childhood mood disorder
Introduction
Introduction to childhood emotional disorders Emotional disorders are mainly caused by psychological factors such as certain mental stimuli, or abnormal performance caused by improper family education, which makes the child feel painful or affects social adaptation. Generally, there is no organic disease, and there are few neurological disorders in adulthood, and the course of the disease is short. basic knowledge The proportion of illness: 0.03% Susceptible people: children Mode of infection: non-infectious Complications: depression
Cause
Causes of childhood emotional disorders
Causes
There are many reasons for childhood emotional disorders, and most scholars believe that it is related to psychological factors and susceptibility.
Psychosocial factors (40%):
Children's lives are simpler than adults, but in the environment of family and school, they also encounter various psychological and social stress factors, such as overprotection or excessive demand of parents, rude attitudes, and inappropriate education methods for families and schools. The intimidation of unexpected life events, the inability to resolve contradictions, etc. can all have adverse effects on children's psychological activities, causing excessive and lasting emotional reactions.
Genetic factors (20%):
Parents pass on the genetics to the offspring. The offspring not only inherit the appearance of the parents, but also the personality and emotional response characteristics. The disease is mostly caused by the genetic susceptibility and personality type (such as emotional instability). And the introverted personality), coupled with the effect of the external environment on the susceptible quality, it is reported that the coincidence rate of twins is 47%, and the family with the same disease accounts for 16.9%.
Severe physical illness in childhood (10%):
Children are prone to emotional problems during the treatment of the disease.
Pathogenesis
According to the different diseases in childhood emotional disorders, the following are described as follows:
Child separation anxiety
(1) Desire is not satisfied: According to Freud's theory of psychodynamics, when there is a psychological conflict in the individual's subconscious, it will be expressed as anxiety, which is caused by the individual's need for desire and the limitation of real life to desire. Is the result of the struggle between "superego" and "self" in the personality structure.
(2) Genetic factors: About 15% of parents and siblings of children with anxiety also have anxiety performance, and the anxiety comorbidity rate of MZ can reach 50%.
(3) Bad parent-child relationship: Bowlby (1977) believes that under normal circumstances, parents should give their children a safe and warm environment, but they cannot rely on this environment, and when the parent-child relationship is bad, they should be on the other hand. The attitude is cold and harsh, and on the other hand, the children are attached to themselves, leaving their children in a contradictory situation.
(4) Life events: Before the separation anxiety occurs, there are often life events as incentives. Common life events are suddenly separated from parents, unfortunate accidents, serious illness or death of relatives, and frustration in kindergartens.
2. The cause of school phobia
(1) Bad parent-child relationship: As early as the 1970s, Bowlby had noticed that the abnormality of parent-child relationship can lead to the occurrence of school phobia. This abnormal parent-child relationship often manifests as: mothers are mostly chronic anxiety patients, always hope Keeping children at home to be with themselves; children are afraid that when they go to school, their parents will suffer misfortune, so they ask to stay at home; children worry that they will be accidentally injured when they leave the family, preferring to stay at home; mothers worry about children going Learn to have an unfortunate accident.
There is a close relationship between school phobia and children's separation anxiety disorder. Both may be the result of poor parent-child relationship. School children with phobia are reluctant to go to school, and more are unwilling to separate from their mother. The basic problem is Severe anxiety symptoms manifested after separation from the mother.
(2) Frustration in learning: Most children with phobias have good academic performance and strong self-esteem. When they are frustrated in school or fail in learning, self-esteem is hurt, resulting in a strong emotional reaction and painful experience. Children are reluctant to face this dilemma, do not want to try this painful experience again, and use the avoidance coping style to stay at home. At this time, the inappropriate treatment of parents will aggravate the severity of symptoms: 1 Children's behavior at home 2 protection and support; 2 parents' dissatisfaction with children and fear of adopting a sympathetic attitude; 3 parents' children's going out and showing an anxiety reaction to school can strengthen children's fear of schooling behavior, and school fear symptoms will come The stronger it is.
3. The cause of childhood depression
(1) Genetic factors: The importance of genetic factors in the incidence of affective disorder has been recognized by most scholars. Although the genetic study of childhood depression is not as many as that of adult patients, the following three studies also indicate heredity. Importance: 1 Adults with depression have more parents with depression; 2 Both longitudinal and horizontal comparison studies have found that children with depression have more depression than expected; 3 a group of studies showed depression Among the relatives of children with children, the proportion of affective disorders is high. Among them, Harringtons research team found in 1993 that the lifetime prevalence of depression in relatives of children with depression was nearly twice that of the non-depressed control group. The results suggest a genetic link between childhood depression and adult depression. Akiskal (1986) reported a concomitant rate of 76% for affective disorder and 19% for DZ.
(2) Psychosocial factors: There are three views on the influence of psychosocial factors on children's depression: 1 The influence of the parent on the offspring, the depression of the parent can affect the living environment of the offspring, and the depression of the offspring Symptoms, alienation of parent-child relationship, family atmosphere, etc., these factors can lead to depression in children, 2 early acute life events, loss of parents, life difficulties, adversity, predisposition to quality is the predisposing factor of childhood depression, of which adversity The influence of children is not only difficult, but more importantly, parents' attitudes towards difficulties and confidence in overcoming difficulties. Insufficient attitudes and lack of confidence can cause depression in children. 3 Special life experiences make children feel depressive, such as divorced parents. Natural disasters such as floods and earthquakes, wars, concentration camps, physical abuse, sexual abuse and psychological abuse all mean important pathogenic effects in the pathogenesis of childhood depression.
From the psychological mechanism, the learned helplessness is the main psychological mechanism of depression. The sense of helplessness often brings waiting for expectation. The hopeless waiting will lead to depression and negative recognition. Knowing activities, negatively affecting yourself and your future, the world around you.
(3) Mental biochemical abnormalities: The current consensus is that the monoamine neurotransmitter system in children with depression has low functional function. There are two reasons for this view: one is that all can cause the central nervous system synaptic gap. Drugs depleted by monoamine transmitters (between nerve cells) can cause depressive symptoms. Second, effective antidepressants, especially tricyclic antidepressants, by inhibiting synaptic interstitial neurotransmitters Re-recovery, so that the level of neurotransmitters in this part is increased, so as to achieve the purpose of eliminating symptoms.
In fact, mental biochemical abnormalities of depression, such as dexamethasone inhibition test and sleep EEG abnormalities, can be seen from some biological markers. The younger the age of onset, the greater the instability of biological markers. .
4. The cause of childhood obsessive
(1) Basal ganglion dysfunction: In the study of mental illness, findings from CT, PET, neurotransmitters and neuroendocrine showed that the symptoms of obsessive-compulsive disorder and the frontal-basal ganglion circuit were abnormal. close relationship.
In clinical practice, clinicians will have such experience: 1 forced obsessive-motor tics and ritual behavior in children with Parkinson's disease after encephalitis have many similarities with the do not do behavior of patients with obsessive-compulsive disorder, 2 Tourette syndrome is a disorder caused by dysfunction of the basal ganglia, and is associated with a significant increase in tics of tics and dance-like dyskinesia in children and adolescents with obsessive-compulsive disorder, 3 due to rheumatic chorea It is because the basal ganglia has an immune response to hemolytic streptococcus, which is manifested as uncontrollable and untargeted dyskinesia. Chapman (1958) reported 8 patients with rheumatoid chorea, 4 patients developed obsessive-compulsive symptoms, 4 many Obsessive-compulsive symptoms can occur at the onset of the disease: rheumatoid chorea, Huntington's disease, liver-like nucleus degeneration (Wilson's disease), idiopathic and post-encephalitis Parkinson's disease, tics-slang syndrome, etc. They are all manifestations of basal ganglia dysfunction.
Rapoport (1991) showed a cranial CT scan of 10 children with obsessive-compulsive disorder and 10 healthy controls. The caudate nucleus of the basal ganglia in children with obsessive-compulsive disorder was significantly smaller than that of normal children.
Researchers at the National Institute of Mental Health and the University of California, Los Angeles, using PET technology to study the local glucose metabolism rate in patients with obsessive-compulsive disorder, found that patients with obsessive-compulsive disorder significantly increased glucose metabolism in the frontal, cingulate, and caudate nucleus. The increase in glucose metabolic rate at these sites suggests a functional abnormality in the frontal-basal ganglia pathway.
(2) Neurotransmitter abnormalities: Currently commonly used anti-obsessive drugs such as chlorpromazine and fluoxetine are selective 5-HT reuptake inhibitors, which effectively block presynaptic cells against 5-HT. The recovery of the transmitter is used for therapeutic purposes, and it is speculated that the 5-HT function is insufficient or decreased in obsessive-compulsive disorder.
Some researchers have observed that dopaminergic neurotransmitter hyperactivity in children with obsessive-compulsive disorder is very similar to the "obsessive concept" and "forced ritual action" that occur when the psychostimulant (amphetamine, methylphenidate) is used excessively.
(3) Neuroendocrine abnormalities: In an epidemiological survey of obsessive-compulsive disorder in high school, Flament (1988) found that men had fewer obsessive-compulsive disorder than women, with mild symptoms, obsessive-compulsive symptoms increased in pre-puberty, and women forced before menstruation. Increased thinking and forced ritual movements, obsessive-compulsive disorder after childbirth, etc. indicate that neuroendocrine changes play a role in the pathogenesis of obsessive-compulsive disorder.
(4) Psychological factors: The psychoanalytic school believes that the symptoms of obsessive-compulsive disorder in children stem from the development of sexual psychology in the anal stage. This period is the period when children are engaged in large and urinal training. Parents require children to obey, while children insist on unconstrained Contradictions cause conflicts in children's hearts, causing children to develop hostile emotions, and the development of sexual psychology is fixed or partially fixed at this stage. Forced symptoms are the external manifestations of heart conflict during this period.
(5) Parental personality characteristics: As early as 1962, Kanner realized that most children with obsessive-compulsive disorder lived in the overdose of parental perfectionism family. Parents had the rules of conformity, step by step, pursuit of perfection, bad change and other personality traits. .
Prevention
Childhood emotional disorder prevention
Emotion is the psychological reaction of people. In adults or children, it is impossible to be always happy and happy, but the emotional reaction of children in infancy is sudden and unstable. As they grow older, parents hope to be able to Help your child learn to correct his negative emotions and turn them into a healthy direction. Here are a few ways to refer to them.
Fear
If a person does not know the fear, it is easy to encounter danger, but too much fear, it is difficult to live a normal life, the key to overcoming fear is:
(1) Understand the child's fear: Three or four-year-old children begin to pay attention to the world around them, which causes many fears and fears, and often causes unreasonable fear of people or things. Parents should express their understanding and make a relaxed tone. Talk to your child about what he is afraid of.
(2) Discuss with the child what is feared: If the child is afraid of real life things (such as earthquakes, floods, wars, etc.), parents can discuss these things with the children and tell them what happens when such things happen. Measures can protect yourself and your family from harm.
(3) If the child is afraid of something that is imaginary, the parent should clearly tell him that such a thing does not exist at all.
(4) If the child is often afraid for a period of time, but can't say why, parents should patiently listen to the child's conversation and find out the reasons that bother him.
2. How to educate
Some parents are often angered by the "disobedient" children because they are uncomfortable at work or life. They are used to fighting and giving birth, which makes the early education cast a "shadow". To this end, modern American psychologists point out that tutoring is an art. Whether the child is obedient depends on whether the parents teach well or not, and taking too much snoring to coerce the child to "take the court" and "obey" will definitely backfire.
(1) Love is the premise: In a family with strong cohesion, love is a bridge to communicate ideas and feelings.
(2) Peace of mind: When an adult is excited, he can say something that he later regrets. If there is anger, press it first, and wait until the mood is stable. We are not easy to get angry with adults. This attitude is also suitable for ourselves. Child.
(3) Words should not be more: chattering often leads to deafness of children. This kind of preaching often uses "when I am as big as you are" to make an opening statement, followed by words such as "you will understand in the future", because Children grow up in the real environment, parent education is best to use the popular language to guide the situation.
(4) Respect for children: Give children the right to speak when discussing daily housework. Something to discuss with the child, things are always easier to do, and at the same time let him realize his status and identity in the family.
(5) Listening patiently: If the child has something to let him finish, don't interrupt the words at random. After he finishes speaking, he may repeat his main meanings, find out what is going on, and then make suggestions if the child loses his favorite things. Even if the thing is insignificant for adults, parents should have enough patience to satisfy the childlike innocence of the child.
(6) Grasping the timing: The best time to talk about home is before going to bed. At the beginning, you can ask your child if everything is going well on the day. You can say a word, exchange views, and enhance understanding. Another golden time for talking is for children. As the adults do housework.
3. When the child is angry
(1) Persist in asking children to use words instead of actions to express anger. When a child is angry, encourage him to speak out loud and tell the reason as much as possible.
(2) Help the child to find the cause of anger. The child sometimes needs the adult's prompt to think back to himself for reasons of anger, such as: "Are you mad at him because he took your car?"
(3) Understand the child's emotions, such as "I know that you have to wait a little impatient, but there is no way, everyone has to wait like this."
(4) It is forbidden for children to beat people when they are angry. Once such behavior occurs, parents should immediately punish them.
(5) Encourage children to express their wishes straight away, instead of using negative attitudes of grievances and complaints, such as the child sue: "He beat me..." Parents can answer: "Let him tell him not to hit you again,"
(6) Make an example for your child. When you are angry, speak out loud, so that you dont have to be furious when you cant control it. Parents dont have to hide their angry feelings in front of their children, let the children learn how to properly express themselves. Anger, but remember, don't express your emotions to your child with insulting words, only objectively express your feelings and reasons, such as: "I am very angry!" "Don't mess with my things!"
4. Cultivate the brave spirit of children
In recent years, there has been a worrying education softening tendency in real life. For example, some parents of young children are worried that their children will be tanned and play wild, so they are not allowed to play outdoors, play with mud, play with sand, And they are locked in the house to hold dolls, play "family", and some can do things that can be taken care of by children in their own lives. These practices make children timid, dependent, and lack of social role awareness and independence. The competitiveness is weak, how to cultivate the brave spirit of children?
(1) Unreasonable demands on children. When they are young, they say "no", "no", "no", and it is much more beneficial than Baiyi Baishun.
(2) Pay attention to the personality differences in children's age characteristics. For example, children like to imitate, you can tell stories of ancient and modern celebrities and scientists, and develop a good will quality.
(3) Consciously carry out some frustration education, such as holiday outings, experience the taste of fatigue, set up some difficulties above their psychological endurance to let them answer, help them master the correct way to deal with setbacks, and stimulate them. The courage to overcome difficulties in the face of adversity, confidence and perseverance.
(4) When playing chess, playing cards, and playing games with children, don't let them arbitrarily, play them, consciously cultivate their competitiveness, and overcome the psychological barriers that they cannot afford to lose.
(5) Educate children not to be easily irritated by other people's comments, to believe in themselves, to improve their psychological endurance, to eliminate negative emotions caused by setbacks, and to maintain inner balance.
(6) Under a big goal, we can first determine the short-term goals that can be effective in the near future, so that they can get the joy of continuous success and drive out the tension. Of course, the "adversity" exercise should pay attention to moderation, the method should be correct, and it should be gradual.
5. Children are emotionally vulnerable
Generally speaking, emotional sensitivity and vulnerability are just one aspect of a child's personality. It may help or may be harmful to the normal development of the child's personality.
(1) Sensitive children are prone to quarrel with their companions. In normal times, parents can ask various questions when talking with their children, so that he can think about different ways to avoid emotional impulses when encountering such problems.
(2) When the child is sad, let him cry a good time. At this point, the adult does not need to intervene too much, just sit quietly sitting next to the child, let him or her feel your understanding and support, sometimes the child will put your arms in, you need to hug and gently touch But sometimes, he only needs to be alone, quietly sighing his sorrow.
(3) To help the child learn to make a calm response, only after he is quiet can he gradually help him to deeply understand things and teach him to deal with unpleasant things better.
(4) In the case of a tough problem, you can temporarily let the child avoid it, change the environment for a while, and then help him solve the problem later.
6. Correct the child's temper
The child's initial temper is to vent anger and dissatisfaction. When he finds that this can control adults and let adults meet their various requirements, losing their temper becomes a means of asking adults, and expressing anger and dissatisfaction Not so important, when children have such problems, they should be controlled and corrected.
(1) Don't promise any child's request at this time, don't let the child think that he can get what he wants when he loses his temper. What requirements can be said directly? You can't ask the adult with a long face. The child should learn to use it directly. Words express their needs.
(2) When the child starts to lose his temper, he will find a way to stop it. You can walk away, ignore him, or take him to his room. You can also scream him harshly... no matter which one you use. The purpose is to stop this situation from continuing and prepare to take the next step...
(3) After the child has attacked, give him appropriate punishment and let him remember that the next time he can never do this again. If this time is a new mistake, you can also give some specific punishments. If you do not allow toys, you are not allowed. Watching TV, etc. In short, let the children feel that the consequences of losing their temper are terrible, and they will not be able to do so in the future.
(4) When you find that your child is going to lose his temper, you may wish to get a slap in the first place. The child is particularly prone to temper in some places. For example, when you come to the store or at home, the parents often tend to be too gentle and compromise on these occasions, so that the child has The opportunity is to take advantage of it. Therefore, the more parents are at such an occasion, the more determined they are and the stronger their tone, so that the children do not use these opportunities to make demands.
(5) When you are very busy and have no time to take care of your child, make appropriate arrangements for your child. Don't let him get involved in adult nervous and boring things.
7. If the child is narrow-minded, learn to be tolerant
(1) Parents should consciously praise the merits of others in front of their children, including those who have conflicts with themselves, especially after the child has a dispute with others, but also actively guide the children to think about the strengths of others and understand others. The fault of his own child should urge him to take the initiative to apologize and reconcile with others.
(2) Tolerance is based on understanding and respecting others. In dealing with peers, children should be required to understand and respect their partners, not to infringe on the rights and interests of their partners, to be humbly and trustworthy, to be generous and to be friendly with their partners.
(3) Parents should also give more understanding and tolerance to their children. Don't see a few shortcomings, mistakenly hold them down, even turn old accounts, expose old people, accuse him of "how to get old," etc., stab wounds The child's self-respect.
(4) Help children overcome the bad mentality of self-centeredness, and ask the children to have others in their hearts, let the children know that: delicious food can not be eaten by themselves, should be shared by everyone; toys can not be monopolized by one person, and must be played with partners.
(5) If necessary, let the child have some experience of concession, so as to exercise the child's restraint ability, so that it has a wide tolerance and open-minded conservation.
(6) Family members should be friendly and tolerant, so that children can live in a warm, harmonious, friendly and tolerant family environment from an early age, so that they can gradually form a stable and tolerant and modest quality.
8. Separation anxiety
(1) For children who are raised alone in the family, they should be allowed to contact as many people as possible outside the family. They should train their children to greet strangers and say goodbye to prevent children from being timid, afraid of strangers, and fearing many people. Waiting for a group phenomenon.
(2) Pay attention to cultivating their ability to live, let them learn to eat, wash their hands, urinate, dress shoes, etc., to prevent excessive dependence on adults, can not adapt to the collective life, after entering the nursery, too nervous, fear.
(3) Before sending the nursery school, you should do the preparatory work before enrollment. Parents should always introduce the situation of the nursery school to the children, so that they can have love nursery schools before enrollment, and they are not afraid of the mental preparation of the nursery school.
(4) If you find that your child is timid and afraid to go to the nursery school, you should not push them to the nursery school. You should take them there to play and see, be familiar with the environment, and then formally enter the nursery. Prevent separation anxiety.
(5) If there is a separation anxiety reaction, you should immediately suspend the nursery school, ask the doctor to correct it, and make up the preparation before entering the caregiver. Do not be too hasty to prevent anxious attacks.
Complication
Childhood mood disorder complications Complications depression
The disease belongs to affective disorder. It is mainly caused by depression in clinical practice. When patients have depression manifestations, psychological counseling should be carried out as soon as possible, and appropriate psychological intervention should be given to the child to restore their mental state to normal level. Depression is manifested in the lack of fun in life, snooze, feeling that everything in life is boring, and even eager to end his life.
Symptom
Symptoms of Childhood Emotional Disorders Common Symptoms Irritability Children Divorce Anxiety Depression Autism Attack Behavior Nightmare Impulsive Destruction Nausea Appetite Decline Mental Disorder
Separation anxiety disorder
Most occur in preschool children. The main manifestation is that there is excessive anxiety and panic when leaving with their loved ones. People who are worried may suffer accidents, or fear that they will never return, and they are required to stay at home and do not want to go to school, such as sending children to school. Telling about headaches, abdominal pain, etc. Check for no abnormal signs.
2. phobia disorder of childhood
It refers to children's excessive fear of the objective things or situations in daily life, and the persistent strong terrorist reaction exceeds the dangerous level of the actual situation. Although comforting and explaining, there is still no fear of clearing, even avoiding and withdrawing. Daily activities. When panic, it may be accompanied by autonomic symptoms such as pale, palpitations, sweating, frequent urination, and dilated pupils.
Another type of child mainly shows horror to the school, strongly refuses to go to school, long-term absenteeism, obvious anxiety and fear of going to school, and often complains that he is sick, but can't find out where his disease is, but can learn at home, and no other. The performance of bad behavior, this phenomenon is called school phobia. Common in school-age children, girls are more common than boys. The causes of school phobia may be related to fear of school-related things, academic failure, boredom of learning, or fear of separation from mothers.
3.social sensitivity disorder
Most of them are seen in children aged 5 to 7 years old. They mainly show excessive sensitivity, nervousness, timidity, shyness, and retreat when they are in contact with their surroundings. Therefore, they are unwilling to go to a strange environment and fear of separation from their mothers.
4. Childhood obsessive-compulsive disorder (child obsession)
More common, repeated, rigid obsessive or forced actions, such as excessive washing hands, repeated checks of their behavior, meaningless counting, sorting order, repeated recalls of what they have just done or considering some meaningless things. The child knows that these thoughts and actions are unnecessary and meaningless, but they cannot restrain themselves.
5. Child hysteria
Common in young children, women are more common than men. Family disharmony, improper educational methods, and excessive parental love and protection of children can easily lead to snoring in children. Children with low cultural programs and low family economics or local customs and superstitions are also prone to snoring. The type of clinical seizure form is basically the same as that of adults. One type is a somatoform disorder, which refers to a non-organic motor, sensory or autonomic symptom called a conversion reaction; the other is a segregation reaction, which is expressed as Episodes of consciousness, emotional outbursts, abnormal behaviors, etc., the interictal period is normal. With age, seizure performance is similar to adult snoring.
The diagnosis of snoring is to understand the history and examination in detail and to clarify the nature of the disease. Symptoms of snoring are various, often with false physical symptoms and neurological symptoms, which are easily misdiagnosed, especially when physical illness is accompanied by certain mental factors.
6. Child depression
It is the core symptom of childhood unsatisfactory mood, low mood, sad crying, decreased interest, reduced activity, dullness, less speech, insomnia, loss of appetite. A few cases can be associated with other bad behavior. This disease occurs mostly in adolescence, the cause is not clear, may be caused by multiple factors, including genetic factors, biochemical metabolic defects and environmental factors. The diagnostic criteria for childhood depression, according to Weinberg, summarize the following four points:
(1) Poor mood and low self-assessment.
(2) 2 or more of the following 8 symptoms: 1 aggression; 2 sleep disorders; 3 reduced contact with other; 4 unwilling to go to school; 5 decline in grades; 6 body complaints; 7 lack of energy; Appetite and/or weight changes.
(3) These symptoms can indicate that the child's behavior changes more than usual.
(4) Symptoms last at least 1 week.
Examine
Childhood emotional disorder check
There are few experimental studies on childhood emotional disorders, and the younger the age of onset, the greater the instability of biological markers, and the increased urinary catecholamine and its metabolites in children with anxiety disorders. Peripheral sympathetic excitation is related, the results of the study are still inconsistent, and it is still difficult to be a valuable reference for the diagnosis of anxiety disorders.
Diagnosis
Diagnostic identification of childhood emotional disorder
diagnosis
1. Child separation anxiety
Childhood and juvenile anxiety should be very cautious. On the one hand, it must be differentiated from normal people's anxiety reaction to avoid diagnosis and enlargement; on the other hand, attention should be paid to the concealment of anxiety disorder to avoid misdiagnosis, CCMD-3 separation anxiety for children. The diagnostic criteria for the diagnosis are as follows.
(1) Symptom criteria: There are at least the following three items:
1 Excessively worried that the attachment object may encounter injury, or fear that the attachment object will never return.
2 Excessively worried that he would be lost, kidnapped, killed, or hospitalized, so that he would be separated from the attachment.
3 Because they do not want to leave the attachment object and do not want to go to school or refuse to go to school.
4 I am very afraid of being alone, or not accompanying an attachment, never going out, preferring to stay at home.
5 When you are not attached, you are unwilling or refuse to go to bed.
6 Repeated nightmares, the content is related to the separation, so that many times wake up at night.
7 Excessive fear before separation from attachment objects, excessive emotional reactions such as irritability, crying, tantrum, pain, apathy, or social withdrawal after separation or separation.
8 When you are separated from the attachment object, there are repeated physical symptoms such as headache, nausea, vomiting, but no corresponding physical illness.
(2) Serious criteria: impaired daily life and social function.
(3) The course of disease: the onset of symptoms before the age of 6 years, met the symptom standard and the serious standard for at least 1 month.
(4) Exclusion criteria: not due to extensive developmental disorders, schizophrenia, childhood fear anxiety disorder, and other diseases with anxiety symptoms.
2. Children's school phobia CCMD-3 is not included in children's school phobia. Since this is one of the common obstacles, the trial diagnosis is as follows. For children's school phobia, children are afraid of school environment or going to school. , anxiety and avoidance behavior, but have nothing to do with school or non-school environment (such as at home).
(1) Symptom criteria:
1 There is a lasting fear, anxiety and avoidance behavior in going to school.
2 Feeling pain, discomfort, crying, speaking or withdrawing from the school environment.
3 children have self-awareness about their behavior and showed excessive attention.
4 When you are not in the school environment or not attending school, and when you are with family members or people you are familiar with, you will behave normally.
(2) Severe criteria: impaired social function.
(3) Course duration criteria: meet the symptom criteria and serious criteria for at least 1 month (excluding the first month of initial enrollment).
(4) Exclusion criteria: not due to schizophrenia, extensive developmental disorders, affective disorder, epileptic disorder, generalized anxiety disorder, etc.
3. Childhood obsessive disorder
Childhood obsessive-compulsive disorder refers to childhood and adolescent neurosis subtypes with obsessive-compulsive symptoms. The characteristics of obsessive-compulsive symptoms are that both conscious self-forcing and conscious self-reaction are coexisting. The conflict between the two causes the patient to be nervous and very painful. The patient knows that the obsessive-compulsive symptoms are abnormal, but they can't get rid of. The children with obsessive-compulsive disorder have normal intelligence level, usually quieter, good thinking, strict family requirements, more tube bundles, more slow onset, longer course, and lighter and heavier symptoms. Obsessive-compulsive symptoms may be the main manifestation of early stage of childhood schizophrenia, or a combination of autism, anxiety, depression, and Tourette syndrome. Therefore, extensive data should be collected to confirm the diagnosis and avoid delay in treatment.
4. Children's social phobia
It refers to children's fear, anxiety and avoidance behavior in the new environment or strangers. It is manifested as: persistent interaction with strangers (including peers), social avoidance behavior; when dealing with strangers, suffering from Children are self-aware about their behavior, showing guilty or excessive attention; feeling painful, uncomfortable, crying, speechless or quit in the new environment; when the child is with the family or a familiar person, the social relationship is good, the child's The function of social (including peers) is obviously affected, resulting in limited communication, and the above performance has been at least 1 month before diagnosis.
Differential diagnosis
1. Discussion on CCMD-3 in children with dissociative anxiety disorder
It is normal for young children and preschool children to actually or may be separated from the person they are attached to. Only when this fear of separation becomes the center of anxiety and occurs in early childhood is it diagnosed as isolated anxiety disorder. The key to the identification of this disorder and normal dissociative anxiety is that the excessive anxiety generated when separating from the person with whom it is attached (usually the parent or other members of the family) is not simply a part of general anxiety in many occasions, which is serious. Degree, duration, and social function are unusual (diagnostic). Separation anxiety, such as occurs in an inappropriate age group during development (such as adolescence), should not be diagnosed and coded here unless it is an appropriate age group Abnormal continuation of the dissociative disorder, the occurrence of this disease may often be related to the refusal to go to school, but refusing to go to school is one of the manifestations of dissociative anxiety. It should be pointed out that the refusal of schooling in juveniles should not be diagnosed and coded unless it Essence is the manifestation of segregation anxiety, which occurs before the preschool age and reaches an unusual level, child separation Anxiety disorder should pay attention to the following identification of anxiety or anxiety can sometimes become associated with disease:
(1) Anxiety: refers to an experience, such as worry, fear, caused by many biological, psychological, and social changes in learning, life, work, friendship, love, examination, progression, employment, labor income, and material distribution. , anxiety, etc., this can be considered as a protective response of normal people in stress. Moderate anxiety can arouse vigilance and stimulate fighting spirit, but teenagers and children are in the stage of maturing to the body and mind, if pressure from the objective environment and subjective growth If the confusion is not properly psychologically counseled, it will be affected by severe negative emotions, which directly affects the entire mental state of adolescents and children, hinders the development and integrity of personality, and can be accompanied by various emotions. All kinds of physical discomfort, serious accidents, even life-threatening, need to pay attention to, children can not accurately describe and express their own state of mind, emotions, often when emotional problems develop to seriously affect learning and life, only cause people Concern and see a doctor.
(2) Situational anxiety: Situational anxiety is adolescents with normal mood on weekdays. In a certain environment, symptoms such as autonomic nervous disorder are often accompanied by short-term tension, worry, nervousness and other symptoms caused by serious life. Also known as state anxiety, such as students who are usually more stable, they will have anxiety during the test period, and they will return to normal as soon as they are tested.
(3) Quality anxiety: Quality anxiety refers to the personality traits of adolescents and children from the early childhood showing different sensitivity to children of the same age, as well as excessive reaction to things, worry, nervousness and other anxiety tendencies, if in life Encounter some stress factors to make the symptoms clear, called quality anxiety. These children usually have very gentle personality, strong self-esteem, discipline, restraint, high intelligence, and are very serious and overly nervous. It is common in primary and secondary school students. Their parents often have sensitivity, hesitation, worry, lack of self-confidence, etc. Parents with anxiety personality characteristics also respond anxiously to the anxiety symptoms of children, which will make them The symptoms are more serious. If the parents are affected for a long time, the anxiety of the child will prolong and heal, becoming chronic anxiety, which is very unfavorable for the formation of children's personality.
(4) Children's and adolescents' generalized anxiety disorder: This kind of anxiety refers to a group of emotional disorders that are mainly caused by fear and uneasiness. This kind of fear has no specific directivity. The anxiety is only for the future and not. Clear danger or objectiveness does not have enough stimulation to cause anxiety, the degree and duration of anxiety, the stimulation is extremely disproportionate, the child has excessive and unrealistic fears, and always feels ominous things happen, symptom duration Anxiety disorders are more than 3 months, and anxiety-based mood disorders often appear simultaneously with symptoms such as depression, fear, and coercion, which is more pronounced in adolescents.
2. Discussion on CCMD-3 in Children's Phobia
Children, like adults, can also have fears of a wide variety of objects or situations. Some of these fears (such as square phobia) are not seen in the normal psychosocial development of individuals, but some fears have significant development. Stage characteristics, the key to diagnosis is the unusually excessive fear of specific developmental stages in children and is not part of a broader mood disorder.
3. Discussion on children's social phobia CCMD-3
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