lecture 8 *PDD*

essential to survival

helps avoid dangerous situations

adaptive → problematic → pathological

*depending on intensity , duration and pervasiness

most children have one or two fears appropriate to their age

interference with daily life and development

genetic predisposition

temperament

cognition

insecure attachemnt

enducation and aprental style

negative life events

1. excessive fear and anxiety

1. related behavioural disturbances

fear : emotional response to real / percieved imminent threath

anxiety: anticpation of future threath

1. non attributable to physiological effects of :

Medication/substance

Medical condition

one of the most prevelent disorders

often eary onset

2:1 female to male ratio

wax and wain over time (goes up and down )

high comorbidity

1. Separation Anxiety Disorder (e.g., parents leaving)
2. Selective Mutism
3. Specific Phobia
4. Generalized Anxiety Disorders
5. Social Anxiety Disorder
6. Panic Disorder
7. Agoraphobia

1. OCD

1. acute stress disorder
2. PTSD

execcise anxiety ( or anticipation ) of going away from home or leaving attachement figures

excessive worry that caregicer may be harmed

frequent nightmeres abour separation

reccurent physical complaints when not in close proximity to attachement

child showa xonsistent failure to speak in specific ocial situations in which there is and expectation for speaking, despite speaking in other situations

disturbance interberes with educational achievement and social interaction

duration : at least 1 month ( not limited to the first month of school)

not atributed to lack of knowledge

the disturbance is not better explained by other disorders

often co exists with social anxiety disorder

claustrophobia , needles , flights ,

marked as intense fear / anxiety or specific object or situation that substantially interfers with the person's ability to function

phobic : object almost alweys evokes immediate and persistent fear/anxiety

Phobic object is actively avoided or enduredwith intense fear/anxiety

Fear/anxiety is out of proportion (irrational)

Persistent: >6months

Animals

Natural environments

Blood Injection injury

Situational

Other

7.4% cross national life prevelene

yoing obset ( 8 years old )

60% has at least 1 comorbid disorder

often suffered so many years → not alweys overt anxiety in daily life

recognise excessivness of their fear reaction but not actual danger

following traumatic event

informational trnasmission

observational learning

Excessive anxiety and worry, occurring more days than not for at least 6 months about number of events or activities

dificulty controllin the worry

associated with three or more other symptoms

clnical distress or impairment

3% prevelence

age of onser 25-30 years old

1. Marked fear/anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others

social interactions ,being observed ,performing in fornt of others

1. individual fears he/she will act in a way or show anxiety symptoms that will be negativly evaluated

humiliating or embasasing ,leading to rejection or offendicg others

2. social situations are voided or endured with high anxiety

Social situations almost always provoke fear or anxiety

Fear/anxiety is out of proportion

Persistent: > 6 months

Clinically significant distress or impairment

Not attributable to substance, medication, or other disorder/condition

Prevalence: 2 - 5%
Age of onset: adolescence (10- 15 years old )
panick attacks may occur

recurrent unexpected panick attacs

attacks are followed by one month period or more of

*persistent worry about having n additional atack

*significat changes in behaviour because of attack

Abrupt surge of intense fear or discomfort that reaches a peak within 10 minutes and during which time 4 or more of the following symptoms occur:

1. Pounding or accelerated HR
2. Sweating
3. Trembling or Shaking
4. Shortness or breath
5. feelings of choking
6. Nausea
7. Feeling dizzy, unsteady, light heade or faint
8. Chills or heat sensations
9. Numbness or tingling sensations
10. Derealization or depersonalization
11. Fear of losing control or going crazy
12. Fear of dying

Prevalence: 2-3%
Age of onset: early adulthood (20-24 y/o))

A panic attack ≠ panic disorder

Great variety in severity and frequency of attacks

Possible episodic outbreaks with years of remission in between

*fear or anxiety for more than 6 months about two or more of the following 5 situations

1. Using public transportation
2. Being in open spaces
3. Being in enclosed spaces
4. Standing in line or being in a crowd
5. Being outside of the home alone

*sitautions re avoided or endured with ntense fear

*interferese with routin or functioning

now diagnosed irrespective of panic disorder

Prevalence: 2%

Mean onset is 17 years

30% of persons with agoraphobia have panic attacks or panic disorder

May fear social situations too

obsessions or compulsions ( most oftn both )

Obsessions or compulsions are time consuming (min.1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

vary egree of insight

persistant and reccurent intrusive thoughts , ideas , images or impulses

*content , disturbing, offensive or irrational themes

*related to uncertainty about frightness

*causes severe anxiety

repetitive behaviours , urges, rituals acts

*regarded as excessive or exaggerated ( especially in calmer moments)

Prevalence: 1 2% of population

Somewhat more women than men

Age of onset: early teens/adolescence

Suffer for several years before diagnosis

Checking is most prevalent compulsion (80% of OCD patients)

Common factors: excessive fear/anxiety and behavioral disturbances

Differences: focus of fear/anxiety and content of thoughtselieves

Cognitive behavior therapy is the gold standard treatment

Thoughts, behaviors and emotions all mutually influence on another target for treatment

exposure to one or more event(s) that involved death or threathenes death actual or threthned serious injury or threthned sexual violation

direct exposure

witnessiong the trauma

learning that a relative or close frind was exposed to trauma

indirect exposure to adversive details of the trauma usally in the cousre of proffesional duties ( medics , reporters, investigators )

60.7% males

51.25% females

lifetime prevelence common mental disorders in conflic setting

PTSD : 30.6 %

depression : 30.8%

55% the tramatic event troubles within 1 month

15% within 4 months

5% after 6 months

exposire to actual threatnd death , serious injury , sexual violence in one or more of following ways

1. directly expirincing traumatic event
2. itnessing , in person , events as occurd
3. learning traumtic event about close member
4. expirincing repeated or extreme exposire to aversivities of traumatic events ( collecting human remains )

the traumstic event is persistently re expirinced in the following way(s)

*unwanted upsetting memories

*nightmaares

*flashbacks

*emotional distress after exposure to traumatic reminders

*physical reactivity after exposure to tramuatic reminders

avoidance of trauma related stimuli after the trauma in the following ways (s) :
1. avoid memories and taught
2. avoid external reminders of event

negative thoughts or feelings that began or worsten after the trauma in the folloing ways

1. inability to recall key features of the trauma
2. persistent and negative beliefs
3. persistent distorted cognitions about cause
4. persistent negative emotional state
5. markedly diminished interet in participation in significant activities
6. feelings of detatchement
7. persistent inability to expirince [ositive emotions

trauma related ariusal and reactivity that began or worsten after the trauma in the followinf ways :

1. Irritability or aggression
2. Risky or destructive behavior
3. Hypervigilance
4. Heightened startle reaction
5. Difficulty concentrating
6. Difficulty sleeping

genetic vulnerability

female seks

low age

intelligence

low SES

prior trauma

prior psychiatric symptoms

perceived threat

negative interpretation of event

fysiological arousal

anger and shame

Dissociation during event

social support

coping

negative interpretation of consequences of event

new life events