Avoidance Disorder of Childhood or Adolescence
The essential feature of this disorder is an excessive shrinking from contact with
unfamiliar people that is of sufficient severity to interfere with social functioning in
peer relationships and that is of at least six months' duration. This is coupled with
a clear desire for social involvement with familiar people, such as peers, the
person knows well and family members Relationships with family members and
other familiar figures are warm and satisfying. The diagnosis is not made if the
disturbance is sufficiently pervasive and persistent to warrant the diagnosis of
Avoidance Personality Disorder.
A child with this disorder is likely to appear socially withdrawn, embarrassed,
and timid when in the company of unfamiliar people and will become anxious
when even a trivial demand is made to interact with strangers. When social
anxiety is severe, the child may be inarticulate or mute, even if his or her
communication skills are unimpaired.
Associated features. Children with this disorder are generally unassertive
and lack self-confidence. In adolescence, inhibition of normal psychosexual
activity is common. The disorder rarely occurs alone; children with this disorder
usually have another Anxiety Disorder, such as Overanxious Disorder.
Age at onset. The disorder typically appears during the early school years,
within the context of increased opportunities for social contact. It may, however,
develop as early as two and a half years, after "stranger anxiety," as a normal
developmental phenomenon, should have disappeared.
Course. The course seems variable: some children improve spontaneously,
whereas others experience an episodic or chronic course. How often this
disorder becomes chronic and continues into adulthood, as a Social Phobia,
Generalized Type, or Avoidance Personality Disorder, is unknown.
Impairment. Age-appropriate socialization skills may not develop. The
impairment in social functioning is often severe.
Predisposing factors. There is some evidence that Specific Developmental
Disorders involving language and speech may predispose to the development of
this disorder.
Complications. The most serious complication is failure to form social bonds
beyond the family, with resulting feelings of isolation and depression.
Prevalence. The disorder is not common
Sex ratio. The disorder is apparently more common in females than in
males.
Familial pattern. There is some evidence that Anxiety Disorders may be
more common in the mothers of children with the disorder.
Differential diagnosis. Socially reticent children are slow to warm up to
unfamiliar people, but after a short time can respond, and suffer no impairment in
peer interaction. In Separation Anxiety Disorder, the anxiety is focused on
separation from the home or major attachment figures rather than on contact with
unfamiliar people per se, but both disorders may be present. In Overanxious
Disorder, anxiety is not focused on contact with unfamiliar people, but, again,
both disorders may be present. In Major Depression and Dysthymia, social
withdrawal is commonly present, but is generalized. In Adjustment Disorder
with Withdrawal, the withdrawal is related to a recent psychosocial stressor and
lasts less than six months.
The diagnosis is not made if the disturbance is sufficiently pervasive and
persistent to warrant the diagnosis of Avoidance Personality Disorder.
(Diagnostic Criteria for Avoidance Disorder of Childhood or Adolescence)
A. Excessive shrinking from contact with unfamiliar people, for a period of six
months or longer, sufficiently severe to interfere with social functioning in
peer relationships.
B. Desire for social involvement with familiar people (family members and
peers the person knows well), and generally warm and satisfying relations
with family members and other familiar figures.
C. Age at least 21/2 years.
D. The disturbance is not sufficiently pervasive and persistent to warrant the
diagnosis of Avoidance Personality Disorder.
Overanxious Disorder
The essential feature of this disorder is excessive or unrealistic anxiety or worry
for a period of six months or longer. A child with this disorder tends to be
extremely self-conscious; to worry about future events, such as examinations, the
possibility of injury, or inclusion in peer group activities, or about meeting
expectations, such as deadlines, keeping appointments, or performing chores;
and to be concerned even about past behavior. Because of his or her anxieties,
the child may spend an inordinate amount of time inquiring about the discomforts
or dangers of a variety of situations and need much reassurance. For example,
routine visits to the doctor may be anticipated with excessive worry about minor
procedures. The child may also be overly anxious about competence in a
number of areas and, especially, about what others will think of his or her
performance.
In some cases physical concomitants of anxiety are apparent; the child may
complain of a lump in the throat, or experience gastrointestinal distress,
headache, shortness of breath, nausea, dizziness, or other somatic discomforts.
Difficulty falling asleep is common. The child may constantly appear nervous or
tense.
Preoccupation with a neighbor or adult school figure who seems "mean" or
critical has been observed. As the child becomes older, such preoccupations
usually focus on more general forms of judgment, such as peer, social, or athletic
acceptance, and school grades.
If another disorder is present (e.g., Separation Anxiety Disorder, Phobic
Disorder, Obsessive Compulsive Disorder), the anxiety and worry extend beyond
the focus of that disorder. for example, if Separation Anxiety Disorder is present,
the anxiety and worry are not exclusively related to separation.
A diagnosis of Overanxious Disorder is not made if the disturbance occurs
only during the course of a psychotic disorder or a Mood Disorder.
Associated features. Social and Simple Phobia may also be present.
Children with this disorder may refuse to attend school because of their anxiety in
that setting. They often seem hypermature because of their precocious"
concerns. Perfectionist tendencies, with obsessional self-doubt, may be evident;
the child may be excessively conformist and overzealous in seeking approval.
Sometimes excessive motor restlessness or nervous habits, such as nail-biting
or hair-pulling, are observed. The child may be reluctant to engage in
age-appropriate activities in which there are demands for performance, such as
sports.
Course. The onset may be sudden or gradual, with exacerbation�s
associated with stress The disorder may persist into adult life as an Anxiety
Disorder, such as General ized Anxiety Disorder or a Social Phobia.
Age at onset. No information.
Impairment. In unusually severe cases, this disorder can be incapacitating
and result in inability to meet realistic demands at home and in school.
Complications. Complications may include unnecessary medical evaluations
for somatic symptoms.
Predisposing factors This disorder seems to be more common in eldest
children, in small families, in upper socioeconomic groups, and in families in
which there is a concern about achievement even when the child functions at an
adequate or superior level.
Prevalence. The disorder is not uncommon. Most of the children without the
additional diagnosis of Separation Anxiety Disorder seen in clinical settings are
13 years or older; those with both disorders are usually under 13.
Sex. The disorder is apparently equally common in males and in
females
Familial pattern. There is some evidence that Anxiety Disorders are more
common among mothers of children with Overanxious Disorder than mothers of
children with other mental disorders.
Differential diagnosis. In cases of Separation Anxiety Disorder unassociated
with Overanxious Disorder, the anxiety is focused solely on situations involving
separation.
Children with only Attention-deficit Hyperactivity Disorder may appear nervous
and jittery, but are not unduly concerned about the future. The two disorders may
coexist however. In Adjustment Disorder with Anxious Mood, the anxiety is
related to a recent psychosocial stressor and lasts less than six months.
Overanxious Disorder should not be diagnosed when the anxiety is a
symptom of a psychotic disorder or a Mood Disorder.
(Diagnostic Criteria for Overanxious Disorder)
A. Excessive or unrealistic anxiety or worry, for a period of six months or
longer, as indicated by the frequent occurrence of at least four of the
following
(1) excessive or unrealistic worry about future events
(2) excessive or unrealistic concern about the appropriateness of past
behavior
(3) excessive or unrealistic concern about competence in one or more
areas, e.g., athletic, academic, social
(4) somatic complaints, such as headaches or stomachaches, for
which no physical basis can be established
(5) marked self-consciousness
(6) excessive need for reassurance about a variety of concerns
(7) marked feelings of tension or inability to relax
B. If another disorder is present (e.g., Separation Anxiety Disorder, Phobic
Disorder, Obsessive Compulsive Disorder)r the focus of the symptoms in A
are not limited to it. For example, if Separation Anxiety Disorder is present,
the symptoms in A are not exclusively related to anxiety about separation.
In addition, the disturbance does not occur only during the course of a
psychotic disorder or a Mood Disorder.
C. If 18 or older, does not meet the criteria for Generalized Anxiety
Disorder.
D. Occurrence not exclusively during the course of a Pervasive
Developmental Disorder, Schizophrenia, or any other psychotic
disorder.
Page 10
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The essential feature of this disorder is an excessive shrinking from contact with unfamiliar people that is of sufficient severity to interfere with social functioning in peer relationships and that is of at least six months' duration. This is coupled with a clear desire for social involvement with familiar people, such as peers, the person knows well and family members Relationships with family members and other familiar figures are warm and satisfying. The diagnosis is not made if the disturbance is sufficiently pervasive and persistent to warrant the diagnosis of Avoidance Personality Disorder.
A child with this disorder is likely to appear socially withdrawn, embarrassed, and timid when in the company of unfamiliar people and will become anxious when even a trivial demand is made to interact with strangers. When social anxiety is severe, the child may be inarticulate or mute, even if his or her communication skills are unimpaired.
Associated features. Children with this disorder are generally unassertive and lack self-confidence. In adolescence, inhibition of normal psychosexual activity is common. The disorder rarely occurs alone; children with this disorder usually have another Anxiety Disorder, such as Overanxious Disorder.
Age at onset. The disorder typically appears during the early school years, within the context of increased opportunities for social contact. It may, however, develop as early as two and a half years, after "stranger anxiety," as a normal developmental phenomenon, should have disappeared.
Course. The course seems variable: some children improve spontaneously, whereas others experience an episodic or chronic course. How often this disorder becomes chronic and continues into adulthood, as a Social Phobia, Generalized Type, or Avoidance Personality Disorder, is unknown.
Impairment. Age-appropriate socialization skills may not develop. The impairment in social functioning is often severe.
Predisposing factors. There is some evidence that Specific Developmental Disorders involving language and speech may predispose to the development of this disorder.
Complications. The most serious complication is failure to form social bonds beyond the family, with resulting feelings of isolation and depression.
Prevalence. The disorder is not common
Sex ratio. The disorder is apparently more common in females than in males.
Familial pattern. There is some evidence that Anxiety Disorders may be more common in the mothers of children with the disorder.
Differential diagnosis. Socially reticent children are slow to warm up to unfamiliar people, but after a short time can respond, and suffer no impairment in peer interaction. In Separation Anxiety Disorder, the anxiety is focused on separation from the home or major attachment figures rather than on contact with unfamiliar people per se, but both disorders may be present. In Overanxious Disorder, anxiety is not focused on contact with unfamiliar people, but, again, both disorders may be present. In Major Depression and Dysthymia, social withdrawal is commonly present, but is generalized. In Adjustment Disorder with Withdrawal, the withdrawal is related to a recent psychosocial stressor and lasts less than six months.
The diagnosis is not made if the disturbance is sufficiently pervasive and persistent to warrant the diagnosis of Avoidance Personality Disorder.
(Diagnostic Criteria for Avoidance Disorder of Childhood or Adolescence)
A. Excessive shrinking from contact with unfamiliar people, for a period of six months or longer, sufficiently severe to interfere with social functioning in peer relationships.
B. Desire for social involvement with familiar people (family members and peers the person knows well), and generally warm and satisfying relations with family members and other familiar figures.
C. Age at least 21/2 years.
D. The disturbance is not sufficiently pervasive and persistent to warrant the diagnosis of Avoidance Personality Disorder.
Overanxious Disorder
The essential feature of this disorder is excessive or unrealistic anxiety or worry for a period of six months or longer. A child with this disorder tends to be extremely self-conscious; to worry about future events, such as examinations, the possibility of injury, or inclusion in peer group activities, or about meeting expectations, such as deadlines, keeping appointments, or performing chores; and to be concerned even about past behavior. Because of his or her anxieties, the child may spend an inordinate amount of time inquiring about the discomforts or dangers of a variety of situations and need much reassurance. For example, routine visits to the doctor may be anticipated with excessive worry about minor procedures. The child may also be overly anxious about competence in a number of areas and, especially, about what others will think of his or her performance.
In some cases physical concomitants of anxiety are apparent; the child may complain of a lump in the throat, or experience gastrointestinal distress, headache, shortness of breath, nausea, dizziness, or other somatic discomforts. Difficulty falling asleep is common. The child may constantly appear nervous or tense.
Preoccupation with a neighbor or adult school figure who seems "mean" or critical has been observed. As the child becomes older, such preoccupations usually focus on more general forms of judgment, such as peer, social, or athletic acceptance, and school grades.
If another disorder is present (e.g., Separation Anxiety Disorder, Phobic Disorder, Obsessive Compulsive Disorder), the anxiety and worry extend beyond the focus of that disorder. for example, if Separation Anxiety Disorder is present, the anxiety and worry are not exclusively related to separation.
A diagnosis of Overanxious Disorder is not made if the disturbance occurs only during the course of a psychotic disorder or a Mood Disorder.
Associated features. Social and Simple Phobia may also be present. Children with this disorder may refuse to attend school because of their anxiety in that setting. They often seem hypermature because of their precocious" concerns. Perfectionist tendencies, with obsessional self-doubt, may be evident; the child may be excessively conformist and overzealous in seeking approval. Sometimes excessive motor restlessness or nervous habits, such as nail-biting or hair-pulling, are observed. The child may be reluctant to engage in age-appropriate activities in which there are demands for performance, such as sports.
Course. The onset may be sudden or gradual, with exacerbation�s associated with stress The disorder may persist into adult life as an Anxiety Disorder, such as General ized Anxiety Disorder or a Social Phobia.
Age at onset. No information.
Impairment. In unusually severe cases, this disorder can be incapacitating and result in inability to meet realistic demands at home and in school.
Complications. Complications may include unnecessary medical evaluations for somatic symptoms.
Predisposing factors This disorder seems to be more common in eldest children, in small families, in upper socioeconomic groups, and in families in which there is a concern about achievement even when the child functions at an adequate or superior level.
Prevalence. The disorder is not uncommon. Most of the children without the additional diagnosis of Separation Anxiety Disorder seen in clinical settings are 13 years or older; those with both disorders are usually under 13.
Sex. The disorder is apparently equally common in males and in females
Familial pattern. There is some evidence that Anxiety Disorders are more common among mothers of children with Overanxious Disorder than mothers of children with other mental disorders.
Differential diagnosis. In cases of Separation Anxiety Disorder unassociated with Overanxious Disorder, the anxiety is focused solely on situations involving separation.
Children with only Attention-deficit Hyperactivity Disorder may appear nervous and jittery, but are not unduly concerned about the future. The two disorders may coexist however. In Adjustment Disorder with Anxious Mood, the anxiety is related to a recent psychosocial stressor and lasts less than six months.
Overanxious Disorder should not be diagnosed when the anxiety is a symptom of a psychotic disorder or a Mood Disorder.
(Diagnostic Criteria for Overanxious Disorder)
A. Excessive or unrealistic anxiety or worry, for a period of six months or longer, as indicated by the frequent occurrence of at least four of the following
(1) excessive or unrealistic worry about future events
(2) excessive or unrealistic concern about the appropriateness of past behavior
(3) excessive or unrealistic concern about competence in one or more areas, e.g., athletic, academic, social
(4) somatic complaints, such as headaches or stomachaches, for which no physical basis can be established
(5) marked self-consciousness
(6) excessive need for reassurance about a variety of concerns
(7) marked feelings of tension or inability to relax
B. If another disorder is present (e.g., Separation Anxiety Disorder, Phobic Disorder, Obsessive Compulsive Disorder)r the focus of the symptoms in A are not limited to it. For example, if Separation Anxiety Disorder is present, the symptoms in A are not exclusively related to anxiety about separation. In addition, the disturbance does not occur only during the course of a psychotic disorder or a Mood Disorder.
C. If 18 or older, does not meet the criteria for Generalized Anxiety Disorder.
D. Occurrence not exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or any other psychotic disorder.