46 Generalized Anxiety Disorder

Name: Piglet
Source: The World of Pooh by A.A. Milne (books, 1954)

Background Information

Piglet is a young male pig and Winnie the Pooh’s friend. Since he is portrayed as a baby, he is probably in the age range of 0-3 years old. Piglet does not have a job and his family history is unknown. He does not have any physical health problems but he displays characteristics of anxiety and nervousness. He stutters quite a bit and he is fearful of wind and darkness. Piglet also does not like bees or woozles (which are creatures that Piglet has not yet seen). Piglet lives in the Hundred Acre Wood with Pooh and all of the other Winnie The Pooh characters. He lives in a house in a large beech tree with a sign outside that says “Tresspassers W” which to Piglet means his Grandfather lived there and his name was “Tresspassers William”. Piglet’s goals are to become brave, not so timid, and to catch a heffalump (a creature that resembles an elephant).

Description of the Problem

Piglet is a very timid piglet. He shows characteristics of anxiety and he stutters. He thinks of how any situation can go wrong and he argues with himself about what he should do if a situation does go wrong. For example, while trying to catch a heffalump, Piglet thinks to himself how he can fake a headache so he will not have to face one of these creatures, in case it is fierce. Then he thinks to himself that if he fakes a headache he will be stuck in bed all morning, so he does not know what to do. These are the types of scenarios that make him anxious. He has thoughts that he creates that jump from one bad scenario to another. Piglet also shakes and blushes. His ears twitch when he is scared or nervous, which is often. He is usually very flustered.

Diagnosis

The diagnosis that would best fit Piglet is Generalized Anxiety Disorder (300.02).

1. In children, to be diagnosed with Generalized Anxiety Disorder, only one of these symptoms must be present:

(1)Restlessness or feeling keyed up or on edge
(2) Being easily fatigued
(3) Difficulty concentrating or mind going blank
(4) Irritability
(5) Muscle tension
(6) Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
Piglet definitely shows signs of restlessness or feeling keyed up or on edge. He also has difficulty concentrating (his thoughts jump from one bad scenario to another).

1. Excessive anxiety and worry (apprehensive expectation), occurring more days for at least six months about a number of events or activities (such as work or school performance).

Piglet has had anxiety problems his whole life as far as we know from the books. He definitely has probably had anxiety problems for more than six months.

1. The person finds it difficult to control their worry.

Piglet cannot control his worry which is why he struggles with trying to be brave. He manages to live with his worry and anxiety but the thoughts are still there and he voices his worry to his friends.

1. An unrealistic fear or worry, especially in new or unfamiliar situations.

Piglet is afraid of the dark and wind. He has an unrealistic fear of heffalumps and woozles.

1. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during post-traumatic stress disorder.

Piglet anxiety and worry are not due to any of the above features.

1. The anxiety, worry, and physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Piglet’s anxiety and worry does cause him clinically significant distress because he is always worrying about or is afraid of something. He shows distress from his anxiety.

1. The disturbance is not due to the direct psychological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder.

Piglet does not use drugs, nor does he suffer from any physical medical conditions and he does not have any of the above disorders.

Accuracy of Portrayal

The average person reading The World of Pooh by A.A. Milne would be exposed to an accurate portrayal of generalized anxiety disorder in Piglet. Piglet trembles, twitches, and is shaky. Piglet also has exaggerated startle responses to things that scare him. He also shows symptoms of autonomic hyperarousal, like rapid heart rate and shortness of breath. When Piglet is in stressful conditions his anxiety levels tend to elevate and worsen. This is typical of young people with generalized anxiety disorder. Children with this disorder may also show signs of being unsure of themselves. The book accurately portrays generalized anxiety disorder in Piglet.

Treatment

In treating Piglet, one would try to avoid medicines since he is a child and some of the side effects of certain medications can be suicidal thoughts in children.Starting out treating Piglet with cognitive behavioral therapy (CBT) would be optimal. CBT could help Piglet recognize his negative thoughts and try to change his thoughts to more positive thoughts that are more realistic. It would also help Piglet with relaxation techniques such as breathing exercises that could help him learn to relax better in stressful situations that cause anxiety for him. After participating in the behavioral therapy and learning relaxation techniques Piglet could better handle and manage his own anxiety. This could lead to a much happier, comfortable, and positive life. His quality of life would be better after the treatment.