Evaluating the Case for Differential Diagnosis between Anxiety Disorders and Attachment - Essay Example

? Evaluating the Case for Differential Diagnosis between Anxiety Disorders and Attachment Psychology Evaluating the Case for Differential Diagnosis between Anxiety Disorders and Attachment Introduction Mental health conditions have existed ever since the history of mans existence; there management being what has evolved with time. One such management tool is the use of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Attachment is a developmental and biological concept that intricate to any living being and determines the relationship of the being with its surrounding. Children become attached with their caregivers and thus during their development either develop trust in their care givers or perceive their caregivers as threats. This greatly influences the type of intra and interpersonal relationships that an individual has with other people. In case of dysfunctional attachment in younger years, and adolescent or adult may present with anxiety disorders. This is illustrated by trepidation in rather normal situations compared to other individuals and is dependent on the stressor causing the apprehension. This illuminates that there is a relationship between the attachment framework and anxiety disorders (Brumariu & Kerns, 2009). In this light, both disorders will be elaborated then justification as to whether they should both be considered as separate or unique in DSM-IV will be delineated. Characteristics of Anxiety Disorders and Attachment Anxiety Disorders Anxiety disorders have been classified as the 2nd most common mental disorders which are more frequently misdiagnosed or missed. However, upon diagnosis of anxiety disorders, there are treatments that can be used to effectively treat the condition. According to the DMS-IV anxiety disorders are described as disorders which present with anxiety at high levels or the individuals attempt to avoid anxiety. It is described as apprehension or anticipation of lurking danger leading to the individual presenting with symptoms of tension, and dysphoria and it usually presents when an individual is undergoing stressful situations. Anxiety is multifaceted and has three dimensions: physiological response, subjective misery, and escape or avoidance behavior. The difference between normal anxiety and anxiety disorders is the extent to which the anxiety alters an individual’s interpersonal, work and performance of activities of daily living. When one of the normal functioning patterns of an individual is impaired, and the individual presents with behavioral syndrome, anxiety is now described as anxiety disorder as it meets the DSM-IV diagnostic criteria of the disorder (Casey & Pillay, 2008). Anxiety is usually first experienced by an individual during the individual’s childhood years and is majorly caused by physical or psychosocial stressors. Moreover, there has been documented evidence that anxiety is genetic hence predisposing individuals of the same family line to developing the anxiety disorder. After the initial trigger during the younger years of the individual, it predisposes the individual to experiencing anxiety disorders all through his life especially in the presence of the stressors (antecedents). Moreover, anxiety disorders present with the majority of behavioral symptoms of all the mental disorder. This therefore calls for more intricate diagnostic criteria (DSM-IV) of anxiety disorder (Casey & Pillay, 2008). According to the DSM-IV diagnosis criteria, there are two behavioral symptoms that must be present for an individual to be diagnosed as having an anxiety disorder. The first symptom is panic attack; where the individual evidences apprehension about a situation. Panic is evidenced by sweating of hands, trembling, dilatation of the pupils, palpitations, and the individual in severe cases may have shortness of breath accompanied by fear of losing control. Having established the panic attacks, to tell apart the type of anxiety disorder, it is important to relate the panic attack with the antecedent hence classify the anxiety disorder as either social, generalized or Obsessive Compulsive Disorder(OCD). The second behavioral symptom is escape of avoidance from the identified antecedent that is causing panic in the individual. An example is that in social phobia, the individual avoids social situations while in agoraphobia, the individual avoids enclosed areas. Panic attacks and avoidance behaviors are the two symptoms emulated by DSM-IV that aid in the diagnosis of anxiety disorder and the use of antecedents to classify the anxiety disorder (Casey & Pillay, 2008). Table 1 There are various types of anxiety disorders depending on the antecedent identified in the DSM-IV classification criteria. Agoraphobia is an anxiety disorder characterized by an individual’s inability to stay in areas where there is no evidence route of escape. They are individuals who are termed as being claustrophobic; they are anxious in enclosed areas. Generalized anxiety disorder has no specific antecedent but the individual may present with severe apprehension. Social phobia is characterized by an individual becoming anxious in social situations hence such individuals avoid being in social gatherings. Post-Traumatic Stress Disorder (PTSD) is the other anxiety disorder where the individual tries to avoid the stressing situation hence alters his activities of daily living and presents with panic and avoidance. Obsessive Compulsive Disorder (OCD) is where an individual is fanatical about something or someone to an extent that it makes him anxious and panics about the situation. It forms the epitome of his being and the individual does anything to acquire gratify the obsession. For the purposes of this paper, anxiety disorders will be the term used and the paper will not be specific on one anxiety disorder (Brumariu & Kerns, 2009). Having had an insight into anxiety, its definition, characteristic and DSM-IV classification, it is important to recon that one of the antecedents causing anxiety disorders may be maladaptive attachment behavior. It is in this view that prior to reviewing if it is justifiable to consider anxiety disorder and attachment separately, an overview of attachment will be delineated. Attachment Attachment was conceptualized in the mid 1960s by a researcher by the name Bowlby (1969). He avowed that the emotional and social development of a child was greatly influenced by the relationships established early in the child’s life. He described attachment as an intricate drive supported by biological evidence that greatly influenced the survival of the species. He also evidenced that by the species employing selective attachment, they were able to protect themselves from predators. He associated this with the dependency of an infant on its care giver and hence the development of attachment and the effects of disruption of the attachment as the child grew. In an attempt to describe this relationship, Bowlby stipulated the four phases of the attachment cycle (Parade, Leerkes, & Blankson, 2010). Phase one: is the genesis phase where crying by the child is the representation of the quest for attachment from the caregiver. Upon the child crying, the caregiver meets to the feeding, curdling, toileting, or sleeping needs of the child hence the child forms an attachment with the available caregiver. Moreover, the child uses other reflexes like grapping that inculcate touch into the attachment, sucking, and rooting reflexes, all aimed at prolonging the physical contact between the child and the caregiver. In this phase, there are no discriminatory figures. Phase two: stipulates the onset of discriminatory figures in the attachment cycle. It is during this phase that the child can identify with a specific caregiver and show preference over other caregivers. This takes place in week 8 all through to week 12 of the child’s development. It is at this stage that the child tries to reach for the preferred caregiver. Though the child has identified the preferred caregiver, attachment has not yet commenced (Parade, Leerkes, & Blankson, 2010). Phase three: illustrates the beginning of the actual attachment between the child and the caregiver. It is during this phase that the child begins to pursue the caregiver identified in phase two. In the previous phase, the child used passive behaviors to communicate with the caregiver. However, during this phase, the child uses active behaviors like tailing behind the caregiver, always wanting to be in close contact with caregiver and showing affection to caregiver upon return. Signals are also used by the child since this phase continues up to 2 years when language begins to develop. This leads to the development of goal centered behavior where the infant anticipates the actions of the caregiver as a result of conditioned consistency. Through this observation, the child is able to develop attachment behaviors that are fashioned to enhance attachment relationship with the caregiver. Phase four: is characterized by the infant comprehending the independence of the caregiver. It is during this phase that the infant starts to comprehend the feeling and motives of the caregiver. This leads to a more intricate form of attachment relationship between the child and the caregiver. During this phase, the child uses the organized attachment behaviors to elicit reciprocal behavior from the caregiver (Parade, Leerkes, & Blankson, 2010). This attachment framework is used to illustrate that attachment ensues from a subjective experience of the infant based on the meeting of his needs during the infancy years. The attachment that the child develops to the caregiver is dependent on the ability of the caregiver to adequately meet the behavioral requests and biological needs of the infant. When the caregiver is able to meet the need, the infant finds the caregiver as a reliable source of comfort and security and thus inculcates a relationship of trust with the caregiver. These early experiences of the child play an important role in determining the interpersonal attitudes, perceptions and expectation of the adult years of the child. This is since the attachment serves as the internal functioning model of the child which can either be consistent or inconsistent hence creating a great bearing on anxiety resulting from severed attachment relationship. Insensitivity of the caregiver in meeting the needs of the infant influences the attachment of the infant and predisposes the infant to maladjustment behaviors like anxiety in the later years (Parade, Leerkes & Blankson, 2010). Having had an insight into the two mental health conditions, it is now relevant to discuss how they are related as pertains to DSM-IV. This will aid in illuminating the differential diagnosis that occurs in the two conditions with an aim of justifying their classification. The discussion will be aimed at shedding light on the prospect that both conditions should be treated separately or they should be treated as unique as pertains to DSM-IV. Justification if anxiety disorders and attachment should be considered separately or unique in DSM Attachment theoretical theory framework suggests that social anxiety is greatly influenced by the quality of attachment that existed between a child and the caregiver during the early years of the infants’ life. It has been documented that children who have a secure attachment with their care givers perceive them as responsive, caring and available. This is in contrast to children who are insecurely attached to their care givers hence predisposed to anxiety tendencies. Such individuals who have insecure attachments are hypothesized to suffer from free-floating anxiety; which just needs a trigger for it to be full blown and adversely affect the adjusting mechanisms of the child in later years. Consequently, when a child has confidence that the attachment figure will be accessible, the child will be less susceptible to feelings of anxiety and fear. This is in contrast to a child who has pessimistic perspectives as pertains to the availability of the caregiver. This serves as a genesis that illustrates the differential diagnosis in anxiety disorders and attachment as a result of the synergy in the presenting signs and symptoms illustrating the need to present them as unique psychological conditions (Brumariu, & Kerns, 2009). Hypotheses have been developed aimed at illustrating the relationship between anxiety and attachment. The first hypothesis asserts that anxiety is developed and maintained by children when they lack security from the caregivers. These children develop avoidant and ambivalent attachments that make the children more at risk of developing anxiety disorder. This further affirms the earlier foretold statement that children who have insecure relationships with their caregivers develop internalized symptoms that make them more prone to anxiety disorders. This is in contrast to children who have developed secure relationships with their caregivers hence have positive attachment tendencies. Research reveals that children, who experienced insecure relationships in their infancy years, had negative relationships with their peers during their preadolescence years. This was further aggravated in their adolescent years and they presented with more pronounced anxiety symptoms. Basing on the evidence that ambivalently and avoidant attached children are at a more risk of developing anxiety disorder; this supports our hypothesis that there indeed exists a relationship between attachment and anxiety conditions (Brumariu & Kerns, 2009). The alternative hypothesis asserts that there are only specific samples of insecure attachments models that in turn lead to increased risk of developing symptoms of anxiety. This hypothesis avows that ambivalent attachment is more related to the development of anxiety disorders, compared to avoidant attachment. This is revealed in a study conducted where the results illustrated that ambivalent children tended to worry more about the absence of their attachment figures and hence were perceived to be at a greater risk of developing symptoms of anxiety. Other studies conducted revealed that children who had ambivalent attachment disorder were twice at a higher risk of developing anxiety disorders. This led to the prediction of ambivalent attachment as the main type of attachment that predicted the prevalence of anxiety in the adolescence life if the child. This therefore means that our alternative hypothesis is viable and it is justifiable to consider attachment and anxiety disorders as unique in the DSM-IV-TR classification of psychological conditions (Brumariu & Kerns, 2009). However, despite the research available to justify the second hypothesis, research has been conducted illustrating that avoidant attachment also greatly influences to a great extent the presentation of anxiety symptoms in an individual. This was on the basis of results from research carried put among chronically ill and healthy children. The results illustrated that children who reported avoidant attachment, garnered high scores as pertained to internalizing their problems compared to the children who had ambivalent attachment. By the age of 7 years, children who had avoidant attachment compared to their secure counterparts were able to display internalizing symptoms. Bearing in mind that the research was conducted among children who might have been undergoing stressors like the chronically ill children, this may have contributed to the internalizing of symptoms. Though there is a more positive correlation between ambivalent attachment and the development of anxiety, the association of internalization of symptoms with avoidant attachment is of significance. This is to ensure that children who have ambivalent attachment are not ignored since they are at risk of developing anxiety disorders. This therefore illustrates that it is justifiable to consider anxiety disorders and attachment as unique in DSM-IV-TR classification of mental health illnesses (Brumariu, & Kerns, 2009). Moreover, anxiety disorders have been documented as being heterogeneous since they are characterized by combination of avoidance and fear as the presenting symptoms. In case there is predominance of fear, the individual will majorly internalize the symptoms as evidenced in ambivalent and avoidant attachment behaviors described in the two hypotheses. Anxiety is related to attachment since the presentation of anxiety is usually in a quest to find an attachment figure that can relay the anxiety. Consequently, environments may predispose an individual to perceive past attachment failure environments that can be presented in the current environment. Lack of attachment is further elaborated by the child’s fear of absence of the parents and the safety of the parents and the child becomes predominantly concerned on the probability of facing rejection from the parents. This further portrays that a child who is insecure will more frequent than not become anxious even in situations where anxiety is benign. Symptom of possible development of anxiety and vigilance of the child further increases the probability of the child developing an anxiety disorder in future. This further exemplifies the justification that attachment and anxiety disorders should be treated as unique conditions in DSM-IV-TR (Ma, 2006). Separation anxiety disorder (SAD) is a type of anxiety disorder that results from severance from a familiar surrounding or an attachment figure. This therefore illustrates the evidence of differential diagnosis as severed attachment presents as an anxiety disorder. SAD has been hypothesized to occur during the childhood years. According to the DSM-IV-TR classification of mental illnesses, the classification as SAD has to have presented with symptoms prior to 18 years for it to be classified as a psychological disorder. Moreover, the ICD-10 affirms that a diagnosis of SAD can only be arrived at if the current symptoms the patient presenting with, are a continuation of symptoms that commenced in childhood. This shows that according to DSM-IV-TR classification of mental disorder, it is justifiable to treat anxiety and attachment disorders as two unique disorders but they reinforce each other. Separation anxiety is dependent of a severed attachment relationship and especially during the early years of the individual (Seligman & Wuyek, 2007). There is a close interrelationship between anxiety disorders and attachment. This was illustrated in a study carried out assessing the social anxiety disorder and its relationship with attachment among college youth and adolescence. A study carried out among 44 adults who responded to having concerns as pertains to separation from their attachment figures, 82% (36 participants) were classified as having SAD according to the DSM-IV-TR classification of symptoms. The bulk of the diagnosis was composed of female participants (72%) who affirmed that their anxiety social disorders had commenced in their childhood years. Consequently, a significant proportion of the participant attributed their panic attacks and agoraphobia to result from being separated from their attachment figures (Seligman, & Wuyek, 2007). Conclusion The health of an individual cannot be defined as holistic if the mental health is lacking. This is since the mental health of an individual greatly determines the ability of an individual to competently perform the activities of daily living. Attachment is sired in the developmental stages of a child where the child identifies a significant caregiver and develops attachment behaviors to this particular caregiver. Presence of avoidant or ambivalent attachment translates to insecurity in the individual hence qualifies to be a stressor that may predispose an individual to anxiety disorders. Anxiety is characterized by panic attacks and alteration in behavior in an attempt to avoid the situation that poses panic. There is evidence of existence of differential diagnosis between attachment and anxiety disorder. To begin with, both conditions are mental health conditions and are classified according to the DSM-IV. Secondly, they are disorders that commence in the early years of an individual and triggers in the latter life aggravate and present as a mental health disorder. Consequently, both conditions present with apprehension as the individual fights to seek solace elsewhere rather than the current place. Moreover, studies reveal positive results between avoidant and ambivalent attachment behaviors and their predisposition of individuals to anxiety disorders. This documented as credible information as pertains to attachment and anxiety disorders therefore justifies that the two conditions should not be considered separately but should be considered as unique in the DSM-IV classification of mental disorders. References Bowlby, J. (1969), “Attachment and Loss”, Vol. 1: Attachment. London: Pimlico. Brumariu, L., & Kerns, K. (2009), “Mother- Child Attachment and Social Anxiety Symptoms in Middle Childhood”, J App Dev Psychol. 29 (5): 393-402. Casey, P., & Pillay, D. (2008), “Anxiety disorders: A modern problem”, Irish Medical Times, 42(21), 42-42 Fong, M. L., & Silien, K. A. (1999), “Assessment and diagnosis of DSM-IV anxiety disorders”, Journal of Counseling and Development: JCD, 77(2), 209-217. Ma, Kenneth. (2006), “Attachment theory in adult psychiatry. Part 1: Conceptualizations, measurement and clinical research findings”, Advances in Psychiatric Treatment; 12: 440-449. Parade, S. H., Leerkes, E. M., & Blankson, A. N. (2010), “Attachment to parents, social anxiety, and close relationships of female students over the transition to college”, Journal of Youth and Adolescence, 39(2), 127-137. Seligman, L. D., & Wuyek, L. A., (2007), “Correlates of separation anxiety symptoms among first-semester college students: An exploratory study”, The Journal of Psychology, 141(2), 135-45. APPENDIX A Source: Fong, M. L., & Silien, K. A. (1999), “Assessment and diagnosis of DSM-IV anxiety disorders”. Journal of Counseling and Development: JCD, 77(2), 209-217. Retrieved from http://search.proquest.com/docview/219023682?accountid=45049 Read More