Advanced Mental Health

Advanced Mental Health

Advanced Mental Health
Advanced Mental Health

DSM-V Across the Lifespan: Anxiety and Obsessive-Compulsive Disorders

Note the presentation and treatment similarities and differences of each disorder across the lifespan

Children and Adolescents

Anxiety disorders are the most prevalent mental illness in Canadian children between 4 and 17 years of age. Approximately 4 in 100 children have severe problems with worries and fears warranting a clinical diagnosis (Waddell, Shepherd Schwartz, & Barican, 2014). Many childhood fears are developmentally normal: it is common for toddlers to fear the dark, for school-aged children to fear animals, and for teenagers to worry about relationships with peers. These typical anxiety experiences do not usually interfere with the child’s development and functioning (Children’s Health Policy Centre, Simon Fraser University, 2007). Children with anxiety disorders, however, experience excessive, prolonged, or recurrent fears or symptoms of anxiety, with accompanying impairment in age-appropriate functioning at home, at school, and with peers (Manassis, 2004). Mood and anxiety disorders often coexist; therefore, it is important to assess for both especially in children.

Generalized Anxiety Disorder

Presentation: Signs and Symptoms

  • GAD is characterized by excessive anxiety and worry about many events or activities.
  • The intensity, duration, or frequency of the anxiety and worry is out of proportion to the actual likelihood or impact of the anticipated event.
  • Children tend to worry excessively about their competence or the quality of their performance, such as academic performance or athletic prowess on sports teams. However, the focus of the worry can change over time.
  • In addition to the excessive and debilitating anxiety and worry, the child may experience feeling on edge and being easily fatigued, have difficulty concentrating, and experience irritability, muscle tension, and disturbed sleep (American Psychological Association [APA], 2013).


  • CBT (Coping Cat program)
  • pharmacotherapy (sertraline)

*Those children rated as much or very much improved did best with combination therapy. CBT was slightly more effective than sertraline, and the children experienced less insomnia, fatigue, sedation, and restlessness. All therapies were superior to placebo.

Separation Anxiety Disorder

Separation anxiety disorder is excessive anxiety on separation from home or a major attachment figure before adulthood (taken as the age of 18 years). It is manifested by:

  • acute distress
  • frequent nightmares about separation
  • reluctance or refusal to separate
  • clinically significant impairment in social or academic functioning.

*Separation anxiety disorder may be the childhood equivalent of panic disorder in adults.


Several therapeutic approaches are used in treating separation anxiety disorder, including:

  • individual psychotherapy
  • behavioural treatment
  • pharmacotherapy

Obsessive-Compulsive Disorder (OCD)

As with anxiety disorders, obsessive-compulsive disorder (OCD) occurs in both adults and children. OCD is characterized by:

  • intrusive thoughts that are difficult to dislodge (obsessions, i.e., unwanted persistent, intrusive thoughts, impulses, or images related to anxiety)


  • ritualized behaviours that the child feels driven to perform (compulsions, i.e., unwanted behavioural acts or patterns) to prevent or reduce anxiety.

*The most common obsessions in children are fears of contamination. Worries about personal and family safety are also frequent. The most common compulsions are excessive washing, cleaning, and checking actions.


Treatment goals focus on reducing the obsessions and compulsions and their effects on the child’s development.

CBT, particularly exposure response prevention (ERP), was found to be an effective intervention in children with OCD (Bolton & Perrin, 2008). Exposure consists of gradual confrontation with events or situations that trigger obsessions and cause the urge to ritualize.


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