Book contents
- Seminars in Child and Adolescent Psychiatry
- College Seminars Series
- Seminars in Child and Adolescent Psychiatry
- Copyright page
- Contents
- Contributors
- Abbreviations
- Chapter 1 Children’s Mental Health Services in Context
- Chapter 2 Normal Childhood Development: Theories and Influence
- Chapter 3 Risk Factors for Childhood Psychopathology
- Chapter 4 Infant Mental Health
- Chapter 5 Classification and Epidemiology
- Chapter 6 Law in Relation to Children and Young People
- Chapter 7 What Does a Good Assessment in Children and Adolescents Look Like?
- Chapter 8 Neurodevelopmental Disorders in Children and Young People
- Chapter 9 Intellectual Disabilities in Children and Young People
- Chapter 10 Antisocial Behaviours in Young People
- Chapter 11 Attachment, Anxiety Disorders and Experience of Trauma in Children and Adolescents
- Chapter 12 Self-Harm and Suicide in Young People
- Chapter 13 Mood Disorders in Young People
- Chapter 14 Psychosis in Children and Adolescents
- Chapter 15 Substance Misuse in Young People
- Chapter 16 Evolving Perspectives on Eating Disorders: From Diagnosis to Digital Therapies
- Chapter 17 Benefits and Risks of the Digital World
- Chapter 18 Bodily Distress Disorder and Dissociative Disorders
- Chapter 19 Psychosocial Approaches in CAMHS
- Chapter 20 Gender Diversity and Mental Health in Young People
- Chapter 21 Mental Health Prevention in Services for Children
- Chapter 22 Moving from Models of Liaison Psychiatry to Psychological Medicine: New Approaches
- Chapter 23 Forensic Mental Health Services for Young People
- Index
- References
Chapter 11 - Attachment, Anxiety Disorders and Experience of Trauma in Children and Adolescents
Published online by Cambridge University Press: 10 October 2025
Edited by
Book contents
- Seminars in Child and Adolescent Psychiatry
- College Seminars Series
- Seminars in Child and Adolescent Psychiatry
- Copyright page
- Contents
- Contributors
- Abbreviations
- Chapter 1 Children’s Mental Health Services in Context
- Chapter 2 Normal Childhood Development: Theories and Influence
- Chapter 3 Risk Factors for Childhood Psychopathology
- Chapter 4 Infant Mental Health
- Chapter 5 Classification and Epidemiology
- Chapter 6 Law in Relation to Children and Young People
- Chapter 7 What Does a Good Assessment in Children and Adolescents Look Like?
- Chapter 8 Neurodevelopmental Disorders in Children and Young People
- Chapter 9 Intellectual Disabilities in Children and Young People
- Chapter 10 Antisocial Behaviours in Young People
- Chapter 11 Attachment, Anxiety Disorders and Experience of Trauma in Children and Adolescents
- Chapter 12 Self-Harm and Suicide in Young People
- Chapter 13 Mood Disorders in Young People
- Chapter 14 Psychosis in Children and Adolescents
- Chapter 15 Substance Misuse in Young People
- Chapter 16 Evolving Perspectives on Eating Disorders: From Diagnosis to Digital Therapies
- Chapter 17 Benefits and Risks of the Digital World
- Chapter 18 Bodily Distress Disorder and Dissociative Disorders
- Chapter 19 Psychosocial Approaches in CAMHS
- Chapter 20 Gender Diversity and Mental Health in Young People
- Chapter 21 Mental Health Prevention in Services for Children
- Chapter 22 Moving from Models of Liaison Psychiatry to Psychological Medicine: New Approaches
- Chapter 23 Forensic Mental Health Services for Young People
- Index
- References
Summary
This chapter reviews a broad spectrum in Child and Adolescent Mental Health; that of the anxiety disorders. The chapter briefly introduces the concept of attachment and touches on how attachment disorders, and attachment styles evolve. It focuses in on PTSD and C-PTSD, with a particular spotlight on C-PTSD as a new diagnostic concept, and considers its importance in understanding presentations of trauma and emotional dysregulation in children and young people. The chapter also investigates the epidemiology and course of anxiety disorders; and considers the differentiating features of the different presentations. We finish with an overview of interventions, including the rise of computerised approaches in treating the anxiety disorders in young people.
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- Seminars in Child and Adolescent Psychiatry , pp. 161 - 175Publisher: Cambridge University PressPrint publication year: 2025
References
World Health Organisation. The ICD-11 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organisation, 2022.Google Scholar
Mikulincer, M, Shaver, PR. An Attachment Perspective on Psychopathology. World Psychiatry. 2012;11(1):11–15.CrossRefGoogle ScholarPubMed
Cassidy, J, Kobak, RR. Avoidance and Its Rrelation to Other Defensive Processes. In Belsky, J & Nezworski, T, Clinical implications of attachment. Lawrence Erlbaum Associates, 1988.Google Scholar
Colonnesi, C, Draijer, EM, Stams, GJ, Van der Bruggen, CO, Bogels, SM, Noon, MJ. The Relationships Between Insecure Attachment and Child Anxiety. J Clin Child Adolesc Psychol. 2011;40(4):630–45.CrossRefGoogle Scholar
Spruit, A, Goos, L, Weenink, N, et al. Attachment and Depression in Children and Adolescents: A Multi-level Meta-analysis. Clin Child Fam Psychol Rev. 2020;23(1):54–69.CrossRefGoogle Scholar
Jardin, C, Venta, A, Newlin, E, Ibarra, S, Sharp, C. Secure Attachment Moderates the Relation of Sexual Trauma with Trauma Symptoms Among Adolescents from an Inpatient Psychiatric Facility. J Interpers Violence. 2017;32:1565–85.CrossRefGoogle ScholarPubMed
Ensink, K, Fonagy, P, Normandin, L, Rozenberg, A, Marquez, C, Godbout, N. Post-traumatic Stress Disorder in Sexually Abused Children: Secure Attachment as a Protective Factor. Front Psychol. 2021;12:1–10.CrossRefGoogle ScholarPubMed
NICE. Post-Traumatic Stress Disorder. NICE, 2018. Available from: https://www.nice.org.uk/guidance/NG116 (accessed 6 April 2025).Google Scholar
Nooner, KB, Linares, O, Batinjane, J, Kramer, RA, Silva, R, Cloitre, M. Factors Related to Posttraumatic Stress Disorder in Adolescence. TVA. 2012;13(3):153–66.Google ScholarPubMed
Lewis, SJ, Arseneault, L, Caspi, A, et al. The Epidemiology of Trauma and Post-traumatic Stress Disorder in a Representative Cohort of Young People in England and Wales. Lancet Psychiatry. 2019;6:247–56.CrossRefGoogle Scholar
Copeland, WE, Keeler, G, Angold, A, Costello, J. Traumatic Events and Posttraumatic Stress in Childhood. Arch Gen Psychiatry. 2007;64:577–84.CrossRefGoogle ScholarPubMed
Alisic, E, Zalta, AK, van Welsel, F, et al. Rates of Post-traumatic Stress Disorder in Trauma-Exposed Children and Adolescents: Meta-analysis. Br J Psychiatry. 2018;204(5):335–40.Google Scholar
Herman, J. Complex PTSD: A Syndrome in Survivors of Prolonged and Repeated Trauma. J Trauma Stress. 1992;5(3):377–91.CrossRefGoogle Scholar
Courtois, CA. Complex Trauma, Complex Reactions: Assessment and Treatment. Psychol Psychotherapy. 2004;41(4):412–25.Google Scholar
Cloitre, M, Galvert, DW, Weiss, B, Carlson, EB, Bryant, RA. Distinguishing PTSD, Complex PTSD and Borderline Personality Disorder: A Latent Class Analysis. Eur J Psychotraumatol. 2014;5:1–10.CrossRefGoogle ScholarPubMed
Sweeney, A, Filson, B, Kennedy, A, Collinson, L, Gillard, S. A Paradigm Shift: Relationships in Trauma-Informed Mental Health Services. BJPsych Advances. 2018;24(5):319–33.CrossRefGoogle ScholarPubMed
Woolgar, F, Garfield, H, Dalgleish, T, Meiser-Stedman, R. Systematic Review and Meta Analysis: Prevalence of Posttraumatic Stress Disorder in Trauma-Exposed Preschool-Aged Children. J Am Acad Child Adolesc Psychiatry. 2022;61(3):366–77.CrossRefGoogle ScholarPubMed
Felding, SU, Mikkelsen, LB, Bach, B. Complex PTSD and Personality Disorder in ICD-11: When to Assign One or Two Diagnoses? Australas Psychiatry. 2021;29(6):590–94.CrossRefGoogle ScholarPubMed
Brewin, CR, Cloitre, M, Hyland, P, et al. A Review of Current Evidence Regarding the ICD-11 Proposals for Diagnosing PTSD and Complex PTSD. Clin Psychol Rev. 2017;58:1–15.CrossRefGoogle ScholarPubMed
Vasey, MW, Dadds, M. The Developmental Psychopathology of Anxiety. Oxford University Press, 2001.CrossRefGoogle Scholar
Muris, P, Meesters, C, Merckelbach, H, Hulsenbeck, P. Worry in Children Is Related to Perceived Parental Rearing and Attachment. Behav Res Ther. 2000;38:487–97.CrossRefGoogle ScholarPubMed
Rutter, M. Research Review: Child Psychiatric Diagnosis and Classification: Concepts, Findings, Challenges and Potential. J Child Psychol Psychiatry. 2011;52(6):647–60.CrossRefGoogle ScholarPubMed
Costello, EJ, Egger, HL, Copeland, WE, Erkanli, A, Angold, A. The Developmental Epidemiology of Anxiety Disorders: Phenomenology, Prevalence, and Comorbidity. In Silverman, WK & Field, AP (eds.), Anxiety Disorders in Children and Adolescents. 2nd ed. Cambridge University Press: 2011, 56–75.CrossRefGoogle Scholar
Alonso, J, Angermeyer, MC, Bernert, S, et al. Prevalence of Mental Disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Acta Psychiatr Scand Suppl. 2004;109:21–27.CrossRefGoogle Scholar
Gallagher, SB. Epidemiology of Childhood Anxiety: Longitudinal Perspectives. DClinPsy thesis. School of Psychology, University of Leeds, 2011.Google Scholar
Costello, EJ, Mustillo, S, Erkanli, A, Keeler, G, Angold, A. Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence. Arch. Gen. Psychiatry. 2003;60:837–44.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.CrossRefGoogle ScholarPubMed
Aschenbrand, SG, Kendall, PC, Webb, A, Safford, SM, Flannery-Schroeder, E. Is Childhood Separation Anxiety Disorder a Predictor of Adult Panic Disorder and Agoraphobia? A Seven-Year Longitudinal Study. J Am Acad. Child Adolesc Psychiatry. 2003;42(12):1478–85.CrossRefGoogle ScholarPubMed
Last, CG, Perrin, S, Hersen, M, Kazdin, AE. A Prospective Study of Childhood Anxiety Disorders. J Am Acad Child Adolesc Psychiatry. 1996;35:1502–10.CrossRefGoogle ScholarPubMed
Mian, ND, Wainwright, L, Briggs-Gowan, MJ, Carter, AS. An Ecological Risk Model for Early Childhood Anxiety: The Importance of Early Child Symptoms and Temperament. J Abnorm Child Psychol. 2011;39(4):501–12.CrossRefGoogle ScholarPubMed
Mesman, J, Bongers, IL, Koot, HM. Preschool Developmental Pathways to Preadolescent Internalizing and Externalizing Problems. J Child Psychol Psychiatry. 2001;42(5):679–89.CrossRefGoogle ScholarPubMed
Cantwell, DP, Baker, L. Stability and Natural History of DSM-III Childhood Diagnoses. J Am Acad Child Adolesc Psychiatry. 1989;28(5):691–700.CrossRefGoogle ScholarPubMed
Foley, DL, Pickles, A, Maes, HM, Silberg, JL, Eaves, LJ. Course and Short-Term Outcomes of Separation Anxiety Disorder in a Community Sample of Twins. J Am Acad Child Adolesc Psychiatry. 2004;43(9):1107–14.CrossRefGoogle Scholar
Carballo, JJ, Baca-Garcia, E, Blanco, C, et al. Stability of Childhood Anxiety Disorders Diagnoses: A Follow Up Naturalistic Study in Psychiatric Care. Eur Child Adolesc Psychiatry. 2010;19:395–403.CrossRefGoogle ScholarPubMed
Beesdo-Baum, K, Hoffler, M, Gloster, AT, et al. The Structure of Common Mental Disorders: A Replication Study in a Community Sample of Adolescents and Young Adults. Int J Methods Psychiatr Res. 2009;18(4):204–20.CrossRefGoogle Scholar
NICE. Social Anxiety Disorder: Recognition, Assessment and Treatment. NICE, 2013. Available from: https://www.nice.org.uk/guidance/cg159 (accessed 6 April 2025).Google Scholar
NICE. Obsessive-Compulsive Disorder and Body Dysmorphic Disorder: Treatment. NICE, 2005. Available from: https://www.nice.org.uk/Guidance/CG31 (accessed 6 April 2025).Google Scholar
Bisson, JI, Berliner, L, Cloitre, M, et al. The International Society for Traumatic Stress Studies New Guidelines for the Prevention and Treatment of Post-Traumatic Stress Disorder: Methodology and Development Process. J Trauma Stress. 2019;32:475–83.CrossRefGoogle ScholarPubMed
Ruf, M, Schauer, M, Neuner, F, Catani, C, Schauer, E, Elbert, TE. Narrative Exposure Therapy for 7-to-16-Year-Olds: A Randomized Controlled Trial with Traumatized Refugee Children. J Trauma Stress. 2010;23(4):437–45.CrossRefGoogle ScholarPubMed
Hitchcock, C, Goodall, B, Wright, I, Boyle, A, Johnston, D, Dunning, D. The Early Course and Treatment of Post-traumatic Stress Disorder in Very Young Children: Diagnostic Prevalence and Predictors in Hospital Attending Children and a Randomized Proof of Concept Trial of Trauma Focused Cognitive Therapy, for 3- to 8-Year-Olds. J Child Psychol Psychiatry. 2022;63(1):58–67.CrossRefGoogle Scholar
de Jongh, A, Resick, PA, Zoellner, LA, et al. Critical Analysis of the Current Treatment Guidelines for Complex PTSD in Adults. Depress Anxiety. 2016;33:359–69.CrossRefGoogle ScholarPubMed
Sachser, C, Keller, F, Goldbeck, L. Complex PTSD as Proposed for ICD-11: Validation of a New Disorder in Children and Adolescents and Their Response to Trauma-Focused Cognitive Behavioural Therapy. J Child Psychol Psychiatry. 2017;58(2):160–68.CrossRefGoogle Scholar
Cervin, M, Lundgren, T. Technology-Delivered Cognitive-Behavioral-Therapy for Pediatric Anxiety Disorders: A Meta-analysis of Remission, Posttreatment Anxiety, and Functioning. J Child Psychol Psychiatry. 2022;63(1):7–18.CrossRefGoogle ScholarPubMed
Nordh, M, Vigerland, S, Ost, LG, et al. Therapist-Guided Internet-Delivered Cognitive-Behavioural Therapy Supplemented with Group Exposure Sessions for Adolescents with Social Anxiety: A Feasibility Trial. BMJ Open. 2017:7(12):1–11.CrossRefGoogle ScholarPubMed
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