Sample Article Review on Anxiety

Emotion regulation, social anxiety disorder and anxious responding

According to Helbig-Lang et al (2015) anxiety disorders are largely considered as mental illnesses. These illnesses, which are predominantly social, are often characterized by constant fear of negative judgments in social contexts. This is however a type of disorder that is developed overtime throughout the socialization process. Social anxiety disorder also shares an association with the impairment of an individual mental wellbeing, the quality of life that they live and their ability to function as social beings. Recent approaches to the understanding of social anxiety disorders have suggested that emotional regulation play a contributory role in determining the severity of mental disorder than an individual is suffering. In addition, through the multidimensional process on which emotions are regulated there are suggestions that individual suffering from any form of emotional disorders are often identified by high emotional intensity, relatively low levels of awareness in the understanding of their emotional functioning and their inability to effectively engage their emotional regulation strategies.

These factors in the view of Helbig-Lang et al (2015) are used in the identification of individuals with emotional disorders can be said to playing a contributory role in the development and the understanding of social anxiety. The evaluation of the attributes that characterize the lives of socially anxious individuals can be related emotional regulations especially by assessing their experience and expression of intense emotions. In addition, whenever an individual is found to be suppressing emotional responses in social setting sit is possible to argue that such a person is in the process of developing social anxiety. The development of these processes overtime reduces the level of emotional understanding and acceptance hence reducing the cognitive capacity to elaborate and understand all forms of social information. This form of reduction is essential in understanding instances of social anxiety disorder. This is because low levels of cognitive ability among individuals’ results in less successful social interaction processes hence contribution to the development of situational and anticipatory disorders (Helbig-Lang et al, 2015).

Numerous aspects of emotional regulation difficulties often characterize social anxiety disorders. Emotional awareness unlike all the other aspects of emotional regulation has a less significant possibility of leading to the development of social anxiety disorders. This is because unawareness in terms of emotional capacity is largely a nonclinical complication. This means that it is an attribute that is largely developed on social platform and through the socialization process, especially among peers individuals often begin improving on their level of understanding of their own emotions (Helbig-Lang et al, 2015). Despite its relatively low contribution in the development of social anxiety disorders, it is possible to argue that lack of emotional awareness can have an indirect link with social anxiety disorders. This is because individuals suffering from Social anxiety disorder often tend to suppress their feelings either consciously or unconsciously. Through socialization, the level of emotional awareness often heightens self-attention, which often shares a relationship with the perception of threat. The development of this awareness could by an improvement in the levels of emotional understanding create some form of clarity (Helbig-Lang et al, 2015).

The absence of a direct link between emotional awareness and social anxiety disorder creates the notion that personality differences can be perceived as the main cause of social anxiety disorders. This is because through these differences, individuals from divergent backgrounds reveal different aspects of emotional experience. Complications in personality disorders and emotional regulation difficulties contribute to different ratings of the level of social anxiety disorders in the society. This means that proper diagnosis of clinical problems associated with social anxiety disorders must be understood form an individual’s perspective. In addition, through such considerations it will be relatively easier for clinical officers to determine the role that social anxiety plays in the emotional and cognitive development of an individual (Helbig-Lang et al, 2015).

One of the major techniques that can be used in the provision of the most appropriate solutions to social anxiety disorders is through the understanding of the type of social situation that an individual fears. The level of anxiety will be measured through different cognitive ability and interpersonal relationship attributes.

The cognitive abilities of these individuals will be measured by their ability to make and implement rational decision s in different social situations. In addition, mental healthcare officials also have a responsibility of ensuring that they maintain high levels of interaction with the concerned personalities to enable easy and sufficient identification and diagnosis of their problems. In terms of interpersonal relationships, social anxiety disorders contribute to a reduction of the capacity of an individual to engage other individual within a specific social setting in a mutually exclusive interaction (Helbig-Lang et al, 2015).

The process of developing different intervention techniques often face difficulties considering that different individual hold varied perceptions on the ability of emotional regulation attempts to generate then most effective solutions. This has been considered as an inefficient way through which individuals with low levels of self-efficacy heighten the possibility of suffering from more difficulties related to social anxiety disorder (Helbig-Lang et al, 2015).


Pain, depressive and anxiety disorders

Gerrits et al (2014) stresses on the relationship between depression and anxiety disorders. This is because of their ability to recur on individuals in situations where ineffective intervention methodologies have been realized. This means that t is the responsibility of healthcare practitioners to identify the best methodologies through which they can ensure that their patients are safe from the possibility of depressive and anxiety disorders. Chronic disease when combined with different aspects of pain often contributes to the possibility of recurrence of anxiety disorders. One of the major reasons for this possibility id s the discomfort and other negative attributes that are associated with chronic diseases and the prevalence of pain. Through such attribute, sit is often relatively easier for the concerned individuals to develop negative coping strategies. Such strategies are often exacerbated by the occurrences of disabilities, and a reduction in the quality of life. Heightened levels of such attributes often lead to acute depressive and anxiety related disorders.

Chronic diseases in the view of Gerrits et al (2014) are necessary but sufficient in providing an explanation for the recurrence of depressive and anxiety disorders. This is because an increase in the intensity of these illnesses cannot be used as a measure of predicting any deform of relapse in the treatment of the disorders. Despite their limited contribution it is possible to argue that the level of severity of chronic illnesses can be used in the determination of the amount of pain tha the said individual will be experiencing. This means that the resulting pain from any chronic illness can lead to the development of anxiety disorder in patients.

Different levels of pain according to Gerrits et al (2014) can be used in the assessment of the symptoms of depressive and anxiety disorder. Pain locations have been found to be contributing to the level of mental distress and anxiety among different individuals. This is because the numbers and the levels of severity of the pain locations can be used in determining the degree of pain that an individual is expected to undergo. An increase in the number of pain locations for instance is often expected to increase the severity of pain. In addition, this means that such levels of pain may increase the possibility that the said individual will experience heightened depression and pain recurrence.

For the patients and the medical experts to be able to identify the best possible solution to the problem of pain and anxiety disorders, it would be important to develop a strategy targeting both pain and the levels of depression. A mutually reinforcing strategy that will be developed must be based on the understanding that the existence high levels of pain often cause depression among patients with chronic diseases. The possibility of developing anxiety disorder increases with the levels of pain and the degree of depression. Change in pain can also be perceived as an essential predictor of depression and anxiety recurrence. This means that failure to recognize the attributes of pain is in itself a risk in anxiety recurrence. In addition, anxiety disorder and recurrence can also be perceived to be resulting from the prevailing societal and community expectations on the part of the patient. In certain case the perception that a chronic illness that is associated with high level pain often leads to suffering may cause varied levels of anxiety among patients (Gerrits et al, 2014).

It is therefore the responsibility of the medial practitioners with the help of mental health experts to evaluate the prevailing situation in terms of pain. This is a way of minimizing the possibility that an individual will suffer from any form of depression and anxiety recurrence. Failure by the medical fraternity to develop he most effective procedures in such situation often leads to the development of a vicious circle characterized by negative coping techniques. In addition, such individual may also be faced by impaired physical and social capacity to function in a social setting due to the pain and affective symptoms (Gerrits et al, 2014).

Existing evidence suggests that any form of overlap in the neural networks that coordinate the emotive and pain recognizing parts of the neural system can be perceived as contributing factors to the increase possibilities of depressive and anxiety recurrence. Pain for instance has been perceived to be the main cause of changes in the ability of the nervous system to operate. This is because it facilitates the increment of cortisol levels. In addition, pain also changes the autonomic nervous system by increasing the sympathetic while decreasing the parasympathetic ability of the system to function (Gerrits et al, 2014). These changes often lead to new depressive disorder episodes, which exacerbate the possibility of anxiety disorder among patients. Sympathetic part of the nervous system contributes to anxiety recurrence since it is one way through which patient become more vulnerable to instances of pain. For anxiety exist among ailing patient it is important that they must undergo some form of depression. The levels of depression can be used in conduction an assessment on the functioning of the nervous system. Failure of the nervous system may lead to the development of the conclusion that pain does not have a direct association with anxiety but is a cause of depressive recurrence among patients (Gerrits et al, 2014).

Little children, anxiety disorders and the engagement of parents

Mian (2014) argues that one of the greatest mental health problems in the contemporary society is childhood anxiety disorder. This is especially in preschool age children due to substantial impairment. It is possible for easy interventions to mitigate the problem especially when the most appropriate approaches are used in addressing the challenges. The most challenging aspects of mental health disorders in preschool children are largely in the inability of the parents and to some extent medical experts to conduct an effective diagnosis. This explains why it is often less likely those younger children will receive treatment. The causes of anxiety disorder among children may be relatively complex to identify. However, the symptoms of this disorder may be chronic and relatively stable throughout different growth and development sessions if left untreated at childhood.

In the mental health care sector, substantial progress has been made especially in the development of the most efficient treatment and healthcare support programs that facilitate the prevention of such disorders in children. The involvement of the parents in the development of these programs has been cited as essential in ensuring its success. This is because parents are the primary socialization agents of their children and therefore any form of anxiety disorder is the sole responsibility of the parent to manage with the help of mental healthcare practitioners (Mian, 2014). The challenge in the involvement of parent can also be said to be arising from their inability to recognize and seek assistance in anxiety related complications. This means that the parent will only be involved in this process at when the disorders are at acute stages and are able to reveal different signs.

Existing studies have indicated that there is implication associated with the involvement of family in anxiety disorder matters. The inclusion of parent from the diagnosis to the treatment of anxiety disorder in children often plays the role of reducing parenting behavior. This is because of the relationship that exists between the identification of anxiety disorder symptoms in children and the possibility of a rise in the levels of anxiety in parents. Earlier interventions therefore can be essential in facilitating the development of positive coping strategies and cognitive behavior therapy among the affected members of the family. This is an indication that the involvement of the family, especially the parent can be used as a platform for the transfer of knowledge and skills from mental health professionals to the parents. This knowledge can later be inculcated into the children. The success of this approach towards addressing anxiety disorders can be viewed as a positive approach towards the realization of positive ends in treatment (Mian, 2014).

Three are different levels of growth in terms of the approached that have been used for preventive purposes. One of the greatest objectives of these approaches to anxiety disorder is the development of a cost-effective model. Anxiety is considered as one the greatest challenges in mental health due to its prevalence, the associated risk factors and the availability of tools and equipment for screening purposes. In terms of the risk factors one of the areas that have been identified is the inhibition of behavior and the resulting parental anxiety disorder. However, these attributes can be addressed through the introduction of the best possible approaches in early recognition of the illness (Mian, 2014).

This article however recognizes the need for more research initiatives that can explain the relevance of using risk factors in the process of diagnosing anxiety disorder among children. In addition other areas of study in relation to the preventive measures are the optimal development episode that a prevention mechanism can be used.  It is possible to use earlier intervention as a technique of reducing the possibility of the symptoms increasing in terms of their levels of severity as the children grow (Mian, 2014).

In terms of treatment of anxiety in preschool children, the article suggests that operate approaches can the most effective approaches to treatment. This is because through this approach it children learn to associate different aspects of phobia with different forms of reward and punishment. Despite its assumed efficiency, there are also empirically supported clinic methodologies that are believed to be better placed in the provision of the most appropriate solutions. These include the maximization of the representative nature of clinical samples. one of the criticism again these treatments is that they were designed to treat phobia but it is unclear whether they are able to address issues related to anxious emotions. These include generalization of stimuli, bias in attention and cognitive distortions (Mian, 2014). These are attribute that are visible in more complex anxiety disorders hence the need for treatment that surpasses behavioral techniques. These include interventions such as cognitive restructuring especially in relatively older children. Other anxiety disorders emanating from features such as fear may be treated sufficiently through operant approach such as exposure. This can only be conducted through the process of identifying the aspect of phobia and developing solutions towards the specific problem (Mian, 2014).

Preschool anxiety disorders

According to Carpenter et al (2015) there is need to conduct an exploration on the relationship between generalized anxiety, social phobia and amygdala-prefrontal dysregulation among school age children. this is due to the realization that the levels of anxiety among school going children was largely dependent on the neurobiological differences that are often resulting from the mode of socialization at the family and the community stage. There is preliminary evidence that impaired anxiety at its early stages ma affect the proper functioning of the brain in later childhood years. This is because of the differences in neurobiological compositions of different individuals in relation to specific anxiety disorders. The regulatory networks often affect the amygdala-prefrontal emotion in anxiety. This is because different individual experience some variance in their ability to control anxiety resulting from any form of phobia in the school environment.

The socialization process often determines that reactions that children will have towards intimidation, buying and interpersonal communication between members of different sexes. This means that the ability of a child to experience any form of discomfort in addressing relatively larger population of age mates will be dependent on his or her level of exposure with different aspects that define the society. Children who are affected with different factors related to pre-school anxiety will still experience anxiety and phobia related complication in their school age. The neurodevelopment process is therefore essential while addressing the history of a school age child with anxiety.  This process begins in the early stages of life, especially when a child begins interacting with the environment. The process continues in school age when such children learn the technique of developing positive and negative attributes concerning their environment (Carpenter et al 2015).

The neurobiological differences that affect the ability of an individual to handle generalized anxiety, separation anxiety and social phobia among children must also be understood from the perspective of the role of the community in the development of a child. Generalized anxiety for instance is often prevalent among children with a decrease in their dorsolateral prefrontal cortex (Carpenter et al 2015). This is often aided by failure by the socialization agent to introduce the child to different aspects that give general information concerning their environment. Children with social phobia are slightly different in terms of the development of their prefrontal cortex. These children do not demonstrate phobia to all forms of environmental systems but are only concerned with interaction with other members of the society. Such children feel socially excluded especially when they are mocked or bullied by their colleagues at school going age (Carpenter et al 2015).

The differences in the patterns of amygdala-prefrontal connectivity are therefore essential in the determination the type and the level of anxiety among school age children. This is because the amygdala-prefrontal connectivity is responsible for the development of positive and negative deface recognition. According to Carpenter et al (2015) fearful and angry faces among children is an indication of disorder. This is because it is facilitated by the presence of some of disruption in different anxiety related aspects such as emotional regulation, which often leads to the development of varied patterns in anxiety disorders. All forms of anxiety can be perceived in relation to their ability to depict disruption of any form of emotional regulation. There is however need for additional studies on the role of suppression and reappraisal and their involvement in the development of amygdala-prefrontal dysregulation.

The relationship in terms of the history of the relationship between pre-school generalized anxiety, separation anxiety and social phobia can be attributed to the socialization process which the children are often made to experience. According to the findings of this study, children with a history of social phobia were experiencing limited school-age functional and operational connectivity between amygdale and the ventral prefrontal cortices to an angry face. Generalized preschool anxiety aiming school age children was linked to lower functional connectivity between amygdale and the dorsal prefrontal cortices. This often happens in response to fearful facial expressions. The findings of this study also documented preschool separation anxiety have limited relationship of school age functional connectivity between amygdale and the ventral prefrontal cortices. This was in the case of their reaction to angry faces (Carpenter et al 2015).

These results suggest that there are long-term neurobiological effects that are related with a history of pre-school anxiety. These forms of anxiety occur as the effects of subsequent emotional symptoms. Preliminary evidence from this study also suggests that the neurobiological differentiation that are specific to anxiety disorders.  Brain development in from this study is often affected byte prevailing environmental circumstances. For an individual to experience high levels of development it would be important for the socialization angst such as the family and school to consider the prevailing circumstances and address these challenges from the child’s surrounding as a way of minimizing the possibility of developing acute anxiety disorders. This will increase or reduce the effects of anxiety on the amygdale-prefrontal cortices (Carpenter et al 2015).

Preschool predictors of childhood anxiety

According to Wichstom et al (2013) there is a tendency of anxiety disorders in children and adolescence to persist. This often necessitates the possibility of long term effects on the patients. It is important for the parents and the medical practitioners to engage in processes that enhance prevention, early identification and the implementation of treatment interventions. The process of realizing these strategies towards the minimization of the side effects of anxiety disorders require a procedure of identifying the risk factors and the institutionalization of protective factors at early life stages.  From a conceptual perspective, there are different attributes of child, parent and peer involvement that often reduce the possibility of developing protective factors. These assist in the process of moderating and mediating the effects of risk and protective factors.

An analysis of preschool anxiety disorders among children often emanate from different attributes that are developed overtime in the socialization process. These include shyness, parental anxiety and the desire of parents to regulate all the aspects in the life of a child. These are considered as risk factors that are often developed as the children begin interacting with different factors in their environment (Wichstom et al, 2013). This is what is considered as early emerging anxiety that shares some form of correlation with risk factors that lead to the emergence of anxiety disorders at the later stages of life. The process of overcoming all the risk factors associated with emerging disorders requires parents to involve physicians in a process that will identify the type of anxiety and the possible effects if this anxiety fails to be mitigated in its early stages. There is also need for extended research especially while addressing the long-term effects of the early emerging anxiety among children (Wichstom et al, 2013).

There are distal risk factors that necessitate the development of childhood anxiety. One of the distal risk factors in childhood anxiety includes the propensity to react to new experiences especially when there is a tendency of the level of wariness to increase. From a conceptual perspective it is closely related to the reactive temperament of fear which often compels the individual under such circumstances to withdraw and retreat. One of the major effects of this level of fear is that it causes intimidation among children making it less probable that they will be engaged in meaningful and interactive procedures (Wichstom et al, 2013). The initial anxiety of fear often makes the situation relatively unbearable especially. One of the major challenges in addressing distal factors is the limited clarity in understanding whether the anxiety disorders that characterize this risk factors form part of a separate construct or whether they are a reflection of an inhibited temperament. It is therefore essential to differentiate different forma of anxiety disorders before any form anxiety disorders can be understood in relation to their connections (Wichstom et al, 2013).

There are other distal risk factors such as attention-deficient disorders and construct disorders which often co-occur in the presence of anxiety disorders. In addition, there are other family related factors that also necessitate the possibility that anxiety disorders will develop into child anxiety with long term life effects. Existing evidence indicates that there is a link between insecure attachments from the parents and the development of anxiety in children. Negative life events such as constant family quarrels often increase the risk of anxiety in children. This is because children will develop a heightened perception that the world is largely an uncertain place that is characterized by threatening and dangerous events (Wichstom et al, 2013).

Parents and peers play a major role in the development of anxiety disorders among children. Children who experience high levels of parental control and peer victimization have contributed to low scores in social skills and interpersonal skills. Such children experience these scores because their parents often deny them the opportunity to explore different societal aspects that are said to be definitive of their responsibilities in the society (Wichstom et al, 2013). The fear of punishment or any form of sanctions often reduces the possibility that children will develop a specific form of behavior. In addition, peer victimization contributes to low score in social and interpersonal skills because such children do not have the courage to exercise their will and integrate with other children in the social context (Wichstom et al, 2013).

The results of this study, while basing their assumption on the impact of socialization of the development of anxiety disorders, attribute such disorders to socialization agents. Avoiding unfamiliar situations for the fear o failure or punishment of instance often leads children into perceiving such situations at threatening to their lives. This increases the possibility that they will develop anxiety disorders especially when the situation perceived to be uncontrollable in the absence of a regulating authority such as the parent. The absence of social skills contributes to the development of anxiety since it prevents children from interacting with other members of the society. This increases the possibility of anticipated risk and failure due to ridicule. Other than poor social skills, other factors such as cognitive distortions may also contribute to the risk of developing an anxiety disorder (Wichstom et al, 2013).

Sensitivity and specificity in accessing anxiety disorders

According to DeSousa et al (2013) the prevalence of anxiety disorders in childhood and to adolescence have been cited as the contributing factors to the significant levels of impairment if left untreated or misdiagnosed. This means that any form of anxiety disorders among children may result in acute psychiatric complications in their adult years. Such problems often include anxiety and depressive disorders, drug and substance abuse. The development of these attributes can be said to be in relation to the need to minimize the effects of anxiety disorder. The best methodology that can be used to ensure early recognition of these disorders is through the use of adequate tools for the purpose of assessments. These assessments will include the identification of anxiety symptoms and the screening for the diagnosis of anxiety disorders (DeSousa et al, 2013).

The study documents the essence of the Screen for Child Anxiety Related Emotional Disorders (SCARED) as the most effective tool in the assessments of anxiety related disorders among children and adolescents.  The efficiency and effective nature of this tool is that it was specifically developed for the assessment of both pediatric and adult anxiety symptoms (DeSousa et al, 2013). In addition, its efficiency is in relation to the scale that s used in the evaluation of anxiety symptoms. SCARED uses a criterion that enables easy identification of different forms of anxiety disorders such as general anxiety, social phobia and separation anxiety. This instrument can also be used in the measurements of school anxiety to enable easy diagnosis and the development of effective intervention strategies. The process of measuring anxiety symptoms requires an instrument that will measure the level of sensitivity and specificity. This is because different children develop varied types and degrees of disorders due to the differences in their socialization environment (DeSousa et al, 2013).

The essence of SCARED does not only involve its ability to measure anxiety disorder symptoms in terms of their severity and specificity but it is also able to differentiate anxiety patients from those without any symptoms of anxiety. This is often based on the notion that anxious children often reveal higher scores in their rating scores. In the process of determining the scores of anxiety disorders, both the total and subscale scores have been considered to be important (DeSousa et al, 2013). The importance emanates from the understanding that the subscale scores are often used in differentiating participants when assessing patients for definite anxiety disorders. The efficiency of SCRAED also arises from the understanding that it can be used in the delivery of prompt results. For instance children and adolescents suffering from anxiety disorders can complete SCARED within minutes while waiting for the interventions of the doctor. This provides the doctors and other medical practitioners with a platform upon which they can assess the situation of their patients before deciding on the best intervention. SCARED therefore enables clinicians and other medical practitioners to operate and make decisions on the basis of information gathered by the instrument (DeSousa et al, 2013).

The results of this study indicate that the SCARED was more effective in measuring separation anxiety disorder over all the other forms of disorder. In the process of measuring these symptoms one of the outstanding features was that SCARED was more effective in measuring anxiety symptoms in children socialized in the urban set up while less effective in measuring these symptoms in children from the rural setting (DeSousa et al, 2013). This is an indication that SCARD cannot be used as a substitute of a complete diagnostic study done by specialists. Instead it can only be used in validating and improving on the areas that other instruments often neglect in the process of assessing the levels of anxiety among children. Despite this negativity, SCARED has continuously been essential in the measure of sensitive specific anxiety disorders. This is because of its ability to show reasonable value in the prediction of pediatric anxiety disorders (DeSousa et al, 2013). This is an indication that SCARED is a valid and reliable tool in addressing complications related to anxiety disorders. Other than its efficiency in terms of time taken to diagnose an anxiety disorder, SCARED can be used over larger population of children and adolescents. In addition, the instrument is relatively easier to use in terms of the level of sophistication and the financial resources needed to train the medical experts on how to use the device (DeSousa et al, 2013).

The essence of operating with an effective instrument in the measurement of anxiety disorder symptoms among the adolescents and children contributes to the possibility that the medical fraternity together with other stakeholders such as parents contributes to better ways of assessing and detecting anxiety disorders in the patients. This plays a contributory role in the reduction of the morbidity rates that are associated with infrequent and misdiagnosis in their specific population. A decrease in morbidity rates is an indication that there will be prevalence of early recognition of the disorders hence enabling easy intervention by the medical practitioners with the assistance of the parents (DeSousa et al, 2013).

Anxiety sensitivity and disorder

Attention deficit/hypersensitive disorder (ADHD) in the view of Bilgiç et al (2013) is considered as one of the most common neuropsychiatric anxiety disorders among children. This disorder is relatively complicated since it often shares similarities with other forms of disorder such as the oppositional –defiant disorder (ODD) which is largely considered as an externalization disorder. The positive relationship between anxiety and externalization deficiencies may be mediated through numerous processes which include engaging in a process of specifically identifying the contributing factors to the prevalence of the disorders (Bilgiç et al, 2013). It is important to note that most children suffering from ADHD risk the possibility of misdiagnosis due to the existence of externalizing disorders. These disorders often create anxiety –provoking situations in their surroundings. This in some situations results in consecutive comorbidity. Other than the comorbidity, it is also possible for factors such as methodological confounders to fail in identifying the existence of ADHD considering the availability of various associated anxiety disorders which often threaten the possibility of correct disorder diagnosis (Bilgiç et al, 2013).

The association between ADHD and ODD often affect the assessment of the impact of disruptive behavior disorders. This is because of the possibility that such a disruption often has an effect on the techniques through which the process of diagnosis and treatments of can be enabled. The arising inconsistencies in the diagnoses of anxiety disorders can be attributed to frequency in the ways by which related anxiety disorders overlap (Bilgiç et al, 2013). For instance, aspect of behavioral inhibition and social withdrawal are all forms of anxiety disorders that are associated with ADHD and ODD. Behavioral inhibition for instance is the tendency to exhibit fear, restraint and withdrawal in the presence of new stimuli. This presents a plethora of anxiety disorders that relate to the ability of an individual to socialize with a new environment (Bilgiç et al, 2013).

Inasmuch as behavioral inhibition may be used as a restraint factor for children not to engage in deviant behavior, it is also possible to argue that it reduces the ability of a child to be imitative and creative whenever he is confronted with new challenges. The essence of behavior inhibition as factors of social anxiety is that it enhances the development of desirable personality attributes but from an external perspective it may lead to social problems such as depression (Bilgiç et al, 2013). Externalization factors must therefore be considered in the process of diagnosing any form of anxiety disorder to minimize the possibility of misdiagnosis. Social withdrawal is also anxiety disorders that often arise from the realization that a specific behavioral attribute is in disagreement with information gathered from the socialization process. In such a scenario it is possible for the children to associate the environment with societal threats hence the decision to abstain from engaging in such form so behavior (Bilgiç et al, 2013).

Anxiety sensitivity is a social construct that relates to the tendency to develop fear towards the symptoms of anxiety. These include somatic sensations and their inability to interpret impending social and psychological catastrophes. Anxiety sensitivity has been found to be common among children and adolescents who have never experienced any form of panic disorder. Inasmuch as anxiety sensitivity develops on the basis of hereditary traits, its development originates from parental behavior which is independent of the genetic association between parents and their children. This means that anxiety disorder is affected by both genetic and environmental factors (Bilgiç et al, 2013).

An increase in anxiety sensitivity is often a common phenomenon among individuals suffering from different forms of anxiety disorders. This is often in those suffering from panic disorders including major depressive disorders including drug and substance abuse. Anxiety sensitivity play a role in the development of anxiety disorders coupled with other internalization symptoms in children and in adolescents. This is an indication that anxiety sensitivity falls in the category of vulnerability factors which are essential for the development of anxiety disorders in the lives of children and the adolescents (Bilgiç et al, 2013). Inasmuch as the findings of this study have continuously identified anxiety sensitivity as from an etiologic perspective, there are still questions regarding its relationship with other externalization factors. While there is a complex relationship between anxiety disorder and externalization factors, there are studies that have shown that this relationship is often a product of environmental factors which compel the internal fears of an individual to interact with the external environment (Bilgiç et al, 2013).

Behavior of children with conduct disorders (CD) often generates anxiety provoking situations in their surroundings. This is an environment that necessitates the development of anxiety disorders. Inasmuch as the anxiety sensitivity does not provide evidence for the existence of ODD in children suffering from ADHD, it does provide the factors that necessitate the development of different forms of anxiety sensitivity (Bilgiç et al, 2013). There is however need for experts in the field of anxiety disorder to conduct additional studies on the relationship that exists between anxiety and externalization disorders. Such studies will provide a platform of understanding the contributory role of different forms of environmental factors in the development of anxiety disorders. This will minimize the possibility of any form of misunderstanding between externalization and internalization disorders (Bilgiç et al, 2013).



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