Fear: An emotional response to a real or perceived imminent threat

Anxiety: Expectation of Future Threats

? Panic disorder: panic disorder (with or without place terror)

? Agoraphobia: place phobia (no panic disorder)

? Specific phobia: specific phobia

? Social phobia: social phobia

? Obsessive-compulsive disorder: obsessive-compulsive disorder

? Generalized anxiety disorder

? post-traumatic stress disorder (PTSD)

OCD and PTSD are listed separately in the fifth edition.

"Neurotic Disorder" in CCMD-3

Anxiety disorders

frightened

Obsessive-compulsive disorder

Somatoform disorder

Neurasthenia (neurasthenia)

Arthur kleinman thinks neurasthenia is an outdated concept. Most neurasthenia patients can be classified as depression and chronic fatigue syndrome, and it is more likely to be different degrees of depression.

Separation anxiety-separation anxiety.

? Selective mutism-selective silence

? Specific phobia-specific phobia

? Social anxiety disorder (social phobia)-social phobia.

? Panic disorder-panic disorder

? Agoraphobia-place phobia

? Generalized anxiety disorder (gad)- generalized anxiety disorder.

? Substance/drug-induced anxiety disorder-substance/drug-induced anxiety disorder

The lower the anxiety disorder, the later the onset age.

Symptom (symptom standard)

? Duration (course standard)

? Severity (severity standard)

? Exclusion (exclusion criteria)

A. When a person leaves his or her main attachment object, he or she will have excessive fear or anxiety that is disproportionate to his or her development stage. This fear or anxiety at least satisfies the following three manifestations.

1. Repeated and excessive pain will occur when separation from family members or main attachment objects is expected or experienced.

2. Persistent and excessive worry about losing the main attachment object, or worry that you may be hurt by illness, injury, disaster or death.

3. Constantly and excessively worrying about the unfortunate events that lead to leaving the main attachment object (for example, getting lost, being kidnapped, having an accident, getting sick).

For fear of leaving, he continues to show unwillingness or refusal to go out, leave home, go to school, go to work or go to other places.

5. Persistent and excessive fear or unwillingness to be alone or away from the main attachment objects at home or elsewhere.

6. Persistent unwillingness or refusal to sleep outside or at home or when the main attachment object is not around.

7. Repeatedly have nightmares about parting.

8. Repeatedly complaining about physical symptoms (such as headache, stomachache, nausea and vomiting) when leaving or expecting to leave the main attachment object.

B.？ This fear, anxiety or avoidance is persistent, lasting at least 4 weeks for children and adolescents and at least 6 months for adults.

C.？ This disorder causes clinical pain, or impairs social, academic, professional or other impaired functions.

D.？ This kind of disorder can't be better explained by other mental disorders. For example, in autism spectrum disorder, people refuse to leave home because they don't want to change excessively; in mental disorder, they worry about leaving because of delusion or illusion; in place phobia, they refuse to go out because they don't have a trustworthy partner; in generalized anxiety disorder, they worry that diseases or injuries will befall other important people; or in disease anxiety disorder, they worry about getting sick.

? Prevalence rate of children: about? 4%

? Prevalence rate of adolescents:? 1.6%

? Adult prevalence rate:? 0.9- 1.9%

? /kloc-separation anxiety is the most common anxiety disorder among children under 0/2 years old.

Environment: loss; Parental overprotection and interference (family overprotection and excessive dependence on family)

? Heredity and physiology: 73%

? Culture-related questions: the age at which children should leave their parents' homes! !

? Girls are more reluctant to go to school or avoid going to school than boys.

? In children, separation anxiety disorder is highly comorbid with generalized anxiety disorder and specific phobia.

"Reluctance":

? Have something (a car, a quilt)

? Yes, leave a familiar place.

? For lost time (grown-up children)

? For children who leave home,

A.？ Although I can speak in other situations, I often can't speak in some social situations (such as school) where I need to speak.

B.？ This kind of obstacle hinders educational or professional achievement or social communication.

C.？ The duration of this obstacle is at least 1 month (not limited to the first month of school).

D.？ This inability to speak can not be attributed to "lack of oral knowledge required for social occasions" or "inadaptability to the required oral English".

E.？ This disorder can not be better explained by a communication disorder (such as fluency disorder in childhood), nor can it only appear in the course of autism spectrum disorder, schizophrenia or other mental disorders.

When they meet other individuals in social interaction, children who are selectively silent cannot speak or respond when others speak to them. Speech loss will occur in social communication with other children or adults. Children with selective mutism can speak in front of their first-degree relatives at home, but they are usually unable to speak in front of close friends or second-degree relatives, such as grandparents or cousins of the same age. The sign of this obstacle is a high degree of social anxiety. Children with selective mutism usually refuse to speak in school, which harms their study or education. It is often difficult for teachers to assess the skills of these individuals, such as reading skills. Silence may hinder social communication, although children with this obstacle sometimes communicate in nonverbal and nonverbal ways (for example, grunting, pointing and writing), and they may be willing, eager or involved in social communication without words (for example, the nonverbal part of school games).

The characteristics of selective mutism may include excessive shyness, fear or social embarrassment, social isolation and withdrawal, dependence, obsessive-compulsive disorder, disobedience, anger or mild confrontational behavior. Children with this disorder usually have normal language skills, and even if they occasionally have communication barriers, they are not considered to be related to specific communication barriers. Usually when these obstacles appear, anxiety will also appear. In the clinical environment, children with selective mutism are almost always given additional diagnosis of other anxiety disorders-the most common is social anxiety disorder (social phobia).

Selective mutism is a relatively rare disease, which has not been included in the epidemiological study of childhood diseases. The time-point prevalence rate of various clinical or school samples varies from 0.03% to 1% according to different environments (such as clinical versus school versus general population) and different individual ages. The prevalence of this disease does not seem to change with gender or race/ethnicity. Compared with teenagers and adults, this kind of obstacle seems to occur more easily in children.

Selective mutism usually begins before the age of 5, but it may not attract clinical attention until after entering school, because there are many social activities and tasks on campus, such as reading aloud. The duration of the disorder is different. Although clinical reports show that many individuals no longer develop selective mutism with age, the longitudinal course of this disease is still unclear. In some cases, especially in individuals with social anxiety disorder, selective mutism may disappear, but the symptoms of social anxiety disorder will persist.

? Temperament: the temperament risk of selective mutism has not been completely determined. Negative emotions (nervousness) or behavioral inhibition may play a role. The history of parents' shyness, social isolation and social anxiety may also play a role. Children with selective mutism may have slight receptive language difficulties compared with other peers, although their receptive language ability is still within the normal range.

Note: Listening and reading are receptive language learning; Productive/expressive language learning in oral English and poetry writing.

? Environment: Parents' social inhibition may provide imitators for children's social silence and selective silence. In addition, parents of children with selective mutism are described as overprotective or have more control than parents of other children with anxiety or children without disabilities.

? Heredity and Physiology: Because selective mutism and social anxiety disorder obviously overlap, they both have the same genetic factors.

When families migrate to countries where different languages are spoken, children may refuse to use the new language because of lack of language knowledge. If children fully understand the new language, but still refuse to speak it, they may be diagnosed as selective mutism.

Selective mutism may cause social damage because children are too anxious to participate in social interaction with other children. As children with selective mutism mature, they may face more social isolation. In the school environment, these children may have academic obstacles because they can't communicate with their teachers about their academic or personal needs (for example, they can't understand the school work and can't ask to use the bathroom). It is quite common to suffer serious damage in academic and social functions, including damage caused by peer ridicule. In some cases, selective mutism may be used as a compensatory strategy to reduce social anxiety.

? A family environment that does not judge or blame.

? Encourage expression

? Wait patiently for the younger children to finish.