Here's how to diagnose an Anxiety Disorder:

 What is an anxiety disorder?

Anxiety is a negative mood state characterized by bodily symptoms of physical tension and apprehension about the future (Barlow, 2002).

Anxiety is a future oriented state while fear is a present oriented state which is an immediate alarm reaction to danger. 

Even though called 'negative', both anxiety and fear are good for us. Social, physical and intellectual performances are driven and enhanced by anxiety. Some scholars like Howard Liddell has even gone far to say that anxiety is the 'shadow of intelligence'. Similarly, fear is our flight or fight response which allows us to deal with an immediate danger. 

But what happens when you have too  much anxiety? This can become troublesome for the individual. It hinders their everyday life and intelligence. All the disorders discussed below are characterized by too much anxiety and panic. Panic is a sudden overwhelming reaction or a response to fear and Panic attack is an abrupt experience of intense fear or acute discomfort accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath and dizziness. Panic and anxiety combine to create different anxiety disorders.  

Causes of Anxiety Disorders: 

The causes of anxiety disorders aren't fully understood. Many scholars have made contributions to understand the causes, some of these are listed below:

1. Anxiety traits can be inherited. 

2. Anxiety is also associated with specific brain circuits and neurotransmitter systems. 

3. A sense of control (or a lack of it) that develops in the early experiences of a child is the psychological factor that makes us more or less vulnerable to anxiety in later life. 

4. Stressful life events trigger our biological and psychological vulnerability to anxiety. 

Triple vulnerability theory by Barlow

Putting all the factors together in an integrated way Barlow has described a theory of the development of anxiety which includes three vulnerabilities that contribute to the development of anxiety disorders. If individuals possess all three, the odds are are greatly increased that they will develop an anxiety disorder after experiencing a stressful situation. These vulnerabilities or diathesis are:

I. Generalized Biological Vulnerability 

A tendency to be uptight, to panic, or to worry might be inherited.

II. Generalized Psychological Vulnerability 

If you grew up believing that the world is dangerous or out of your control, then you might not be able to cope when things go wrong. 

III. Specific Psychological Vulnerability 

If you learnt in your early experiences that some things are to be feared (even if they aren't) then you might become vulnerable to them. 

Below you will find a list of different Anxiety Disorders:

1. Generalized Anxiety Disorder (GAD) 

Diagnostic Criteria:

A. Excessive anxiety and worry occurring for at least 6 months about a number of events or activities.

B. The individual finds it difficult to control the worry. 

C. The anxiety and worry are associated with three (or more) of these symptoms (Note: 1. Symptoms must be present for more than 6 months. 2. One 1 symptom is required in children): 

    

1. Restlessness or feeling keyed up or on edge. 
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank. 
4. Irritability 
5. Muscle tension
6. Sleep disturbance (difficult falling or staying asleep or restless, unsatisfying sleep) 

D. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. 

E. The disturbance is not attributable to the physiological effects of a substance (drug, medication) or another medical condition (e.g., hyperthyroidism). 

F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry for having a panic attack in panic disorder, contamination or other obsessions in OCD, etc.) 

Diagnostic features: 

1. Adults with GAD worry about everyday routine life circumstances such as job, health, finances, household chores, children, etc. 

2. Children with GAD tend to worry excessively about their competence or the quality of their performance. 

3. Focus of worry may shift from one concern to another. 

4. Different from non-pathological anxiety: 

• GAD: worry is excessive and interfere with psychosocial functioning. Everyday Anxiety: manageable, put off when more pressing matters arise. 
• GAD: worry is pervasive, pronounced, distressing; longer duration, frequently occur without precipitants.
• Everyday Anxiety: less likely to be accompanied by physical symptoms. 

5. Muscle tension: trembling, twitching, feeling shaky, muscle aches, soreness. 

6. Somatic symptoms: sweating, nausea, diarrhea.

7. Exaggerated startle response.

8. Automatic hyperarousal symptoms (less prominent than in panic disorder): accelerated heartrate, shortness of breath, dizziness. 

9. Irritable bowel syndrome, headache. 

Prevalence:

1. The 12 months prevalence of GAD:

• United States- 0.9% among adolescents & 2.9% among adults in general community. 
• Other countries- 0.4% to 3.6%

2. Lifetime morbid risk = 9.0%

3. Females are twice as likely as males to experience GAD. 

4. Diagnosis peaks in middle ages and declines across the later years of life.

5. Individuals of European descent experience GAD more than do individuals of non-European descent. 

6. Individuals from developed countries are more likely than individuals from non developed countries to report that they have experienced symptoms of GAD in their lifetime. 

Etiology (Cause of the disorder): 

Temperamental: Behavioral inhibition (a fearful style of reacting when confronted with novelty), neuroticism (overly anxious), harm avoidance. 

Environmental: Childhood adversaries and parental overprotection but not sufficient to make a diagnosis. 

Genetic & Physiological: Genetic risk- One-third. 

Treatment:

1. Drug: Benzodiazepine

• Relief for a short time
• Impair cognitive and motor functioning
• Individual is not alert
• Impair driving
• Associated with falls 
• Create psychological and physical dependence 

2. Antidepressants: Paroxetine (also called Paxil), Venlafaxine (also called Effexor). 

3. Psychological treatments 

•     Long term relief 
• Teaches patient how to relax deeply to combat tension.

4. Cognitive-Behavioral treatment: confront threatening images and thoughts head-on. 

5. Meditation and Mindfulness-based approaches: accepting rather than avoiding.

2. Panic Disorder  

Diagnostic Criteria:

A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur: (NOTE: The abrupt surge can occur from a calm state or an anxious state.)

1. Palpitations, pounding heart, or accelerated heart rate. 
2. Sweating 
3. Trembling or shaking. 
4. Sensations of shortness of breath or smothering. 
5. Feelings of choking.
6. Chest pain or discomfort. 
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed or faint.
9. Chills or heat sensations.
10. Paresthesia (numbness or tingling sensations). 
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
12. Fear of losing control or 'going crazy'. 
13. Fear of dying. 

NOTE: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming, or crying) may be seen. Such symptoms should not count as one of the four required one.

B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:

1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, 'going crazy'). 
2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid panic attacks, such as avoidance of exercise or unfamiliar places).
3. The disturbance is not attributable to the physiological effects of a substance (drug, medication) or another medical condition (e.g., hyperthyroidism). 
4. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations as in social anxiety disorder, etc.). 

Diagnostic features: 

Panic disorder refers to recurrent unexpected panic attacks. The term 'recurrent' means more than one unexpected panic attack. The term 'unexpected' refers to a panic attack for which there is no obvious cure or trigger at the time of occurrence- that is, the attack appears to occur from out of the blue, such as when the individual is relaxing or sleeping. 

1. Frequency: can be moderately frequent attacks (e.g., one per week) for months at a time, or short bursts of more frequent attacks (e.g., daily) separated by weeks or months without any attacks or with less frequent attacks (e.g., two per month) over many years. 

2. More than one unexpected full symptom attack is required for the diagnosis of panic disorder. 

Prevalence:

1. 12 months prevalence estimate -

• US and several European countries: 2%-3% 
• Asian, African & Latin American counties- 0.1%-0.8%

2. Females are more frequently affected than males, at a rate of approximately 2:1.

3. Low before 14 years of age, gradual increase in adolescence and peak during adulthood. Decline in older individuals. 

Etiology (Cause of the disorder): 

Temperamental: Anxiety sensitivity, neuroticism (overly anxious), separation anxiety in childhood.  

Environmental: Experiences of sexual and physical abuse in childhood; smoking and other identifiable stressors. 

Genetic & Physiological: Parents with anxiety, depressive and bipolar disorders, past respiratory disturbances. 

Treatment:

DRUG:-

• Benzodiazepine
• Serotonin reuptake inhibitors (SSRIs) like Prozac & Paxil
• Serotonin norepinephrine reuptake inhibitors (SNRIs) like Venlafaxine. 

PSYCHOLOGICAL TREATMENT:- 

• Gradual exposure exercises: arrange conditions in which the patient can gradually face the feared situations and learn there is nothing to fear. 
• Relaxation & breathing techniques 
• Panic Control Treatment (PCT): concentrates on exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind them of their panic attacks.  
• Teaches patient how to relax deeply to combat tension.
• Cognitive Therapy: basic attitudes and perceptions concerning the dangerousness of the feared but objectively harmless situations are identified and modified. 

3. Agoraphobia  

Panic disorder is accompanied by a closely related disorder called agoraphobia, which is the fear and avoidance of situations in which a person feels unsafe or unable to escape to get home or to a hospital in an event of a developing panic, panic like symptoms or other physical symptoms, such as loss of bladder control. 

The term agoraphobia was coined in 1871 by Karl Westphal, a German physician and in the original Greek, refers to the fear of marketplace. 

Diagnostic Criteria:

A. Marked fear or anxiety about two (or more) of the following five situations: 

1. Using public transportation 
2. Being in open spaces (e.g., parking lot, marketplace, bridge) 
3. Being in enclosed places (e.g., theater, shops, cinema)
4. Standing in line or being in a crowd 
5. Being outside of the home alone

B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly). 

C. The agoraphobia situations almost always provoke fear or anxiety.

D. The agoraphobia situations are actively avoided, require a presence of a companion or are endured with intense fear or anxiety. 

E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the socio-cultural context. 

F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.

G. The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

H. If another medical condition is present (e.g., inflammatory bowel disease, Parkinson's disease), the fear, anxiety or avoidance is clearly excessive. 

I. The fear, anxiety or avoidance is not better explained by the symptoms of another medical disorder- for example, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder) or are not related excessively to obsessions (as in OCD), etc. 

Diagnostic features: 

1. When experiencing fear or anxiety cued by situations mentioned in Criteria A, individuals typically experience thoughts that something terrible might happen. 

2. Other incapacitating or embarrassing symptoms include:

• vomiting, inflammatory bowel symptoms
• adults- fear of falling
• children- sense of disorientation, getting lost 

3. The fear or anxiety may take the form of a full or limited symptom panic attack i.e., an expected panic attack. 

4. An individual who becomes anxious only occasionally in an agoraphobic situation (e.g., becomes anxious when standing in line on only one out of every five occasions) would not be diagnosed with agoraphobia. 

5. Avoidance can be behavioral- 

• changing daily routines
• choosing a job nearby to avoid public transport 
• arranging for food delivery to avoid marketplace

6. Avoidance can be cognitive-

• using distractions to get out of agoraphobic situations

7. Agoraphobic fears must be differentiated from reasonable fears due to some reasons:

• What constitutes avoidance may be difficult to judge across cultures and sociocultural contexts. 
• Older adults are likely to attribute their fears to age-related constraints and are less likely to judge their fears as being out of proportion to the actual risk. 
• Individuals with agoraphobia are likely to overestimate danger in relation to panic-like or other bodily symptoms. 

Prevalence:

1. 12 months prevalence estimate -

• Adolescence and adults- 1.7%
• Older than 65 years- 0.4%

2. Females are twice as likely as males to experience agoraphobia. 

3. Incidence peaks in late adolescence and early adulthood. 

Etiology (Cause of the disorder): 

Temperamental: Behavioral inhibition, neuroticism, anxiety sensitivity. 

Environmental: Negative events in childhood adversaries; family climate- reduced warmth & increased overprotection.  

Genetic & Physiological: 61% heritability. 

Treatment: 

DRUG:-

• Benzodiazepine
• Serotonin reuptake inhibitors (SSRIs) like Prozac & Paxil
• Serotonin norepinephrine reuptake inhibitors (SNRIs) like Venlafaxine. 

PSYCHOLOGICAL TREATMENT:- 

• Gradual exposure exercises: arrange conditions in which the patient can gradually face the feared situations and learn there is nothing to fear. 
• Relaxation & breathing techniques 
• Panic Control Treatment (PCT): concentrates on exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind them of their panic attacks.  
• Teaches patient how to relax deeply to combat tension.
• Cognitive Therapy: basic attitudes and perceptions concerning the dangerousness of the feared but objectively harmless situations are identified and modified. 

4. Specific Phobia 

Diagnostic Criteria:

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing. or clinging.
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Specify if:

Code based on the phobic stimulus:

300.29 (F40.218)    Animal (e.g., spiders, insects, dogs). 

300.29 (F40.228)    Natural environment (e.g., heights, storms, water).

300.29 (F40.23x)    Blood-injection-injury (e.g., needles, invasive medical procedures).

Coding note: Select specific ICD-10-CM code as follows:

F40.230 fear of blood; 

F40.231 fear of injections and transfusions; 

F40.232 fear of other medical care; or

F40.233 fear of injury.

300.29 (F40.248)    Situational (e.g., airplanes, elevators, enclosed places).

300.29 (F40.298)    Other (e.g., situations that may lead to choking or vomiting; in children, e.g., loud sounds or costumed characters).

Coding note: When more than one phobic stimulus is present, code all ICD-10-CM codes that apply (e.g., for fear of snakes and flying, F40.218 specific phobia, animal, and F40.248 specific phobia, situational).

Diagnostic features: 

1. Common to have multiple phobias, 75% of individuals have more than one phobia.
2. Fear/anxiety is a response to phobic stimulus. 
3. Fear/anxiety is evoked each time an individual comes in contact to phobic stimulus. 
4. Fear/anxiety occurs as soon as the individual encounters a phobic stimulus. 
5. Blood injection-injury specific phobia marked by vasovagal fainting or near fainting response marked by initial brief acceleration of heart rate and elevation of blood pressure followed by a deceleration of heart rate and a drop in blood pressure. 

Prevalence:

1. 12 months prevalence- 

• United States: 7%-9%
• Europe: 6%
• Asian, African, Latin American: 2%-4%

2. Female to male ratio 2:1

3. Age-wise:

• Children- 5%
• 13-17 year olds- 16%
• Older individuals- 3%-5%

Etiology (Cause of the disorder):

Temperamental: Behavioral inhibition, neuroticism. 

Environmental: Parental overprotectiveness, parental loss & separation, physical & sexual abuse. 

Genetic & Physiological: Genetic susceptibility to a certain category of specific phobia.

Treatment:

DRUG:-

• Benzodiazepine
• Serotonin reuptake inhibitors (SSRIs) like Prozac & Paxil
• Serotonin norepinephrine reuptake inhibitors (SNRIs) like Venlafaxine. 

PSYCHOLOGICAL TREATMENT:- 

• Gradual exposure exercises: arrange conditions in which the patient can gradually face the feared situations and learn there is nothing to fear. 
• Relaxation & breathing techniques 
• Panic Control Treatment (PCT): concentrates on exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind them of their panic attacks.  
• Teaches patient how to relax deeply to combat tension.
• Cognitive Therapy: basic attitudes and perceptions concerning the dangerousness of the feared but objectively harmless situations are identified and modified. 

5. Separation Anxiety Disorder 

Diagnostic Criteria:

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
7. Repeated nightmares involving the theme of separation.
8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment in social, aca- demic, occupational, or other important areas of functioning.

D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder, or concerns about having an illness in illness anxiety disorder.

Diagnostic features: 

1. The anxiety exceeds what may be expected given the person's developmental level.

2. Children maybe unable to stay or go in a room by themselves and may display 'clinging' behavior, staying close to or 'shadowing' the parent around the house or requiring someone to be with them when going to another room in the house. 

3. Dislike sleeping alone. 

4. Children have difficulty at bed time & want someone to stay with them until they fall asleep. At night, may make their way to their parent's bed. 

5. Adults maybe uncomfortable when travelling independently. 

6. Children- physical symptoms- headaches, abdominal complains, nausea, vomiting.  

7. Adolescents & adults cardiovascular symptoms: palpitations, dizziness, feeling faint (rare in younger children). 

8. Social withdrawal, empathy, sadness, difficulty concentrating on work. 

9. Young children at night when alone may report perceptual experiences. 

10.  Children: demanding, intrusive, in need of constant attention. 

11. Adults: peer dependent, overprotective.  

Prevalence:

1. 12 months prevalence- 

• United States: 0.9%-1.9%

2. Equally common in males & females

3. Age-wise:

• Children 6-12 months- 4%
• Adolescents- 1.6%

4. Most prevalent anxiety disorder in children younger than 12 years. 

Etiology (Cause of the disorder):

Temperamental:  Develops after life stress like loss; Parental overprotection & intrusiveness. 

Environmental: Parental overprotectiveness, parental loss & separation, physical & sexual abuse. 

Genetic & Physiological: 73% heritability; children display enhanced sensitivity to respiratory stimulations using COs enriched air. 

6. Social Anxiety Disorder (Social Phobia) 

Diagnostic Criteria:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

C. The social situations almost always provoke fear or anxiety. Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing. clinging, shrinking, or failing to speak in social situations.

D. The social situations are avoided or endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a sub- stance (e.g., a drug of abuse, a medication) or another medical condition.

I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

J. If another medical condition (e.g., Parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

Specify if:

Performance only: If the fear is restricted to speaking or performing in public.

Diagnostic features: 

1. Some individuals fear offending others or being rejected as a result. 

2. Predominant in individuals from cultures with strong collectivistic orientations. 

3. Shy bladder syndrome is common. 

4. Children- crying, tantrums, freezing, clinging, shrinking in social situations. 

5. Individuals may in inadequately assertive or excessively submissive or less commonly highly controlling of the conversation. 

6. Show overly rigid body posture, inadequate eye contact, speak with an overly soft voice. 

7. Man may delay in marrying and having a family; females may become homemaker or mother. 

8. Self- medication with substances is common. 

9. May also include exacerbation of symptoms of medical illnesses such as increased tremor or tachycardia.  

Prevalence:

1. 12 months prevalence- 

• United States: 7%
• Europe: 2.3%
• Asian, African, Latin American: lower in comparison. 

2. More common in females, young adults, adolescents. 

3. Age-wise:

• Older individuals- 2%-5%

Etiology (Cause of the disorder):

Temperamental:  Behavioral inhibition, fear of negative evaluation. 

Environmental: Childhood maltreatment. 

Genetic & Physiological: First degree relatives have 2 to 6 times greater chance of having social anxiety disorder. 

Treatment:

DRUG:-

• Zoloft & Effexor 
• Serotonin reuptake inhibitors (SSRIs)- Paxil

PSYCHOLOGICAL TREATMENT:- 

• Interpersonal psychotherapy (IPT)
• Family based therapy 
• Cognitive Therapy: emphasized real-life experiences during therapy to disprove automatic perceptions of danger.  

7. Selective Mutism 

Diagnostic Criteria:

A. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations. 

B. The disturbance interferes with educational or occupational achievement or with social communication.

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

D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

E. The disturbance is not better explained by a communication disorder (e.g., childhood- onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Diagnostic features: 

1. Don't initiate speech or reciprocally respond. 

2. Speak in front of immediate family members but often not even in front of close friends and second degree relatives. 

3. Disturbance marked by high social anxiety. 

4. Sometimes use non-spoken or non-verbal means to communicate and may be willing or eager to perform or engage in social encounters when speech is not required. 

5. Excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, mild oppositional behavior. 

Prevalence:

1. Rare disorder

2. More common in young children.

Etiology (Cause of the disorder):

Temperamental:  Behavioral inhibition, neuroticism, parental history of shyness, social isolation & social anxiety. 

Environmental: Parents are more overprotective or more controlling than parents of other disorders.  

Genetic & Physiological: share genetic factors with anxiety disorders

Treatment:

PSYCHOLOGICAL TREATMENT:- 

• Cognitive Behavioral Therapy: greater emphasis on speech; it utilizes behavioral interventions such as modeling, stimulus fading and shaping that allow for gradual exposure to the speaking situation. Combined with behavioral reward system.