Recognizing Anxiety Disorders

1. Part One Recognizing Anxiety Disorders When is treatment necessary? Specific phobia Generalized anxiety disorder Social Phobia Separation Anxiety Panic Disorder Agoraphobia Hypochondria

3. Ocd Anxiety Depression Bi-polar Schizophrenia Personality disorders Disorders

4. Withdrawal from friends Extreme fatigue Loss of interest addictions קדושה angry Behaviors

5. Bad Habits Poor coping skills Negative thinking patterns Weak Insecure Perfectionistic Very dependant on approval and admiration Negative and pessimistic thinking and living pattern Spoiled and sensitive

6. Nature and nurture Biological predisposition ***** Affects of parents, environment and life experiences.

7. Sorting out the pieces Developing a plan

8. Anxiety Anxiety occurs when the demands of development EXCEED the ability to cope Anxiety is produced whether or not this feeling is real or simply imagined. There is an underlying feeling of inadequacy to cope.

9. What makes us anxious? • The lack of ability to control the outcome of something that we feel compelled to succeed in. • You can notice that we all have anxiety when we cannot cope: • If we would meet an Arab with a gun – our hearts would start pounding • if we were to meet a bear in the woods alone at night – our hearts would starts pounding. • when we go for a test that we cannot control the outcome- we will become nervous and anxious

10. להרגיל הבנים בדברים שמצד גילם טרם בא הזמן שיוכלו לעמוד בהם, כי אפילו אם הן מצליחות – ספק אם לא גרמו נזק לילד! דע: כל תביעה שלא לפי גיל הילד עלולה להכות פצע נפשי בלבו הרך, פצע העתיד להשפיע באופן מדאיג על כל התפתחותו ואופיו, בצורת פחדים, עצבנות, וחוסר עצמאות בגיל שדרושה עצמאותץ דברים אלה אמורים גם כלפי דברים כה פשוטים כמו נקיות, ישיבה מסודרת על יד השולחן וכדומה, שהאמהות רגילות לדרוש מהילדים כמה שנים לפני הזמן הנכון. (עלי שור ח"א דף רס"ג)

11. Anxiety Response to judgment of risk or danger; A warning sign from the brain Normal anxiety – needed for preparation and protection.

12. When does anxiety become a Problem???

13. Anxiety disorder Normal anxiety Story Walking through the woods alone at night – you suddenly hear some crackling branches nearby – you turn around and see a large hungry black bear!!! Reaction You begin to shiver, your knees start knocking together, you feel frightened, your heart starts pounding, your vision becomes blurred, you feel you are going to pass out. Story Sitting on your porch on a bright sunny day, a bumblebee flies onto the porch and you see it from a distance. Reaction You begin to shiver, your knees start knocking together, you feel frightened, your heart starts pounding, your vision becomes blurred, you feel you are going to pass out.

14. The problem: • When the brain • sends warning messages • to the body • When there is really no need to. • Similar to a false alarm • this is usually done by • Exaggerating the likelihood and the severity of the danger • This triggers very uncomfortable physical and emotional symptoms

15. Emotional symptoms of anxietyIn addition to the primary symptoms of irrational and excessive fear and worry, other common emotional symptoms of anxiety include: • Feelings of apprehension or dread • Trouble concentrating • Feeling tense and jumpy • Anticipating the worst • Irritability • Restlessness • Watching for signs of danger • Feeling like your mindhasgone blank

16. The solution: Part 1 To retrain the mind and the body To recognize what is normal and what is Exaggerated danger. Part two To retrain the thinking pattern to think positively and confidently. Part three Uncover the causes and the Motives that are reinforcing this pattern

17. Step one: • Evaluate the severity of the anxiety • This is measured by • How much the anxiety is in • Disproportion • Disruption • Distress • Duration

18. disproportion How much is the anxiety excessive unreasonable and well out of proportion to the situation or trigger? How much Is the anxiety far beyond the normal expectations for a child this age? How much Is the anxiety out of the control of the child regardless of his efforts?

19. disruption How much Is the anxiety interfering with the child’s ability to function normally? Is the anxiety interfering with regular routine like eating dressing davening learning? Is the anxiety affecting the sleep habits of the child?

20. distress How much Is the anxiety causing the child to be upset, irritable, in a bad mood? How much Is the anxiety a burden and something that makes daily living uncomfortable?

21. Duration How long has the anxiety been a problem? Did it happen suddenly or was is triggered by some event? Has it been getting worse since it began?

22. If the result of these questions Show that the anxiety is severe. The next step is to figure out Exactly in which areas does the anxiety Present itself

23. Specific Phobias

24. specific phobias • intense, irrational fears of certain things or situations • Some common examples • Dogs or other animals • closed-in places elevators (even a bathroom) • Darkness • heights • escalators • tunnels • highway driving • water • flying • injuries involving blood

25. Phobias aren't just extremefear; they are irrationalfear. • You may be able to ski the world's tallest mountains with ease, but panic when going above the 10th floor of an office building. • The feared object or situation brings on a severe anxiety and sometimes a panic attack.

26. To be considered a disorder 1) Exposure to the phobic stimulus provokes an immediate anxiety response, which can reach extreme levels and may take the form of a Panic Attack 2) The person recognizes that the fear is excessive and unreasonable 3) The person goes to great lengths to avoid situations that can bring him in contact with the feared object or situation. 4) The anticipation brings on intense anxiety.

27. Some notes on children Children have specific phobias--for example, a fear of animals, fear of dark… --those fears usually disappear over time. Children don’t always have the insight of realizing that their fears are unreasonable or exaggerated. In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging, without describing the specific anxiety.

28. Generalized anxiety disorder

29. This is the opposite of specific phobia, these are the worrywarts that worry about anything and everything and carry the world on their shoulders. This is the most common form of anxiety It is the uncontrolled worry, rumination and tension over day-to-day events, worrying about all kinds of non-realistic fears. Always anticipating disaster It is usually accompanied by physical symptoms, there are many different symptoms that may present not all of them are necessary for this diagnosis. The worry almost always begins with the question “what if… happens” or ”maybe…. Could happen” how do I know that … is ok. They are constantly seeking reassurance by themselves as well as from others to calm down their worries. Very often they have perfectionistic nature, and have a tremendous fear of making a mistake.

30. The symptoms of GAD • - unstoppable worry • Physical muscle tension • Feeling on the edge • Stomach discomfort • Sleep disturbances • Poor concentration • Irritable • Tiring easily • Sweaty palms • Difficulty breathing • בלבול הדעת • Lacking מנוחת הנפש Must focus on at least two areas of life (ex. finance, relationship, health, school) Must spend a significant amount of time worrying. Not be accompanied by specific phobias or OCD (this will be explained more when we discuss treatment of GAD and OCD)

31. The symptoms of GAD Cont’ In addition to the above there is also usually the Fear of losing control Fear of not being able to cope Fear of failure Fear of rejection or abandonment Fear of death Usually not accompanied by panic attacks Usually not accompanied by specific phobias

32. social anxiety

33. The symptoms of social anxiety • Fear of appearing publicly: • Clumsy • Silly • Shameful • Being observed by others

34. The symptoms of social anxiety Cont’ Some common fears: I will turn red in public. I will not have the right words to answer in a conversation. I will not have an opinion to express. I will start trembling. I will get out of breath. I will start sweating. I will get so anxious that people will notice that something is wrong with me. I may have the urge to do something stupid in public.

35. The symptoms of social anxiety Cont’ Some common behaviors: Avoid meeting new people Avoid going to parties or meetings Avoid eating in front of others Avoid anyone with authority Avoid getting an עליה in Shull Avoid speaking publicly Develop a quiet and reserved personality Become extremely involved in solitary activity (even learning)

36. The symptoms of social anxiety Cont’ Do not confuse with: - Urge to scream out words publicly that will be embarrassing. - Fear of panic attacks in public. - Fear of not being able to compete - Paranoid obsessions about people trying to harm him. Feeling special and having special powers. We will deal with these separately

37. The symptoms of social anxiety Cont’ Four important conditions: Must occur with peers and regular acquaintances. The fears must be unreasonable. There must be significant avoidance of social situations. Not just “simply shy” - does not get better with more familiarity.