Psikologi Anak Pertemuan 10 Emotional Disorders. Anxiety Viewed as a multi-dimensional response to the expectation of threat Anxiety is common Anxiety.

Psikologi Anak

Pertemuan 10Emotional Disorders

Anxiety• Viewed as a multi-dimensional response to

the expectation of threat• Anxiety is common• Anxiety can be adaptive• Symptoms include trembling, palpitations,

sweating, gastro-intestinal discomfort, diarrhea, muscle tension, blushing, confusion

Commonly used terms

• Fear – an emotional reaction to present danger (real or imagined)– Autonomic nervous system– Flight/fight response

• Panic – sudden extreme fear/terror– Physical symptoms

• Anxiety – more persistent and often about things that may happen in the future

Developmental progression• Infancy - strangers, loud noises• 1-2 yrs - separation, animals, dark, loud

noises, the toilet• 4-6 yrs - kidnappers, robbers, ghosts• 6-early adol.- bodily injury, death,

achievement• 10+ - social comparison, appearance, personal

conduct, exams

Separation anxiety

• Developmentally inappropriate and excessive anxiety re separation from home or an individual

• May develop after some life stress• Onset may be as young as pre-school• Prevalence about 4%

Generalized Anxiety Disorder

• Excessive anxiety/worry (apprehensive expectation) about a number of events/activities.

• Accompanied by symptoms - restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, disturbed sleep

• Intensity and duration out of proportion to likelihood or impact of feared event

Obsessive-Compulsive Disorder

• Recurrent obsessions or compulsions that are severe enough to be time-consuming or cause marked impairment or distress

• Obsessions - persistent thoughts, ideas that are experienced as intrusive and inappropriate

• Compulsions - repetitive behaviours or mental acts the goal of which is to reduce anxiety or distress

Specific Phobia

• A marked and persistent fear of clearly discernible, circumscribed objects or situations.

• Exposure - immediate anxiety response• Feared stimulus frequently avoided• Commonly - animals, insects, environmental

fears, situational fears

Social Phobia

• Marked and persistent fear of social or performance situations in which embarrassment may occur

• Exposure - immediate anxiety response• Often situation is avoided• Common features - hypersensitivity to

criticism, negative evaluation, low assertiveness, low self-esteem

Post Traumatic Stress Disorder

• Characteristic symptoms following exposure to an extreme stressor.

• Response to the event must include intense fear, feelings of helplessness or horror – in children disorganized or agitated behaviour

• Persistent re-experiencing of trauma, avoidance of stimuli associated with event, symptoms of increased arousal

Aetiology

• Genetics and neurobiology– family studies & twin studies

• Behavioural inhibition– early manifestation of predisposition

• Psychosocial factors– stressful life events

• Psychoanalytic theory– anxiety central to theory of neurosis

Treatment• Most promising treatment CBT using a combination of behavioural and cognitive

techniques– Relaxation training (BT)– In vivo exposure (BT)– Contingency management (BT)– Self-instructional training (CBT)– Positive self-statements (CBT)

• Recent studies show increased benefits from combining group CBT with family therapy• 10-16 sessions target behavioural and cognitive sequelae of the anxiety disorder

– awareness of physical symptoms– recognition of cognitions– problem-solving skills– self-evaluation and rewards

• All of this is done slowly and using role play, rehearsal and feedback• second 8 sessions employ imaginal and in vivo exposure to anxiety provoking situations

– child practices skills learned earlier in the feared situations– a hierarchy is used to take the child step by step towards the feared situation

Mood Disorders

Types of mood disorders• Major depressive episode– Meets DSM criteria

• Major depressive disorder– Two or more episodes

• Bipolar disorder– Switches between normal mood, depressed mood and

manic states• Dysthymic disorder– Persistent mild depression

Age related symptomatology

• Children do not complain of feeling depressed and may present as irritable, anxious or hyperactive.

• Adults note behavioural indicators• More likely to be referred for and diagnosed

with oppositional behaviour, anxiety, ADHD than with depression

Diagnosis of Depression

• Definition is the same as for adult diagnosis• DSM-IV criteria• Onset in childhood/adolescence constitutes

early onset• Early onset impacts on prognosis

Risk Factors for Depression

• Genetic factors – predisposition• Child factors – temperament• Early adverse environment– Maternal depression• Neglect• Modelling

– Marital conflict– Domestic violence

Precipitants for Depression

• Major Loss– Death of a loved one– Interpersonal loss (relationship)

• Negative life event– Failure (school or work)

• Disciplinary crisis– Arrest

Theories of DepressionPsychoanalytic theory• Unresolved oral conflict• Perceived rejection during oral stage• Failure to develop strong sense of self• Overly dependent on opinions of others• Want to punish those who reject them• Turn anger inward• Loss/rejection leads to depression

Cognitive theory• Early rejection, criticism by or loss of a parent• Unrealistic expectations of self• Cognitive Triad (self, events, the future)• Major loss/disappointment will trigger a depressive reaction• Maintained by distorted thinking patterns

Treatment of Depression

• Treatment depends on your conceptualization of the cause of the depression– Biological– Psychoanalytic– Cognitive– A combination

Suicide

• Suicide is rare in children but does occur• Rates increase through adolescence• 3rd leading cause of death 15-24 year olds• Rates tripled from 1945 to 1995• Increase in depression• Access to means (guns, drugs)• Attempts also increase through adolescence• 1 in 10 girls; 1 in 25 boys

Suicide

Risk Factors• Depression• Family history of suicide• Family discord• Substance abuse

(alcohol, marijuana etc)• Relationship problems• Peer problems• Physical or sexual abuse• School problems• Other emotional

problems

Protective Factors• Having someone to talk

to a friend, school counsellor, teacher

• Having a close/ supportive family

• Having had positive life events

• Emotional stability• Being connected to

school or community• Belonging to a group