A. Fear of social situations where they might be judged, observed, or must perform in front of others
B.Fear that they will be embarrassed and rejected
C. The social situations almost always provoke fear or anxiety
expressed by crying, tantrums, freezing, clinging, shrinking, or failing to socially speak
D. Social situations avoided or endured with intense anxiety
E. Fear or anxiety is out of proportion
F. Fear/ anxiety/ avoidance lasts 6 months or longer, usually
G. Anxiety causes setbacks in functioning
H. Not attributable to any substance
I. Not another mental disorder for sure
J. Fear/ anxiety unrelated if the person has medical conditions
Child can speak but refuses to speak or speaks quietly, caused by fear or embarrassment
Can be limited to performance situations only
Treatment: exposure, knowledge through experience
FEARS
Nota:
Side note: you are most likely to perform well if you are not thinking about others watching you, it was just automatic
Reading aloud
Performance activities
Eating with others
Etc, but all this stuff happens all the time
SOURCE --> inhibition system
Over-controlling/protective parents
Panic Disorder
Nota:
This should actually be under "Anxiety and OCD"
DIAGNOSTIC CRITERIA
Panic attacks reach their peak within 10 mins
4 plus symptoms occur
Heart irregularities, sweating, trembling, can't breath, chest pain, nausea, dizzy or light-headed, chills/heat flashes, numbness/tingling, feels surreal, fear of losing control or dying
And one of these two happens for the next month or more
Fear of 2+ of these
Public transportation
Open spaces
Enclosed spaces
Standing in line / crowds
Being away from home alone
(THESE ARE SYMPS OF AGORAPHOBIA, which is not the same as PD
How might agoraphobia develop in terms of panic disorder?
Negatively reinforced by avoiding situations in which they might have a panic attack
Must be able to escape or be helped in a situation, in case they have a panic attack
Agoraphobia
Fear is excessive
Persists for 6 months
For sure to another mental disorder
You can have a panic attack without having panic disorder
1/3 of adults // 1/10 of children
TYPES OF PANIC ATTACKS
Type A: Calm>PANIC>Calm
(Probs not PD yet)
Type B: Calm>PANIC>Anxious
Type C: Anxious>PANIC>Calm
It becomes panic disorder when you start to fear panic attacks happening again
Generalized Anxiety Disorder
"kiddo" that worries about everything
SYMPTOMS
Tension, Apprehensive expectations, negative self-image, need for reassurance, irritability, physical complaints, concentration problems, brooding, fatigue, psychomotor agitation, sleep problems
THINGS THEY WORRY ABOUT THE MOST IN ORDER
Health of others
Family matters
The little things
School
Self health
Reassurance seeking > negative reinforcement rapidly throughout the day
Internalizing Symptoms
Anxious-Misery Symptoms (last a long time)
Major Depressive Disorder
Dysthymic Disorder
GAD
Fear Symptoms (symptoms occur abruptly and then go away and may only occur in certain situations)
Specific Phobia
Social Phobia
Agoraphobia
Panic Disorder
Worrying + Problem Solving = Normal
Worrying + Rumination = GAD
(rumination is usually past oriented)
OCD
Compulsion: ex-washing/grooming
Repetitive behaviors/thoughts to prevent anxiety or a dreaded event--won't realistically prevent or neutralize
anything
but the compulsion doesn't have to fix the obsession in a sensible way
Obsession: ex-germs
often related to religion or sexual imagery
1. Persistent thoughts, urges, images that come as intrusive thoughts and cause anxiety
2. Attempts to ignore the thoughts and to neutralize them with another thought/action
trying to ignore an intrusive thought = a compulsion
DIAGNOSTIC CRITERIA
A The presence of obsessions, compulsions, or both:
B. Time consuming / Impairs functioning
C. Not the result of drugs
D. For sure not another mental disorder
Classifying OCD
With good or fair insight
realizes beliefs are probe not true
With poor insight:
Thinks beliefs are probe true
With absent insight:
Completely convinced of beliefs
Tic-related:
history of tic disorder
Comorbidity with ASD
Disregulation of the cortico-stratial-thalamic circuit
More Information
Well-learned tasks are performed better in front of an audience
Poorly learned tasks are performed even more poorly
FEAR Plan
CBT for Parent and Child is the most effective treatment
CBT and Sertraline (meds) do not work as well to relieve anxiety alone as they do together, but anything is better that a placebo
Focus on cognitive and behavioral symptoms!
Trauma and Child Maltreatment
PTSD
DIAGNOSTIC CRITERIA (2+ primary criterion)
Behavioral
Cognitive
Intrusion Symptoms - one or more
Distressing memories
Distressing dreams
Flashbacks
Physiological reactions to internal cues
emotional
physiological
Alterations in arousal and reactivity
Angry outbursts
Reckless/self-destructive
Hypervigillance
Exaggerated startle response
Concentration Probs
Sleep disturbances
trauma
sexual trauma
REQUIRED for PTSD diagnosis
Exposure - one or more
Direct experience
Witnessing
Learning about event involving fan member / friend
Repeated exposure to details
Internal or external cues cause distress
Children are more likely to have PTSD symptoms/ PTSD if they are directly exposed to a traumatic event (>indirect>no exposure)
Persistent Avoidance
Negative alterations in cognitions and mood
Amnesia
Negative beliefs about oneself, others, or the world
Detachment from others
Blaming oneself
Negative emotional state
Lack of interest in activities
Inability to be happy
Duration of disturbance > 1 month
Disrupts normal functioning
Critical Incidence Stress Debriefing > not helpful
not due to substance or medical condition
Cortisol reduces the size of the hippocampus in large qualities (depression)
Child Abuse
Definition
Harm Standard:failure to act on the part of caregiver, results in death/physical/emotional harm/sexual abuse/exploitation
Endangerment Standard: act/failure to act that presents risk of serious harm
Symptoms in order of how common they are
Avoidance of people/places
Irritability and tantrums
Sleep disturbance/Distress from reminders
GENERAL MALTREATMENT STATISTICS
Over 900,000 children victims of maltreatment in 2006
12.1 per 1000 children in general population
Nearly 3.6 million received investigation
CHARACTERISTICS OF FAM / PERPETRATOR
Low SES
Single parent / large household
Parents - 85%
Sexual abuse: 50% parents, 50% not
Neglect: 90% mothers
Six Types of Psychological Abuse
Spurning - reject/degrade child
Terrorizing - threatening
Isolating - no interaction w peers
Exploiting - encourage antisocial acts, transport drugs, porn, prostitution