Anxiety Disorders

ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ●​ People with anxiety disorders often see situations as more dangerous than they really are. ANXIETY DISORDERS ●​ Anxiety disorders are conditions that involve too much fear or anxiety, along with behavior changes. So, it’s up to the clinician to decide if the fear is too much, considering the person’s cultural background. ●​ Many anxiety disorders begin in childhood and often continue if not treated. ★​ According to the DSM-5-TR: ●​ ➢​ Fear is the reaction to a real or imagined immediate threat. It often brings a rush of physical energy for fight or flight, thoughts of danger, and efforts to escape. They are more common in girls than boys, with about twice as many girls affected. ●​ A diagnosis is only made when the symptoms aren’t caused by drugs, a medical issue, or another mental health condition. MODULE 8: ANXIETY DISORDERS A ●​ ➢​ Anxiety is worry about a possible future threat. It usually involves tense muscles, alertness, and careful or avoidant behavior. B SEPARATION ANXIETY DISORDER ●​ A person with separation anxiety disorder feels scared or worried about being away from people they’re close to, in a way that isn’t typical for their age. ●​ They may constantly fear something bad will happen to these loved ones or that they’ll be separated from them, and they often avoid going away from them. ●​ This can also cause nightmares and physical signs of stress. ●​ While it usually starts in childhood, it can also appear in adults even if they didn’t have it as kids. ●​ These two feelings can overlap but are different. ●​ People sometimes avoid things to lessen their fear or anxiety. ●​ Panic attacks are a strong fear response and are common in anxiety disorders, though they can also happen in other mental health conditions. ●​ Anxiety disorders vary based on what triggers the fear, anxiety, or avoidance, and how people think about those triggers. ●​ Even though these disorders often occur together, they can be told apart by looking closely at what kinds of situations are feared or avoided and what thoughts or beliefs go along with them. ●​ Anxiety disorders are different from normal childhood fears because they are more intense or last longer than what’s expected for a person’s age. ●​ ●​ They also differ from short-term, stress-related fears because they usually stick around for six months or more. ➢​ Criterion A: This anxiety is more intense than what’s normal for the person’s age or stage of development. ●​ However, this time frame is flexible—especially for children, where some disorders like separation anxiety or selective mutism may show up for shorter periods. PAGE 1 CREATED BY JEMS B1 ●​ DIAGNOSTIC FEATURES The main sign of separation anxiety disorder is strong fear or worry about being away from home or loved ones. Individuals with separation anxiety disorder have symptoms that meet at least three of the following criteria: ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ★​ Criterion A1: They often feel very upset again and again when they expect to be separated from home or loved ones, or when the separation actually happens. ➢​ Criterion B: The disturbance must last for a period of at least 4 weeks in children and adolescents younger than 18 years, and is typically 6 months or longer in adults. ★​ Criterion A2: They worry about the well-being or death of their attachment figures, particularly when separated from them, and they feel a strong need to know their whereabouts and to stay in touch with them. ●​ ★​ Criterion A3: They also worry about untoward events to themselves, such as getting lost, being kidnapped, or having an accident, that would keep them from ever being reunited with their major attachment figure. However, the duration criterion for adults should be used as a general guide, with allowance for some degree of flexibility. ➢​ Criterion C: The disturbance must cause clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning. B2 PREVALENCE ★​ Criterion A4: Individuals with separation anxiety disorder are reluctant or refuse to go out by themselves because of separation fears. ●​ About 4% of children are estimated to have separation anxiety disorder over a 6- to 12-month period. ★​ Criterion A5: They have persistent and excessive fear or reluctance about being alone or without major attachment figures at home or in other settings. Children with separation anxiety disorder may be unable to stay or go in a room by themselves and may display “clinging” behavior, staying close to or “shadowing” the parent around the house, or requiring someone to be with them when going to another room in the house. ●​ In toddlers from the community, boys and girls seem to have it at similar rates, but among school-age children, girls tend to have it more often than boys. ●​ In U.S. adolescents, the 12-month prevalence of separation anxiety disorder is estimated at 1.6%. ●​ The disorder tends to decrease in prevalence from childhood through adolescence and into adulthood. ●​ In clinical samples, boys and girls show equal rates, but in community samples, girls have higher prevalence. ●​ Child self-reports often show higher rates of separation anxiety disorder than parent-reported symptoms. ●​ In U.S. adults, separation anxiety disorder affects about 0.9% to 1.9% of people each year. ●​ Among adults with the disorder, women are more likely than men to have it in both clinical and community studies. ●​ Across 18 countries, the average 12-month prevalence in adults is 1.0%, ranging from less than 0.1% to 2.7% (e.g., 0.3% in Romania, 2.7% in Colombia). ★​ Criterion A6: They have persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home. ★​ Criterion A7: Children with this disorder often struggle at bedtime and may want someone to stay with them until they fall asleep. At night, they might go to their parents’ bed or sleep beside someone close, like a sibling. They may not want to go to camp, sleep over at a friend’s house, or run errands. Adults may feel uneasy traveling alone, such as sleeping in a hotel away from loved ones. They may also have repeated nightmares that show their fear of being separated, like dreams about the family being harmed or lost in a disaster. ★​ Criterion A8: Children often have physical symptoms like headaches, stomachaches, nausea, or vomiting when they expect to be separated from loved ones or when the separation actually happens. PAGE 2 CREATED BY JEMS ABNORMAL PSYCHOLOGY C-PSYM311A ●​ B3 1ST SEMESTER – FINALS In this international sample, women were more affected than men (1.3% compared to 0.8%). ●​ Children with selective mutism do not start conversations or respond when spoken to in social situations. This lack of speech occurs in both children and adults. ●​ At home, they may speak freely with immediate family, but often stay silent even around close friends or second-degree relatives like grandparents or cousins. DEVELOPMENT AND COURSE ●​ Separation anxiety disorder can begin as early as preschool age, but it may also develop at any point during childhood or adolescence. ●​ Separation anxiety disorder shows different signs depending on age. ●​ The condition is usually linked to high social anxiety. Younger children may resist going to school or avoid it completely. ●​ Many children with selective mutism refuse to speak at school, which can cause academic problems, as teachers may struggle to assess skills like reading. ●​ ●​ ●​ They might not talk about specific fears or threats to their parents, home, or themselves—their anxiety often shows up only when separation actually happens. As children grow older, specific worries often appear—such as fears of accidents, kidnapping, mugging, or death, or general concerns about not being reunited with loved ones. ●​ In adults, separation anxiety disorder can make it harder to adjust to life changes, like moving or getting married. ●​ Adults with separation anxiety disorder often show excessive concern for loved ones—such as children, spouses, parents, or pets—and feel strong discomfort when apart from them. ●​ C ●​ ●​ C1 This can lead to major disruptions in work or social life, as they may feel the need to constantly check on the location or safety of someone close to them. SELECTIVE MUTISM Selective mutism means a person regularly doesn’t speak in social settings where talking is expected, like at school, even though they do speak in other places. This lack of speech can seriously affect how well they do in school or work, and it can also get in the way of normal social interaction. DIAGNOSTIC FEATURES PAGE 3 CREATED BY JEMS C2 PREVALENCE ●​ Selective mutism is a rare disorder and is usually not included in large studies that track how common childhood disorders are. ●​ In clinic and school samples from the U.S., Europe, and Israel, the rate of selective mutism ranges from 0.03% to 1.9%, depending on the age group and setting. ●​ Community and treatment-based studies show that boys and girls are affected equally, though some findings suggest it may be more common in girls. ●​ The disorder doesn’t seem to vary by race or ethnicity, but children who must speak a non-native language—like those from immigrant families—may be more at risk. ●​ Selective mutism is more likely to appear in young children than in teens or adults. C3 ●​ DEVELOPMENT AND COURSE Selective mutism usually begins before age 5, but it may not be noticed until the child starts school, where social interaction and performance tasks like reading aloud become more common. ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ●​ The duration of the disorder varies. While many children seem to “outgrow” it, the long-term course is still unclear. ●​ In most cases, selective mutism fades, but symptoms of social anxiety disorder may continue. D SPECIFIC PHOBIA ●​ People with specific phobia feel scared, anxious, or avoid certain clearly defined objects or situations. ●​ Unlike other anxiety disorders, this one doesn’t usually involve specific thoughts or beliefs. ●​ The fear or anxiety happens right away when facing the phobic trigger and is much stronger than the real danger. ●​ There are different types of specific phobias: animals; natural settings; blood, injections, or injury; certain situations; and other specific things. D1 ●​ ●​ ●​ SPECIFIERS It’s common for people with specific phobia to fear more than one thing. On average, a person with this disorder fears three different objects or situations, and about 75% fear more than one. ●​ Many people with specific phobia fear more than one type of phobic stimulus. ●​ To meet the criteria for diagnosis, the person’s reaction must be more intense and longer-lasting than normal, short-term fears that are common in the general population. D3 DIAGNOSTIC FEATURES A key feature of specific phobia is that the fear or anxiety only happens when facing a certain object or situation, called the “phobic stimulus”. PAGE 4 CREATED BY JEMS PREVALENCE ●​ In the U.S., about 8% to 12% of people have specific phobia in a given year. ●​ Rates in European countries are similar (around 6%), while Asian, African, and Latin American countries show lower rates (about 2% to 4%). ●​ Among children, the average rate is around 5%, ranging from 3% to 9% across countries. ●​ In U.S. adolescents aged 13–17, the rate is about 16%. ●​ Rates are lower in older adults (around 3% to 5%), possibly because symptoms become less severe or subclinical. ●​ Across all types, women are affected about twice as often as men. D4 DEVELOPMENT AND COURSE ●​ Specific phobia can develop after a traumatic event, by watching someone else go through trauma, after an unexpected panic attack in the feared situation (like panicking on the subway), or through informational transmission (such as heavy media coverage of a plane crash). ●​ However, many people with specific phobia don’t remember exactly how it started. ●​ The disorder usually begins in early childhood, with most cases starting before age 10. ●​ The typical age when it begins is between 7 and 11 years, and the average is around 10 years. In these cases, each feared object or situation gets its own diagnosis, with a separate diagnostic code based on the type of phobic stimulus (fear). ➢​ For example, someone afraid of thunderstorms and flying would receive two diagnoses: natural environment phobia and situational phobia. D2 ●​ E SOCIAL ANXIETY DISORDER ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ●​ Social anxiety disorder involves fear, worry, or avoidance of social situations where the person might be watched or judged. ●​ These include meeting new people, being seen while eating or drinking, or performing in front of others. ●​ The person often worries about being judged negatively, feeling embarrassed, humiliated, rejected, or upsetting others. ●​ This disorder—sometimes called “social phobia”—involves an intense fear of being watched, judged, or doing something embarrassing in front of others. ●​ In social anxiety disorder (SAD), the fear is much stronger than the situation calls for. ●​ People with SAD often avoid social situations or feel intense fear or anxiety when they have to face them. ●​ Those with SAD may feel extremely self-conscious, even to the point of feeling physically sick when thinking about public activities. ●​ SAD usually involves high anxiety in most social settings, though some people only feel anxious when they have to speak or perform in public—this is called the “performance-only type”. ●​ People with social anxiety disorder (SAD) often have stressful interpersonal relationships. ●​ In romantic couples, those with high social anxiety tend to focus more on negative cues, show less interest and support during conversations, and make fewer positive comments when their partner shares good news. ●​ Unsurprisingly, these couples were more likely to break up within 6 months. E1 SPECIFIERS ●​ People with the performance-only type of social anxiety disorder mainly fear situations where they have to perform or speak in public. ●​ This type of anxiety often affects their professional life—especially for musicians, dancers, performers, athletes, or anyone who regularly gives public presentations. ●​ These fears can also show up in school or academic settings. ●​ Unlike other forms of social anxiety, these individuals do not fear everyday social situations that don’t involve performing. E2 DIAGNOSTIC FEATURES ●​ The most common fears include public speaking and meeting new people. ★​ Criterion A ●​ People with high social anxiety often believe that others are judging them or thinking negatively about them. ➔​ The core feature of social anxiety disorder (SAD) is an intense fear or anxiety in social situations where the person might be watched, judged, or evaluated by others. ●​ Because of this, they stay alert for “threat” signals like disapproval or criticism. ●​ To avoid attention, they use “safety behaviors”—such as avoiding eye contact, speaking less, sitting alone, holding objects to hide shaking, or wearing makeup to cover blushing. ●​ They also tend to be socially submissive to avoid conflict with others. PAGE 5 CREATED BY JEMS ➔​ For children, this fear must happen in peer settings, not just when interacting with adults. (means that the child’s fear (likely social anxiety, shyness, or fear of embarrassment) should appear when they’re around other kids, not only when talking to or being around adults (like teachers or parents). ★​ Criterion B ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ➔​ When faced with social situations, individuals with social anxiety disorder (SAD) fear they will be negatively judged. social gathering or repeatedly in advance. ●​ ➔​ They worry others will see them as anxious, weak, crazy, stupid, boring, intimidating, dirty, or unlikable. ➔​ They also fear that their appearance or behavior—such as blushing, trembling, sweating, stumbling over words, or staring—will be seen as signs of anxiety and lead to negative evaluation. ●​ Some individuals with social anxiety disorder fear offending others or being rejected as a result. ●​ This fear—such as worrying that a gaze or visible anxiety symptoms might offend someone—is especially common in cultures with strong collectivist values. E3 rehearsing a speech In children, this fear may show up as crying, tantrums, freezing, clinging, or shrinking away during social interactions. PREVALENCE ●​ In the United States, the 12-month prevalence of social anxiety disorder is about 7%. ●​ Rates are lower in many other countries using the same diagnostic tools, typically ranging from 0.5% to 2.0%, with a median of 2.3% in Europe. ●​ Prevalence appears to be rising in both the U.S. and East Asian countries. ●​ Among adolescents aged 13–17, rates are roughly half those seen in adults. ●​ For example, someone who fears trembling hands may avoid drinking, eating, writing, or pointing in public. ●​ After age 65, prevalence decreases, with rates in older adults across North America, Europe, and Australia ranging from 2% to 5%. ●​ A person who fears sweating may avoid shaking hands or eating spicy foods. ●​ ●​ Someone who fears blushing may avoid public performance, bright lights, or intimate conversations. In the general population, women are more frequently affected than men, with odds ratios between 1.5 and 2.2; this gender gap is especially pronounced in adolescents and young adults. ●​ In some cases, individuals also fear urinating in public restrooms when others are present, a condition known as paruresis or “shy bladder syndrome”. However, in clinical samples, rates are equal or slightly higher for men, possibly due to gender roles and social expectations influencing help-seeking behavior. ●​ In the U.S., prevalence is lower among individuals of Asian, Latinx, African American, and Caribbean Black descent compared to non-Hispanic Whites. ●​ ★​ Criterion C ➔​ In social anxiety disorder, the feared social situations almost always trigger fear or anxiety. ●​ ●​ ●​ E4 DEVELOPMENT AND COURSE If someone only feels anxious occasionally in these situations, they would not meet the criteria for diagnosis. ●​ The intensity and type of anxiety can vary—for example, it may involve anticipatory anxiety or even panic attacks. In the United States, the median age at onset of social anxiety disorder is 13 years, with 75% of cases beginning between ages 8 and 15. ●​ The disorder may arise from a childhood history of social discomfort or shyness, as shown in U.S. and European studies, and can also begin in early childhood. Anticipatory anxiety can begin well before the event, such as worrying daily for weeks before a PAGE 6 CREATED BY JEMS ABNORMAL PSYCHOLOGY C-PSYM311A ●​ ●​ ●​ ●​ F 1ST SEMESTER – FINALS Sometimes it starts after a stressful or embarrassing event (like being bullied or getting sick during a speech), or it may slowly develop over time. It rarely begins in adulthood, but when it does, it’s often linked to stressful events or major life changes. In some cases, symptoms may diminish after marriage (especially in individuals with dating-related fears) and reappear after divorce. For those seeking treatment, the disorder tends to last a long time. GENERALIZED ANXIETY DISORDER ●​ ●​ F1 ●​ Generalized anxiety disorder mainly involves ongoing and intense worry about many areas of life, like work or school, that the person struggles to manage. It also comes with physical symptoms such as feeling restless or tense, getting tired easily, trouble focusing or blanking out, feeling irritable, tight muscles, and problems with sleep. DIAGNOSTIC FEATURES The core feature of generalized anxiety disorder (GAD) is excessive anxiety and worry—also called apprehensive expectation—about multiple events or activities. ●​ The intensity, duration, or frequency of the worry is out of proportion to the actual risk or impact of what’s anticipated. ●​ People with GAD find it hard to control their worry, and the constant stream of anxious thoughts often disrupts their focus and ability to complete tasks. ●​ Adults with generalized anxiety disorder (GAD) often worry excessively about routine life concerns—such as job responsibilities, health, finances, family well-being, or minor issues like household chores or being late. PAGE 7 CREATED BY JEMS ●​ In children, the worry tends to focus on their competence or performance quality. ●​ Over time, the focus of worry may shift, moving from one concern to another as circumstances change. F2 PREVALENCE ●​ In the United States, the 12-month prevalence of generalized anxiety disorder (GAD) is 0.9% among adolescents and 2.9% among adults. ●​ Globally, the average 12-month prevalence is 1.3%, with a range from 0.2% to 4.3%. ●​ The lifetime morbid risk in the U.S. is 9.0%. ●​ Women and adolescent girls are at least twice as likely as males to experience GAD. ●​ Among older adults, including those aged 75 and above, the 12-month prevalence ranges from 2.8% to 3.1% in the U.S., Israel, and Europe. ●​ Individuals of European descent are more likely to meet criteria for GAD than those of Asian or African descent. ●​ Additionally, people in high-income countries report GAD symptoms more frequently than those in low- and middle-income countries. F3 DEVELOPMENT AND COURSE ●​ Many individuals with generalized anxiety disorder (GAD) report feeling anxious and nervous for most of their lives. ●​ In North America, the average age at onset is 35 years, which is later than other anxiety disorders, and the condition rarely begins before adolescence. ●​ However, the age at onset varies widely and tends to be older in lower-income countries. ●​ Symptoms of excessive worry and anxiety may appear early in life, but often show up first as an “anxious temperament”. ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ●​ In children and adolescents with generalized anxiety disorder (GAD), worries often center on their performance or competence in school or sports—even when they’re not being evaluated. ●​ They may also have excessive concerns about punctuality or catastrophic events, such as earthquakes or nuclear war. ➔​ Chronic: long-lasting or persistent, not just a short episode. ●​ ➔​ Waxing and Waning = symptoms increase and decrease in intensity over time — sometimes they get worse (wax), other times they get better or fade (wane). These children often appear overly conforming, perfectionistic, and unsure of themselves, frequently redoing tasks due to dissatisfaction with anything less than perfect. ●​ The disorder may shift between full diagnostic levels (syndromal) and less severe forms (subsyndromal). They may be intensely focused on gaining approval, seeking excessive reassurance about their performance and other worries. ●​ In older adults, especially those with chronic physical illness, health concerns can become a major source of anxiety. ●​ Among the frail elderly, worries about safety—especially falling—can restrict daily activities. ●​ ●​ Symptoms of generalized anxiety disorder (GAD) tend to be chronic, often waxing and waning throughout life. ➔​ Syndromal: The person meets all the official criteria for the disorder ➔​ Subsyndromal: The person has some symptoms, but not enough to meet the full diagnosis. ●​ The course is generally more persistent in lower-income countries, while impairment tends to be greater in high-income countries. ➔​ Course: The condition tends to last longer or be more chronic (continues for a long time) there. ➔​ Impairment: The condition has a stronger negative impact on people’s day-to-day activities or quality of life. G PANIC DISORDER ●​ In panic disorder, a person has repeated panic attacks that happen without warning and often worries about having more. ●​ This worry can lead to unhelpful changes in behavior, like avoiding exercise or new places. ●​ Panic attacks are sudden waves of intense fear or discomfort that peak within minutes and come with physical or mental symptoms. ●​ If there are fewer than four symptoms, it’s called a “limited-symptom panic attack”. ●​ Panic attacks can be expected—triggered by something feared—or unexpected, happening without a clear reason. ●​ Rates of full remission are very low. (Remission is when symptoms of a disease lessen or go away.) ●​ When generalized anxiety disorder (GAD) begins earlier in life, individuals tend to experience more comorbidity and greater impairment. ●​ Younger adults often report symptoms than older adults. ●​ Despite this, the clinical presentation of GAD remains fairly consistent across the lifespan. ●​ ●​ The main difference lies in the content of the worry, which tends to be age appropriate—reflecting concerns typical of the individual’s developmental stage. They help show how serious a disorder is and often appear in other conditions like anxiety, substance use, depression, or psychosis. ●​ The label “with panic attacks” can be added to anxiety or other mental disorders when panic attacks are part of the symptoms. PAGE 8 CREATED BY JEMS more severe ABNORMAL PSYCHOLOGY C-PSYM311A H 1ST SEMESTER – FINALS AGORAPHOBIA ●​ Mild or moderate anxiety helps us stay alert to danger and respond to potentially hazardous situations. ●​ People with agoraphobia feel scared or anxious in many types of situations. ●​ In contrast, fear is a more intense emotion, typically triggered by a specific threat. ●​ To meet the diagnosis, they symptoms in at least two of these: ●​ Sometimes, however, fear and anxiety arise even when no real danger is present. ➢​ ➢​ ➢​ ➢​ ➢​ Using public transportation Being in open areas Being in closed spaces Standing in line or being in a crowd Being alone outside the home. ●​ When these reactions are unfounded and begin to interfere with daily functioning, causing significant distress or impairment, they may indicate an anxiety disorder. ●​ They fear these situations because they worry it would be hard to escape or get help if they had panic-like symptoms or felt helpless or embarrassed. ●​ These situations regularly cause fear or anxiety and are often avoided or only faced with someone else present. I must have SUBSTANCE/MEDICATION-INDUCED ANXIETY DISORDER ●​ Substance/medication-induced anxiety disorder happens when anxiety is caused by using a substance, stopping it, or taking certain medications. ●​ Anxiety disorder due to another medical condition means the anxiety symptoms are a direct result of a physical health problem. J THE MULTIPATH MODEL OF ANXIETY DISORDERS ●​ Anxiety often leads to tension, worry, and physical symptoms such as restlessness or increased heart rate. ●​ It is commonly an anticipatory emotion—a feeling of unease or dread about something that has not yet happened, but is feared might occur. ●​ Many people experience anxiety because, from an evolutionary perspective, it can be adaptive—triggering bodily reactions that prepare us for “fight or flight”. PAGE 9 CREATED BY JEMS