Issues in Differential Diagnosis: Phobias and Phobic Conditions

Abstract

A high rate of comorbidity between anxiety and depressive disorders has been demonstrated in children and andolescents as well as adults. Rates of depressive disorders in children and adolescents with anxiety disorders range as high as 70%, higher than one would expect by chance. This significant comorbidity has been reported in both community and clinical samples of youth. Comorbidity is associated with a more severe course of psychopathology than anxiety or depressive disorders alone, including more severe depressive symptoms and greater risk for suicidality. For example, Hammen, Brennan, Keenan-Miller, and Herr found that among youth with early onset depression, those with comorbid anxiety disorders were at particular risk for recurrent depression. Similarly, Wittchen and Fehm report that individuals with comorbid social anxiety disorder and depression were more likely to experience additional depressive episodes and less likely to experience a remission in depression than individuals without social anxiety disorder. In this chapter, we present an overview of issues pertinent to the understanding of comorbid anxiety and depression among children and adolescents. Specifically, we will discuss models of conceptutalizing comorbidity and the risk factors, outcomes, and clinical implications of comorbid anxiety and depression.