This document provides information on social anxiety disorder, including its diagnostic criteria, prevalence, comorbidity, and course. It notes that social anxiety disorder involves a marked fear of social situations where one may be scrutinized. It affects 6-12% of children and is twice as common in girls. Two-thirds of those with social anxiety disorder also have another anxiety disorder and 20% have major depression. Onset is typically in early to mid-adolescence.

3. •More than exaggerated shyness.
•A marked, persistent fear of social or performance
requirements that expose the child to scrutiny and
possible embarrassment
•Anxiety over mundane activities
•Most common fear is doing something in front of
others
•More likely than other children to be highly
emotional, socially fearful; and inhibited, sad,
and lonely
Social Anxiety Disorder (Social Phobia)

4. SOCIAL ANXIETY DISORDER
–SOCIAL PHOBIA

5. DIAGNOSTIC CRITERIA FOR SOCIAL PHOBIA

6. •Lifetime prevalence of 6-12% of children
•Twice as common in girls
•Two-thirds also have another anxiety disorder
•20% also suffer from major depression and may self-
medicate with alcohol and other drugs
•Most common age of onset is early to mid-adolescence,
and is rare under age 10
Prevalence, Comorbidity, and Course
SOCIAL ANXIETY DISORDER
–SOCIAL PHOBIA

8. •Repeatedly perceived
memories of the trauma.
•Repetitive behaviors that
may be similar to obsessions
or compulsions.
•Fears linked to the
traumatic event.
•Altered attitudes toward
people, life, or the future,
reflecting feelings of
vulnerability.
POST-TRAUMATIC STRESS
DISORDER (PTSD)

10. • An unusual disorder of ritual and doubt
• Characterized by recurrent, time-consuming and disturbing
obsessions and compulsions
• Obsessions: persistent and intrusive thoughts, urges, or
images - experienced as intrusive and unwanted
• Compulsions: repetitive, purposeful, and intentional
behaviors or mental acts performed to relieve anxiety
• Extremely resistant to reason
• Children often involve family members in rituals
• Normal activities of children with OCD are reduced, and
health, social and family relations, and school functioning
can be severely disrupted
Obsessive Compulsive Disorder

11. OBSESSIVE COMPULSIVE DISORDER

12. •Lifetime prevalence in children and adolescents is 1-
2.5%
•Clinic-based studies find it twice as common in boys
•Comorbidities most common are other anxiety
disorders, depressive disorders, disruptive behavior
disorders
•Substance-use; learning and eating disorders;
vocal and motor tics are also overrepresented
PREVALENCE AND COMORBIDITY
OBSESSIVE COMPULSIVE DISORDER

13. •Originally believed to be rare
•>0.1%
•Recent evidence suggests 1-3% Onset /
Characteristics:
•Males:, high prevalence of checking
•Females:, high prevalence of washing
OBSESSIVE-COMPULSIVE DISORDER

14. •Average age of onset 9-12 years with
peaks in early childhood and early
adolescence
•Chronic disorder - as many as two-thirds
continue to have OCD 2-14 years after
initial diagnosis
ONSET, COURSE, AND OUTCOME
OBSESSIVE COMPULSIVE DISORDER

15. • OCD may include:
• Washing, checking, or other repetitive motor
behavior
• Cognitive compulsions consisting of words,
phrases, prayers, or sequences of numbers
• Obsessional slowness
• Doubts and questions that elevate anxiety
OBSESSIVE-COMPULSIVE
DISORDER

16. • Involuntary intrusive cognition
• Types
• Doubts (74%)
• Thinking (34%)
• Fears (26%)
• Impulses (17%)
• Images (7%)
• Other (2%)
What is an Obsession?

17. • Doubt “Did I lock the door”
• Thought that he had cancer
• Thought / Image that he had knocked
someone down in his car
• Impulse + thought to shout obscenities in church
• Image of corpse rotting away
• Impulse to drink from inkpot and to strangle son
Examples of Obsessions

18. • Obsessions often have common themes
• Contamination, dirt, disease, illness (46%)
• Violence and aggression (29%)
• Moral and religious topics (11%)
• Symmetry and sequence (27%)
• Sex (10%)
• Other (22%)
• The themes often reflect contemporary concerns
(the devil, germs, AIDS)
THEMES IN OBSESSIONS

19. •Scanning text for “life” having read “death”
•Touching the ground after swallowing saliva
•Driving back to check he hadn’t knocked
someone down in his car
•Counting 6,5,8,3,7,4 in your head
•Hand washing
EXAMPLES OF COMPULSIONS

20. LINKING OBSESSIONS AND
COMPULSIONS

21. •Obsessional thoughts found in 90% of people
•It is well replicated that 80%+ of normal people have
intrusive thoughts
•There thoughts are similar in content and form to OCD
patients
•Compulsions
•Many people have compulsions such as stereotyped or
superstitious behaviors
•66% of normal people report some form of checking
behavior
•Is OCD qualitatively distinct?
OCD and “Normal” Experience

22. OCD Not OCD
A man who washes his hands
100 times a day until they are red
and raw
A woman who unfailingly washer
her hands before every meal
A women who locks and relocks
her door before going to work
every day – for half an hour
A woman who double-checks
that her apartment door and
windows are locked each night
before she goes to bed.
A college student who must tap
on the door frame of every
classroom 14 times before
entering
A musician who practices a
difficult passage over and over
again until its perfect
A man who stores 19 years of
newspapers “just in case” – with
no system for filling or retrieving
A woman who dedicates all her
spare time and money to building
her record collection

23. •Exposure and Response Prevention (ERP)
•Responsibility
•Am I a murderer or just worried about being one?
•Normalizing / Other explanations
•Thought = action
•Can I think myself to death?
•Neutralizing
•Experiment to show how thought suppression
increases thought frequency
•Exposure: Cued Intrusions
OCD: Therapy

25. • Characteristics: sudden, overwhelming period of
intense fear or discomfort accompanied by four
or more physical and cognitive symptoms
characteristic of the fight/flight response
• Are rare in young children; common in
adolescents
• Young children may lack cognitive ability to
make catastrophic misinterpretations
• Are related to pubertal development
PANIC ATTACKS

26. •In severe cases, high anticipatory anxiety and
situation avoidance may lead to agoraphobia
•Fear of being alone in and avoiding certain
places or situations
•Fear of having a panic attack in situations
where escape would be difficult or help is
unavailable
•Does not usually develop until age 18 or older
Panic Disorder

27. DIAGNOSTIC CRITERIA FOR
PANIC DISORDER

28. •Panic attacks are common (16% of teens)
•Panic disorder is less common (about 2.5% of teens
13-17 years)
•Panic attacks are more common in adolescent
females than adolescent males
•Comorbidity adolescents with PD
•Most commonly have another anxiety disorder or
depression
•At risk for suicidal behavior; alcohol or drug abuse
Prevalence and Comorbidity

29. •Onset, course, and outcome
•Age of onset for first panic attack
15-19 years; 95% of PD adolescents
are post-pubertal
•Lowest remission rate for any of the
anxiety disorders
Onset, Course, and Outcome

31. •Age-inappropriate persistent, irrational, or
exaggerated fear that leads to avoidance of the
feared object or event and causes impairment in
normal routine
•Lasts at least 6 months
•Extreme and disabling fear of objects or situations
that in reality pose little or no danger or threat
•Child goes to great lengths to avoid the
object/situation
Specific Phobia

32. DIAGNOSTIC CRITERIA FOR
SPECIFIC PHOBIA

33. • Prevalence and comorbidity
• About 20% of children are affected at some point in
their lives, although few are referred for treatment
• More common in girls
• Onset, course, and outcome
• Onset at 7-9 years - phobias involving animals,
darkness, insects, blood, and injury
• Clinical phobias are more likely than normal fears to
persist over time
Specific Phobia

35. • Excessive, uncontrollable anxiety and worry
• Worrying can be episodic or almost continuous
• Worry excessively about minor everyday
occurrences
• Accompanied by at least one somatic symptom,
such as:
• Headaches, stomach aches, muscle tension,
and trembling
GENERALIZED ANXIETY
DISORDER (GAD)

36. DIAGNOSTIC
CRITERIA FOR
GENERALIZED
ANXIETY
DISORDER

37. •Prevalence and comorbidity
•National survey: lifetime prevalence rate - 2.2%
•Equally common in boys and girls
•Accompanied by high rates of other anxiety disorders
and depression
•Onset, course, and outcome
•Average age of onset is early adolescence
•Older children have more symptoms
•Symptoms persist over time
GENERALIZED ANXIETY
DISORDER (GAD)