So far in this blog series we have discussed Separation Anxiety Disorder (SAD), General Anxiety Disorder (GAD), Panic Attacks, Panic Disorder and Obsessive Compulsive Disorder (OCD).  Now, let’s talk about Social Phobia, Selective Mutism and Specific Phobia and how they affect children.

Social Phobia – This painful syndrome is characterized by excessive anxiety related to social events or performance situations where there is the fear of exposure or scrutiny by others. There is a fear of anxiety or even panic which would secondarily lead to humiliation or disgrace. The fear can be quite specific such as speaking in class, or become more general where it can lead to widespread avoidance to areas like socializing, group situations, or even speaking to people at school like teachers or friends. It can be quite disabling. In children who have excessive social anxiety it can present as fearfulness with any stranger, having to cling to a parent, or signs of distress in social situations like crying, tantrums, or freezing up.

Selective Mutism – This syndrome is considered to be a severe example of social phobia where the child presents as failing to speak in certain social situations where there is such an expectation such as in school or sometimes simply outside the house. There is full ability to speak and often a child can be heard speaking well and loudly to a parent (such as in the waiting room of my office only to go mute upon entering my consulting room). This diagnosis is made after other psychiatric syndromes are ruled out which might interfere with speaking such as autism or language/speech/communication disorders.

Specific Phobia – A phobia is a marked and repetitive fear which is stimulated by a situation or object. It is unreasonable, irrational, and is usually recognized as such except in younger children. When exposed to the phobic stimulus there can be great anxiety, possibly a panic attack, crying, a frozen look, tantrums, and excessive clinging. There are literally thousands of phobias described, but the more common ones are of animals, storms, heights, blood, medical procedures, elevators, airplanes, tunnels, insects, or getting an injury.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

Anxiety disorders are mental disorders with some form of anxiety as a major symptom. Although, anxiety is present in nearly all people who suffer from any mental disorder; it is the main symptom in these disorders. The anxiety disorders are categorized by the way the anxiety manifests itself. There are eight main types of anxiety disorder. I’m going to talk in this blog about Separation Anxiety Disorder (SAD), General Anxiety Disorder (GAD) and Panic Attacks and Panic Disorder.

Separation Anxiety Disorder (SAD) -This disorder’s main characteristic is anxiety when a child leaves home or people to whom she is attached. While separation fear is common and expected in young children, especially during the first and second years of life, it usually abates as a child approaches the school years to the point that a separation anxiety is not present. SAD has the following symptoms:

1. A serious worry that something bad (often including death) will happen to parents or caregivers upon separation or to the child, upon separation from the parents or caregivers.
2. This anxiety is manifested even when a separation is anticipated
3. Worries over abduction or being kidnapped
4. School refusal in order to stay near parent, often accompanied by a stomach ache and headache complaints around separation time
5. Fear of being alone or even going to sleep without the parent
6. Bad dreams about separation
7. Bed wetting
8. Rage episodes and tantrums and begging not to be forced to separate

As mentioned above, while we don’t know the exact mechanism of how an anxiety disorder as SAD is generated, the disorder often appears after a major separation, a move to new surroundings, loss of an important care-taking figure, in a house with over protective parents, and in families with others who have the same condition.

Generalized Anxiety Disorder (GAD) – This disorder is characterized by excessive worrying. It is hard to specify the source of worry since it varies quite a bit and is general in nature. The child often feels on edge and is tense most of the time. As a result, she is often tired, has muscular tension states, and finds it difficult to relax, concentrate, or just let loose. There is irritation and often trouble sleeping, as well. Often such children are quite perfectionistic and come from homes that are pressure cookers for performance.

Panic Attacks and Panic Disorder (with or without agoraphobia) – A Panic Attack is one of the most uncomfortable symptoms known to us. Sometimes called anxiety attacks, panic attacks are a discreet period during which a child or teenager feels intense fear, often of doom, going crazy, dying, or some vague dread of being out control. They can last anywhere from several minutes to a half hour. There is an intense need to escape. An outpouring of adrenaline leads to many physical symptoms along with ideas of death or going crazy. The following are listed as the most common symptoms:

1. Shortness of breath
2. Choking feeling
3. Racing pounding heart, sweating, trembling, chills, or hot flushes
4. Chest discomfort
5. Nausea and abdominal distress
6. Feeling unreal or perceiving the world as unreal
7. Dizziness, feeling like fainting or in fact fainting
8. Tingling or numbness in the extremities

Panic Disorder occurs when a worry is experienced after one or more panic attacks and the child begins to anticipate another and, as a result, often alters his behavior to avoid being unable to escape or get help, if one might occur. Thus, many children develop an avoidant (phobic) lifestyle to avoid such situations like leaving home, crowds, being on a bridge, and public transportation. This syndrome is called agoraphobia from the Greek word agora meaning marketplace referring to an open place. Some people never develop the agoraphobia, but simply have panic disorder with recurrent panic attacks and worry, but no avoidance.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

Mental health practitioners are not certain what causes anxiety disorders, but we have always felt that buried inner conflicts may be the underlying culprit. Anxiety can manifest itself in many ways, with many different symptoms. These symptoms can include worrying, apprehension and excessive shyness, to fear of everyday situations and even to panic. Often there are physical symptoms like a racing heart, difficulty breathing, sweating, dizziness, headache, nausea, vomiting and diarrhea, and occasionally, muscle spasms. There can also be a sensation of finger-tingling and weakness in the muscles of the legs.

Children with anxiety disorders have difficulty learning and socializing and have trouble functioning well in school and at home. They also develop phobias where they misperceive and often exaggerate environmental dangers leading to avoidance of many situations. Most children suffering from ongoing anxiety eventually lose confidence, feel helpless and vulnerable, and develop depression. Causes of anxiety can include the following:

1. An inner conflict between such feelings as dependency and anger at important figures is a common generator of anxiety states.
2. Excessive trauma, such as child physical or sexual abuse, might give rise to persistent anxiety states.
3. Some anxiety disorders are thought to have a significant basis in genetic inheritance, such as obsessive compulsive disorder and panic disorder.
4. Some anxiety symptoms are learned through observation of family members who suffer from such problems, called learned anxiety.
5. Some have considered abnormal neurotransmitter activity as a cause.
6. Some medical conditions occasionally give rise to excessive anxiety, such as hyperthyroidism, certain tumors, some neurological illnesses, heart rhythm and valve disorders, certain lung diseases especially with shortness of breath, and some infections.
7. Some medications cause anxiety as a side effect.

We will address seven of the most common anxiety disorders in the next two blogs. In the meantime if you have questions please email me at drpaul@henrypaulmd.com.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

Fear and anxiety are a very necessary part of growing up and they help children to deal with the unsettling experiences and challenging situations that are a part of everyday life.

FEAR

Every child and every adult has fears. Without fear, we would not be able to develop and learn about the many dangers that exist in the world, things that could hurt us. Fear is a rational, appropriate response to danger and having fears or anxieties about certain things is helpful because it makes kids, especially, behave in a safe way. As we get older, we learn more and more about threats and develop the capacity and confidence to handle our fears, so we begin to overcome them. The younger we are, the more fearful we are, and the more global are our responses. The fears that children experience can change with age – babies are afraid of strangers whereas teenagers are afraid of bullying. There are a number of childhood fears – some that we might remember experiencing ourselves. Some common childhood fears include:

1. Separation from caretakers
2. New situations
3. The dark
4. Loud noises including thunderstorms
5. Monsters
6. Getting lost or abducted
7. Animals, especially dogs, snakes, and insects
8. A parent dying
9. The many new challenges that accompany normal childhood development, such as the first day of school or a first date.

Many childhood fears seem irrational to us, but if we think about it, we realize that, without the experience of living and growing, childhood fears are not irrational at all. No one ever completely lives without fear. While there is a wide variation in how each of us responds to fear it is always present.

ANXIETY “apprehension without apparent cause.”

Anxiety resembles fear but it is different. It is essentially an irrational fear based on inner psychological issues. Sometimes it presents as what appears to be a continuation of common childhood fears, as with a ten-year-old who fears the dark excessively or a seven-year-old who cannot separate from his parents and go to school. These situations are no longer simple fears of childhood but are now, most likely, symptoms of one of the anxiety disorders: a diagnosable mental disorder. The following are the more commonly diagnosed disorders in young people:

1. Separation Anxiety (SAD)
2. Generalized Anxiety Disorder (GAD)
3. Panic Disorder & Panic Attacks
4. Obsessive Compulsive Disorder (OCD)
5. Post-Traumatic Stress Disorder (PTSD)
6. Social Phobia
7. Selective Mutism
8. Specific Phobia

Since many anxiety symptoms resemble the normal fears of childhood we often mistakenly say that such sufferers seem immature or infantile, while, in fact, they are suffering from an anxiety disorder. I will break down the phobias in the next couple of blogs and tell you what triggers them and how to treat them.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

Josh was always a lot more sensitive than his sisters. When he was a toddler he was more affected by things like loud noises, meeting new people and our going out at night and leaving him with a sitter. Now he’s in his second year at preschool and he’s started trying to avoid going. It’s become a terrible problem each morning with screaming, tantrums, and fighting until we give in and let him stay home. 

Anxiety disorders are the most common mental disorders in young people. It is estimated that 10 to 20 percent of youngsters under eighteen years of age have some sort of anxiety disorder. This is a remarkably large number and more startling is the fact that only a small fraction of these children will be treated. Without proper treatment, the effects of these disorders can be devastating. It has been reported that the incidence of many mental disorders occurring later in life increases if earlier childhood and adolescent anxiety disorders are left untreated. These include serious adult depressive and anxiety disorders, suicidal tendencies, mental breakdowns, school failure, academic and work failure, and substance abuse.

In my next few blogs, I will address the different types of disorders (including PTSD – Post-Traumatic Stress Disorder), how they appear in young people and how they are treated.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.