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Separation Anxiety Disorder
involves developmentally inappropriate and excessive fear or anxiety related to separation from home or attachment figures as evidence by at least three characteristic symptoms:
recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures
persistent excessive hear of being alone
repeated complaints of physical symptoms when separation from an attachment figure occurs or is anticipated.
The disturbance must last for at least 4 weeks in children/adolescents or six months in adults
often manifests as school refusal and accompanied by stomachache, headache, nausea, and other physical symptoms.
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Separation Anxiety Disorder - school refusal typical age groups
5-7
10-11
14-16
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Separation Anxiety Disorder - treatment
systematic desensitization or other behavioral interventions
older children - cognitive approaches (identifying and replacing negative self-statements)
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Specific Phobia
Characterized by intense fear of or anxiety about a specific object or situation (heights, flying, receiving an injection, etc.) with the person either avoiding the object or situation or enduring it with marked distress.
The fear or anxiety is not proportional to the actual danger posed and is persistent - typically at least 6 months
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Specific Phobia - two-factor theory
attributes phobias to avoidance conditioning, which involves a combination of classical and operant conditioning
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Specific Phobia - Treatment
exposure with response prevention (especially in vivo exposure) that exposes the person to the feared object or situation while preventing them from engaging in cognitive or behavioral avoidance
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Social Anxiety Disorder (Social Phobia)
Intense fear of or anxiety about one or more social situations in which the person may be exposed to scrutiny by others.
They fear they will exhibit symptoms in these situations that will be negatively evaluated, avoids situations or endures them with intense fear or anxiety, and fear or anxiety is not proportional to threat
at least 6 months
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Social Anxiety Disorder (Social Phobia) - treatment
exposure with response prevention enhanced by social skills training or cognitive restructuring and other cognitive techniques
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Panic Disorder
Characterized by recurrent unexpected panic attacks with at least one attack being followed by at least 1 month of persistent concern about having additional attacks or about their consequences and/or significant maladaptive change in behavior related to the attack
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Panic Disorder - panic attack
an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes.
involves a minimum of four characteristic symptoms - palpitations or accelerated heart rate; sweating; trembling; feeling of choking; chest pain or discomfort; paresthesias (tingling or pricking); derealization (feel detached from your surroundings) or depersonalization (feeling that you're observing yourself from outside your body or you have a sense that things around you aren't real); fear of losing control
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Panic Disorder - 12 month prevalence
2-3% with females 2x as likely as males
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Panic Disorder - treatment
cognitive behavioral interventions that incorporate exposure
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Agoraphobia
The presence of marked fear or anxiety about at least two of the following with fear escape might be difficult or help with be unavailable if panic occurs:
using public transportation, being in open spaces, being in enclosed spaces, standing in line or being part of a crowd, and being outside the home alone
6 months
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Agoraphobia - treatment
in vivo exposure with response prevention
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Generalized Anxiety Disorder
excessive anxiety and worry about multiple events or activities that are relatively constant for least 6 months and the person finds difficult to control
must include at least 3 symptoms (1 in children) - restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance
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Generalized Anxiety Disorder - Treatment
CBT with pharmacotherapy - SSRI and SNRI or benzo
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Anxiety and depression share several characteristics. However, while anxiety and depression both involve negative affect, anxiety is associated with a higher level of _______ and _______ arousal
positive affect
autonomic
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Separation Anxiety Disorder involves ________ inappropriate fear or anxiety related to separation from home or attachment figures. For the diagnosis, symptoms must have a duration of at least ________ weeks in children and ________ months for adults
developmentally
4
6
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________ Phobia involves a marked fear of a specific object or situation, while Social Anxiety Disorder is characterized by intense fear of social situation that may entail exposure to ________. Treatment for these two disorders ordinarily includes ________
Specific
scrutiny by others
exposure with response prevention
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Because of the fainting reaction associated with the __________ subtype of Specific Phobia, treatment involves tensing (rather than relaxing) muscles in the presence of the feared stimulus
blood-injection-injury
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A diagnosis of Panic Disorder requires the presence of recurrent ___________ panic attacks with at least one attack being followed by persistent concern of having another attack or and attack's consequences or significant ________ related to the attack.
unexpected
maladaptive behavior
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Agoraphobia is diagnosed in the presence of marked fear of or anxiety about at least two of the following situations: using public transportation, being in open or enclosed spaces, standing in line or being part of a crown, and being _________. Treatment is most effective when it includes _________ exposure to feared situations, although the research is not entirely consistent regarding the relative effectiveness of graded versus intensive (ungraded) exposure.
outside the home alone
In vivo
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When symptoms involve excessive anxiety and worry about multiple events or activities for a period of at least ______ months, the likely diagnosis is GAD. In contrast to people with GAD, those with non pathological anxiety feel they can control their anxiety to some degree, are anxious about a fewer number of events, and are less likely to have associated ______. Treatment for GAD normally involves a __________ intervention that includes psychoeducation, cognitive restructuring, relaxation training, and exposure
6
physical symptoms
cognitive-behavioral
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Obsessive-Compulsive Disorder
recurrent obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impaired functioning
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Obsessive-Compulsive Disorder - Obsessions
persistent thoughts, impulses, or images experienced as intrusive and unwanted with attempts to ignore or suppress
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Obsessive-Compulsive Disorder - Compulsions
repetitious and deliberate behaviors or mental acts a person feels driven to perform either in response to an obsession or according to rigid rules.
The goal of the behaviors or mental acts is to reduce distress or prevent a dreaded situation from happening, but they are either excessive or not connected in a logical way to this goal.
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Obsessive-Compulsive Disorder - 12 month prevalence
1.2%
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Obsessive-Compulsive Disorder - gender
equal, but onset is earlier for males
children and adolescents more prevalent in males
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Obsessive-Compulsive Disorder - Treatment
exposure with response prevention mixed with the trcyclic clomipramine or an SSRI
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Body Dysmorphic Disorder
a preoccupation with a defect or flaw in appearance that appears minor or is unobservable to others. At some time during the disorder the person have performed repetitive behaviors or mental acts because of the defect or flaw and preoccupation causes clinically significant distress or impaired functioning
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Hoarding Disorder
a persistent difficulty discarding or parting with possessions, regardless of their actual value due to a need to save the items or to distress associated with parting with them.
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Reactive Attachment Disorder
A consistent pattern of inhibited and emotionally withdrawn behavior toward adult caregivers as manifested by a lack of seeking or responding to comfort when distressed and a persistent social and emotional disturbance that includes at least two of the following:
minimal social and emotional responsiveness to other people; limited positive affect; episodes of unexplained irritability, sadness, or fearfulness when interacting with adult caregivers.
The diagnosis also requires that the child has experienced extreme insufficient care that is believed to be the cause of the disturbed behavior and is evidenced by at last one of the following:
basic emotional needs for comfort, stimulation, and affection are not met by adult caregivers; repeated changes in primary caregivers that limit the ability to form a stable attachment; rearing in an unusual environment that limits opportunities to form selective attachments.
symptoms evident before 5 and a developmental age of at least 9 months
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Disinhibited Social Engagement Disorder
a pattern of behavior that involves inappropriate interactions with unfamiliar adults
needs at least 2: reduced or absence of reticence in approaching or interacting with unfamiliar adults; overly familiar behavior with unfamiliar adults; diminished or absence of checking with an adult caregiver after venturing away from him/her; willingness to accompany an unfamiliar adult with little or no hesitation.
developmental age of at least 9 months
experienced extreme insufficient care that is believed to be the cause of the disturbed behavior AEB by at least 1: basic emotional needs for comfort, stimulation, and affection are not met by adult caregivers; repeated changes in primary caregivers that limit the ability to form a stable attachment; rearing in an unusual environment that limits opportunities to form selective attachments.
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Posttraumatic Stress Disorder
exposure to actual or threatened death, serious injury, or sexual violence - direct experience, witness to, learning event happened to family member or friend, repeated or extreme exposures to aversive details of the event
At least one intrusive symptom: recurrent, involuntary distressing memories; recurrent distressing dreams; dissociative reactions in which feeling or acting if the event is recurring; intense or prolonged psychological distress when exposed to reminders of event; marked physiological reactions to reminders of event
persistent avoidance AEB one or both: avoidance of distressing memories, thoughts, or feelings related to event; avoidance of external reminders that elicit distressing memories, thoughts, or feelings related to event
Negative changes in cognition or mood associated with the event AEB at least two: inability to remember and important aspect of event; persistent and exaggerated negative beliefs about oneself, others, or the world; persistent distorted cognitions related to the event's cause or consequences; markedly diminished interest in significant activities; feelings of detachment from others; persistent inability to experience positive emotions
Marked change in arousal and reactivity associated with the event AEB at least 2: irritable behavior and angry outbursts; reckless or destructive behavior; hypervigilance; exaggerated startle response; impaired concentration; sleep disturbance
duration of symptoms at least 1 month
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Posttraumatic Stress Disorder - Treatment
comprehensive cognitive-behavioral intervention that incorporates exposure, cognitive restructuring, and anxiety management
Also SSRI
EMDR is used but is controversial
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Acute Stress Disorder
Same criteria as PTSD, with 9 symptoms from any one of five categories
symptom duration 3 days to 1 month
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Adjustment Disorder
Development of emotional or behavioral symptoms in response to one or more identifiable psychosocial stressors within 3 months of the onset of the stressor and must remit within six months after termination of the stressor or its consequences
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OCD is characterized by recurrent obsessions and compulsions that are sufficiently severe to cause _________ or impaired functioning. In adults, OCD is about equally common in makes and females, but in children and adolescents, it is more prevalent in __________. The treatment-of-choice for OCD is generally considered to be a combination of __________ and the tricyclic clomipramine or an SSRI
significant distress
Males
exposure and response prevention
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________ is characterized by a pattern of inhibited and emotionally withdrawn behavior toward adult caregivers, while __________ is characterized by a pattern of behavior that involves inappropriate interactions with unfamiliar adults
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
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PTSD involves the development of characteristic symptoms following exposure to a traumatic event that entails actual or threatened death, serious injury, or sexual violence. Characteristic symptoms include the presence of intrusion symptoms, persistent avoidance of stimuli associated with the event, negative changes in ________, and marked changes in arousal and reactivity. For the diagnosis, symptoms must have a duration of more than ___________ and must cause clinically significant distress or impaired functioning. The delayed expression specifier is applied when the full diagnostic criteria are not met until at least _________ after the traumatic event.
cognition or mood
1 month
6 months
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The treatment of choice for PTSD is a comprehensive ___________ intervention that incorporates exposure, cognitive restructuring, and anxiety management. When symptoms similar to those associated with PTSD have a duration of _______ to one month, the diagnosis is probably Acute Stress Disorder
cognitive-behavioral
3 days
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A diagnosis of Adjustment Disorder requires the development of emotional or behavioral symptoms in response to one or more psychosocial stressors within ________ of the onset of the stressor with a remission of symptoms within _________ after termination of the stressor or its consequences
3 months
6 months
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Generally, when treating a child for school refusal, the initial intervention should be to:
A.begin family therapy.
B.identify factors that are reinforcing nonattendance.
C.temporarily remove the child from the school environment.
D.get the child back to school as soon as possible.
D
When identifying an appropriate intervention for school refusal, it would be important to determine its cause. However, most experts agree that an initial intervention is to get the child back to school as soon as possible.
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The diagnosis of Disinhibited Social Engagement Disorder requires:
A.evidence of self-injurious behavior.
B.an onset of at least some symptoms prior to two years of age.
C.a persistence of symptoms for at least two months.
D.evidence that symptoms are due to extreme insufficient care.
D
Disinhibited Social Engagement Disorder involves a pattern of behavior in which the child actively approaches and interacts with unfamiliar adults. The diagnosis requires evidence that symptoms are related to exposure to a pattern of extreme insufficient care.
Answer A: Self-injurious behavior is not a diagnostic criterion for Disinhibited Social Engagement Disorder.
Answer B: For the diagnosis, the child must have a developmental age of at least nine months.
Answer C: The DSM-5 does not specify a minimum duration of symptoms for Disinhibited Social Engagement Disorder.
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The treatment-of-choice for Agoraphobia is ordinarily:
A.systematic desensitization.
B.covert sensitization.
C.exposure with response prevention.
D.EMDR.
C
For Agoraphobia and many other Anxiety Disorders, exposure with response prevention (ERP) alone or in conjunction with other interventions is the treatment-of-choice.
Answers A and D: While these interventions are used to treat some anxiety disorders, the treatment-of-choice for Agoraphobia is ERP.
Answer B: Covert sensitization is generally used to treat addictions and unwanted behaviors.
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When faced with a feared stimulus, a person with Specific Phobia, blood-injection-injury type will most likely:
A.faint.
B.fall asleep.
C.scream.
D.have a seizure.
A
The blood-injection-injury type differs from other Specific Phobias in terms of the physical reaction to feared stimuli. For people diagnosed with this type, initial symptoms involve an increase in heart rate and blood pressure that is immediately followed by a drop in both, and these physiological responses result in fainting.
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The rates of Obsessive-Compulsive Disorder are:
A.higher for males in childhood but about equal for males and females in adulthood.
B.higher for females in childhood but about equal for males and females in adulthood.
C.about equal for males and females throughout the lifespan.
D.higher for females throughout the lifespan.
A
In adults, the rate of OCD is about equal for males and females. However, because the average age of onset is earlier for males, the rate for males is higher during childhood.
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Ella G. was involved in a serious car accident three weeks ago in which her best friend was killed. Since the accident, Ella has experienced a loss of positive feelings toward friends and family members, increased irritability, flashbacks of the accident, an inability to remember what happened in the days following the accident, nightmares about the accident, and derealization. She has been avoiding the intersection where the accident occurred, doesn't like to talk about the accident, and has been having trouble concentrating and sleeping. Based on these symptoms, the most likely diagnosis for Ella is which of the following?
A.Brief Psychotic Disorder
B.Adjustment Disorder
C.PTSD
D.Acute Stress Disorder
D
The cause, nature, and duration of Ella's symptoms meet the diagnostic criteria for Acute Stress Disorder.
Answer A: As its name implies, Brief Psychotic Disorder involves symptoms of psychosis such as delusions, hallucinations, and/or disorganized speech or behavior. Ella has not reported these symptoms.
Answer B: Adjustment Disorder is a diagnosis for symptoms that represent a response to a psychosocial stressor that does not meet the requirements for a diagnosis of Acute Stress Disorder or PTSD.
Answer C: Although the woman's symptoms are characteristic of PTSD, their duration is not: A diagnosis of PTSD requires a duration of symptoms for more than one month.
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For a diagnosis of Generalized Anxiety Disorder in children, anxiety and worry must involve _____ or more characteristic symptoms.
A.one
B.two
C.three
D.four
A
Generalized Anxiety Disorder (GAD) involves the presence of excessive anxiety and worry about several events or activities. For the diagnosis, anxiety and worry must involve three or more characteristic symptoms for adults or one or more symptoms for children.
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Soon after losing his job, a 43-year-old man develops feelings of sadness and hopelessness. He has trouble even thinking about looking for another job and thinks his unemployment is already having an adverse effect on his marriage. The man's symptoms have lasted for ten days, and he has no previous history of a mental disorder. The most likely diagnosis is:
A.Adjustment Disorder with depressed mood.
B.Adjustment Disorder, unspecified.
C.Major Depressive Disorder.
D.Acute Stress Disorder.
A
The man's symptoms suggest depression but do not meet the diagnostic criteria for Major Depressive Disorder. Also, the nature and duration of his symptoms and the fact that they appear to be the result of his job loss are most suggestive of Adjustment Disorder with depressed mood.
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