Generalized Anxiety Disorder: Video case study video applied to DSM5

 Blog  Add comments
Sep 082018
 

We have nothing to fear, but fear itself!

.

Certainly the inspirational phrase from Franklin Delano Roosevelt was intended for a different reason (to comfort and inspire the homefront during WWII), but it seems somewhat appropriate for this week’s write-up and video.  This week we’ll become informed regarding GAD (eGADs & GADzooks!); Generalized Anxiety Disorder.  It’s the first in a series on the anxiety disorders that include the five major types (as per the U.S. Department of Health and Human Services, quoted here):

“Generalized Anxiety Disorder

  • Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.
  • Obsessive-Compulsive Disorder (OCD)
    Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called “rituals,” however, provides only temporary relief, and not performing them markedly increases anxiety.
  • Panic Disorder
    Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
  • Post-Traumatic Stress Disorder (PTSD)
    Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.
  • Social Phobia (or Social Anxiety Disorder)
    Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation – such as a fear of speaking in formal or informal situations, or eating or drinking in front of others – or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.”

We’ll also look at other anxiety disorders such as “Selective Mutism” and other phobias (specific fears).

.

. Now don’t get nervous!  We’ll take it slow and guide you gently this week.

.

Let’s start at the beginning (Yes, I too remember Mary Poppins singing this sentence).  Let’s look first at that general anxiety category.

.

Anxiety in Our Lives

We all experience nervousness and concern about life events.  Anxiety is a normal and expected emotion in humans all over our blue-green orb.  We often feel tense before taking a test, and worry about problems at work or home.  Important impending decisions make us bite our lips and nails.

.

However, anxiety disorders move beyond everyday stress to longterm distress that interferes significantly with a person’s ability to lead a normal life.  Its causation is more complicated than being of “weak” constitution.  Overcoming it requires more than simply “toughing it out” and “sucking it up”.  An anxiety disorder is a serious mental illness that is socially and emotionally overwhelming… Indeed, it is psychologically crippling.  For people who struggle with anxiety disorders, extreme worry and fear are constant companions.

 

 

As with adults, anxiety in children and youth is a normal part of childhood.  Every child goes through phases… crying as an infant or toddler when separated from the caretaker, fear of the boogie man and other assorted monsters in the closet or under the bed, nervousness about one’s performance before “the big game”, and sweating over the entrance exam for that prestigious high school.  However, these events and phases are temporary and usually emotionally harmless.  Youngsters who suffer from an anxiety disorder experience incapacitating fear, nervousness, and shyness on a persistent long-term basis.  Due to it, they avoid certain places and activities.

.

When Nervousness is Magnified

It is estimated that about 1 in 8 children possess an anxiety disorder. Left untreated, this condition places children at high risk for missing out on important social experiences, performing poorly in school, and engaging in alcohol and/or drug abuse to numb the fears and concerns.  With treatment and support, these youngsters can successfully manage the symptoms and engage in normal childhood activities and pursuits.

 

Anxiety is often “co-morbid” (Yeah, I don’t like that term either… it means “can occur at the same time”) with other disorders such as ADHD, depression, and eating disorders.  Given their insecurities, concerns about being judged by others, and striving for perfection, our anxious youngsters may persistently seek reassurance and approval from others.  Children with anxiety disorders are often quite hard and critical on themselves, psychologically self-flagellating for not being “normal” … beating themselves up, emotionally speaking.

 

Whereas, generalized anxiety disorder (GAD) reveals a pattern of overly strong and constant worry and negative stress pertaining to a wide variety of different events and issues, other variations are more finely tuned.

.

So… WHAT IS GENERALIZED ANXIETY DISORDER?

Everyone gets anxious and concerned, but it the frequency, duration and intensity of that fearfulness of what might transpire that takes a common human condition and turns it into to a disability

Here are the identifiers:

  • Persistent, exaggerated, excessive unrealistic worrying about everyday things with no obvious reason for doing so.
  • Multiple non-specific worries.  Worries about multiple possible happening/negative outcomes.  Difficulty focusing on one concern without bringing others to mind.

It is the most common anxiety disorder (and perhaps the most common mental health condition).

.

.          

.

DSM-5 Diagnostic Criteria (paraphrased)

Must occur for at least 6 months and occur more days than not.

The child/youth finds it difficult to manage the worry.

The child/youth displays one of the following: restlessnes or a feeling of being “one edge”, becoming easily fatiqued, having difficulty concentrating, irritability, muscle tension, or sleep disturbance. (Adults must show 3 symptoms.)

The disturbance is not due to medications, a medical condition, or another mental health disorder.

..

.

Here’s the GAD video, courtesy of one of the revered grad students in my teacher training program in the area of mental health an behavior disorders.  It describes a youngster before comparing his characteristics with the diagnostic criteria for GAD.  Strategies are presented at the end. – https://www.youtube.com/watch?v=g_lZvBtpkys

.

.

.

Interventions

.

Early and intensive provision of emotional support services is mandatory.  Support from parents, school, and peers is essential.  These supporters will most likely need to be trained so that they can be truly therapeutic in their assistance, and avoid inadvertantly heightening the after-effects of the trauma.Most importantly, the supporters of this youngster must work as a team to establish feelings of being safe and protected in the aftermath of happenings that have created doubt of that safety and security. Therapy sessions by well-trained individuals should allow the youngster to play, draw, write or talk freely about the event.  Reflective listening strategies help the youngster to continue addressing the emotional challenge in a supportive environment. 

.

Other sometimes-indicated interventions include behavior modification techniques that promote “desensitization” (engaging in progressive goals that reduce the frequency and intensity of the negative recollections), and cognitive behavioral therapy that teaches the child to reframe the events in a manner that helps to reduce fears and worries.
.
 

.

Medication can also contribute to a lessening of anxiety, and ability to benefit from counseling as the youngster deals with the emotional after-effects of the trauma.  Some of the common prescription meds are: SSRIs (selective serotonin reuptake inhibitors that stop recycling thoughts), antidepressants, and Bensodiazepines (anti-anxiety/sedatives).Bibliotherapy and play therapy are often utilized.

.

During and after the school day, teachers also need to find mental calm; whatever gives one inner peace and strength.  There are many ways to do so; listen to music, exercise, engage in a hobby, spend time with special people, visit the dispensing machine in the teachers’ lounge…

It’s important to ensure that one does not seek calm with too much of this method.

.

To assist with that goal, Dr. Donia Fahim, a former colleague of mine in our Department of Special Education at Hunter College, created an audio relaxation tape.

.

Knowing that her teachers needed to decompress after their work day, “Dr. Donia”, a former colleague of mine in our Department of Special Education at Hunter College would start and end her evening graduate classes with a short relaxation session.  I asked her to make an audio recording for me.  She was kind to do so.  To listen to this free 11 minute audio,  CLICK HERE Click for more options or here ( https://youtu.be/2Mbg9BXNweQ ).  Call it up, close your eyes, and float away..

.

Dr. Mac

.

Tom McIntyre, Ph.D. (Dr. Mac)

Professor of Special Education and Coordinator of the Graduate Program in Behavior Disorders

Hunter College of the City University of New York

DoctorMac@BehaviorAdvisor.com

Buy Dr. Mac a Cup of Coffee! Dr Mac - CupOfCoffee (Click on the cup for info) (or go to paypal to say “Thanks”.)

.

 

.