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separation from the attachment figure. • Dreams or nightmares about separation • Refusal to face situations that involve separation, including sleeping away from home, going to school, visiting friends or relatives, staying at home alone or with child minders • Worry about the consequences of separation including fears of being kidnapped or injured or of the attachment figure being hurt, or killed while apart • Physical symptoms when separation is anticipated including, vomiting, diarrhoea, and stomach aches Generalised anxiety disorder A tendency to worry about a wide range of negative possibilities, that something bad will happen • Repeated and extensive worry about several areas such as family finances, friendships, schoolwork, sports performance, self and family health, and minor, daily issues. • Tendency to repeatedly seek reassurance from parents or others about fears. • Avoidance of novelty, negative news, uncertain situations, and making mistakes. • Physical symptoms, sleeplessness and irritability when worried. Social phobia Fear and avoidance of social interactions or social performance due to a belief that others will negatively evaluate the child • Avoidance of a range of social activities or situations including, speaking or performing in front of others, meeting new children, talking to authority figures such as teachers, being the centre of attention in any way, and for teenagers, fears of dating • Worries about negative evaluation from others including that others will think they are unattractive, stupid, unpleasant, overly confident, or odd • A limited number of friends and difficulty making new friends • High levels of self-consciousness or self-focussed attention Specific phobias The core feature of specific phobias involves fear and avoidance in response to a range of specific cues, situations, or objects. There is a common belief that the object or situation will lead to personal harm Some common fears in children include: • Animals such as dogs or birds • Insects or spiders • The dark • Loud noises and especially storms • Clowns, masks, or unusual looking people • Blood, illness, injections Panic Disorder and agoraphobia* Panic Disorder Experience and fear of unexpected panic attacks, commonly involving several somatic symptoms and fears of dying or going crazy. • Several somatic symptoms that usually peak relatively quickly and last for a specific period • Symptoms commonly include palpitations, breathlessness, dizziness, trembling, and chest pain • At least some attacks occur unexpectedly or "out of the blue" Agoraphobia Agoraphobia involves an additional fear and avoidance of several "agoraphobic" situations, commonly due to a fear of experiencing a panic attack in those situations. • Avoidance of situations due to fear of symptoms or their consequences • Common agoraphobic situations include places from which quick escape is difficult such as public transport, enclosed spaces, cinemas, hairdressers, or heavy traffic. • There is a common reliance on specific safety cues, commonly a safe attachment figure. * Both panic disorder and agoraphobia have their mean age of onset in early adulthood and hence are rare in childhood. Only occasional cases occur prior to 15 years and small numbers will begin to present from 15 to 18 years. Anxiety disorders F.1 4 IACAPAP Textbook of Child and Adolescent Mental Health As mentioned, the key differences between specific anxiety disorders involve the particular triggers for the anxiousness, the situations that are avoided, and the content of the beliefs, as shown in Table F.1.1. Separation anxiety is described in detail in Chapter F.2. Anxiety-related disorders As mentioned, two disorders that were previously incorporated among the anxiety disorders are no longer included under this rubric in the latest version of the DSM. They are covered in their own chapters and hence will be addressed only briefly here. Children with obsessive compulsive disorder (OCD) report repetitive and intrusive thoughts, images or urges, often accompanied by repeated characteristic actions or behaviours with the goal of reducing anxiety. The mental components commonly focus on some expected threat or danger (hence the overlap with anxiety disorders), although sufferers from some forms of OCD may fail to report threat expectations and may focus more on a sense of disgust and a belief that certain actions simply “feel right”. When a threat expectation does exist, the corresponding rituals are generally aimed at preventing or undoing the expected danger. In children, the picture is complicated by the fact that many children, especially younger ones, are unable to clearly describe their beliefs and motivations. Among children, the most common rituals involve washing (and fears of contamination) and checking or ordering (and fears of catastrophe) if certain actions are not adequately performed. Post-traumatic stress disorder involves a constellation of symptoms of heightened arousal (e.g., jumpiness), intrusions (e.g., distress on reminders of the trauma), detachment (e.g., trouble remembering aspects of the trauma, numbness and flatness), and avoidance that occur following a severe (life threatening) event. Although, sadly, many children in our world experience life threatening events, post-traumatic stress disorder is relatively infrequent in childhood (Rapee et al, 2009). Some authors have
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