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Social Anxiety and Generalised Anxiety Disorders (Generalised Anxiety…
Social Anxiety and Generalised Anxiety Disorders
Generalised Anxiety Disorder
Risk and Prognostic Factors
Temperamental
- behavioral inhibition, neuroticism, and harm avoidance.
Environmental
- childhood adversities and parental overprotection
Genetic
- 1/3 of the risk is genetic, overlap with the risk of neuroticism and are shared with other anxiety and mood disorders, particularly MDD
Prevalence and culture-related issues
0.9% in adolescence. Individuals from developed countries more likely to report that they have experienced symptoms that meet criteria
Development and Course
Median age of onset is 30. Early in life may be manifested as an anxious temperament. Onset rarely occurs prior to adolescence. Symptoms tend to be chronic and fluctuate
Remission rates are low.
Children and adolescents tend to worry more about school and sporting performance, punctuality, catastrophic events. Children may be overly conforming, perfectionist, unsure of themselves and redo tasks because dissatisfaction with less-than-perfect performance.
Whereas older adults report greater concern about the well-being of family or their heath. Younger adults = greater severity of symptoms
Differential Diagnosis
Anxiety due to another medical condition.
Substance
/
medication
-induced anxiety disorder.
Social anxiety disorder.
OCD
- worries in OCD are perceived as unwanted and intrusive
PTSD
and
adjustment
- if the anxiety is precipitated by a stressor, Sx seen within 3m and resolve within 6m.
Depressive
, bipolar, and psychotic disorders.
Diagnostic Criteria
C.
Associated with 3+ of the following six symptoms (Note: Only 1 required in children):
Restlessness, feeling wound-up, on edge
Irritability
Easily fatigued
Muscle tension
Sleep disturbance
Difficulty concentrating
D.
Not attributable to a substance use or medical condition
B.
Difficult to control the worry
E.
Causing clinically significant distress or impairment
A.
Excessive anxiety and worry more days than not, 6 months+, about a number of events or activities
F.
Not another mental disorder
Social Anxiety Disorder
Development and Course
Median age at onset is 13 years; 75% of
individuals have an age at onset between 8 and 15. Sometimes from childhood shyness. May follow a stressful or humiliating experience or may develop slowly.
Adolescents = broader pattern of fear and avoidance, (e.g. dating).
30% experience remission within 1 year, ~50% within a few years. ~60% w/o specific Tx, several years or more..
Risk and Prognostic Factors
Temperamental - behavioral inhibition and fear of negative evaluation.
Environmental - No causative role of maltreatment or adversity. However, still are risk factors.
Genetic - behavioural inhibition = strongly genetically influenced, more susceptible to influences such as modelling by parents. First degree relatives 2-6x higher risk.
Prevalence and culture related issues
7% in USA. Lower estimates in much of the world ~0.5%-2.0%. Median prevalence in Europe is 2.3%
5% high in females and more pronounced in adolescence.
In Asian cultures - associated with the fear that the individual makes other people uncomfortable (e.g., "My gaze upsets people so they look away and avoid me"), a fear that is at times experienced with delusional intensity.
Immigrant status is associated with significantly lower rates of social anxiety disorder in both Latino and non-Latino white groups.
Differential Diagnosis
GAD
- Social worries are common in generalized anxiety disorder, but the focus is more on the nature of ongoing relationships rather than on fear of negative evaluation
Normative shyness
- common but not pathological
Central to this diagnosis is the
FEAR
of
negative
evaluation
by others.
This is what differentiates it from a lot of disorders.
Diagnostic Criteria
A.
Marked anxiety about 1+ social situations involving possible scrutiny by others. In children, must occur in peer settings not just with adults.
B.
Fears that they will act in a way or show anxiety symptoms that will be negatively evaluated.
C.
Almost always provoke fear or anxiety. In children, may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak.
D.
Avoided/endured with intense anxiety.
E.
The fear or anxiety is out of proportion to the actual threat posed.
F.
Typically lasting for 6 months+.
G.
Causes clinically significant impairment in important areas of functioning.
H.
Not attributable to the effects of a substance (e.g. drug) or medical condition.
I.
Not better explained by the symptoms of another disorder.
J.
If another medical condition, the fear, anxiety, or avoidance is unrelated or excessive.
Specify if: Performance only. (e.g. restricted to public speaking)