Anxiety Disorders 97Varieties of anxiety disorder
The three most common anxiety disorders are specific phobias, separation
anxiety disorder and generalised anxiety disorder. Social anxiety disorder
and panic disorder are less common, as is post-traumatic stress disorder
(PTSD) (see Chapter 13).
Specific phobias
Characteristic features
Specific fears of circumscribed stimuli are very common in childhood and
adolescence, with different fears peaking at different ages, for example,
fear of animals peaks at age 2–4 years, fear of the dark or of imaginary
creatures peaks at age 4–6, and fear of death or war is particularly common
during adolescence. To be classified as a specific phobia, a fear must result
either in substantial distress or in a level of avoidance that interferes
significantly with the individual’s everyday life. For example, a fear of
dogs is common in childhood and only warrants a phobia diagnosis if
the child often experiences intense and prolonged fear, or if the child’s
avoidance of dogs leads to marked social restriction, for example, refusal
to go to the park to play, or refusal to visit friends’ houses when they
have dogs. The definition of a phobia in adults includes the criterion that
they recognise that their fear is excessive or unreasonable. This criterion
need not apply to children since they may lack the cognitive maturity to
recognise the irrational nature of their own fears.
Epidemiology
Severe specific phobias affect around 1% of children and adolescents.
Girls report more fears than boys at all ages, but severe specific phobias
are only slightly commoner in girls. Similarly, although younger children
report more fears than adolescents, severe specific phobias are only slightly
commoner in children than adolescents.
Treatment
Desensitisation, contingency management and cognitive techniques are all
useful. It is extremely valuable when treating younger children to recruit
parents as co-therapists. For example, parents can be taught to provide
graded exposure as ‘homework’ between formal treatment sessions, ad-
justing the pace of exposure to what their child can manage. Adolescents
with specific phobias are better able to manage their own ‘homework’, but
active parental involvement is usually helpful at this age too.
Course
Though mild fears are often transient, true phobias (particularly if they are
severe) are more likely to be persistent and may continue into adulthood
in the absence of treatment. This is a great shame since specific phobias
are among the most treatable of all child and adolescent disorders. It often