Anxiety Disorders: Diagnostic Criteria

Diagnosis of an Anxiety Disorder

• DSM-IV Diagnoses and Criteria
  • Syndromes: not disorders, but "building blocks for disorders" (like the "episodes" in mood disorders)
    • Panic Attacks
      • not a disorder, but a building block for other disorders
        • multiple symptoms (4 or more:)
          • palpitations, pounding heart or increased heart rate
          • sweating
          • trembling or shaking
          • shortness of breath, smothering
          • choking sensation
          • chest pain
          • nausea
          • dizziness
          • derealization (feelings of unreality) or depersonalization
          • feeling of losing control/going crazy
          • fear of dying
          • paresthesias
          • chills
        • starts abruptly, peaks in about 10 minutes
    • Agoraphobia
      • fear and avoidance of places/situations where one cannot escape.
        • usually, the fear is that one might have a panic attack and be without help.
  • The Disorders
    • Panic Disorder, with and without Agoraphobia
      • recurrent Panic Attacks
      • anticipatory anxiety around the attack
      • "Global Criteria".
      • Can be with or without Agoraphobia.
    • Agoraphobia without History of Panic Disorder\
      • Agoraphobia
      • No panic disorder
      • Not due to a medical/substance disorder
    • Specific Phobia
      • excessive fear of an object/situation
      • avoidance of the object/situation or endurance with intense anxiety.
      • "Global Criteria"
      • Specific Types
        • Animal Type
        • Natural Environment Type (heights, storms, water)
        • Blood-Injection-Injury Type
        • Situational Type
        • Other.
    • Social Phobia
      • Excessive fear of a social situation
        • usually a fear of humiliation
      • Has to meet "Global Criteria" (not just normal shyness)
      • Typical: talking, eating, going to bathroom in public.
        • can be generalized to most social situations.
      • Differs From agoraphobia
        • fear is of humiliation, in agoraphobia it is fear of being in a situation where you might be without help or escape.
    • Obsessive-Compulsive Disorder (OCD)
      • either or both:
        • obsessions
          • intrusive thoughts, usually recognized as such.
        • compulsions
          • repetitive behaviors
          • help to reduce anxiety (ex. washing hands to reduce fear of contamination).
      • Good insight
        • differentiates from a delusion
      • "Global Criteria".
    • Posttraumatic Stress Disorder (PTSD)
      • 3 components:
        • a traumatic situation occurred
        • the trauma is reexperienced
          • can range from recollections to nightmares or flashbacks
        • Avoidance behavior, or numbing of general responsiveness
        • Persistent symptoms of increased arousal
      • Social/occupational dysfunction.
      • Can be acute (< 3 months) or chronic.
        • requires more than 1 month of symptoms
    • Acute Stress Disorder
      • Like PTSD, but less than 1 month.
    • Generalized Anxiety Disorder (GAD)
      • This is the disorder for people who are chronically anxious.
      • Excessive worry, more days than nights, for at least 6 months.
      • Associated with at least 3 of these symptoms:
        • restlessness
        • fatigueability
        • difficulty concentrating
        • irritability
        • muscle tension
        • insomnia
      • Anxiety Disorder Due to a General Medical Condition, and Substance-Induced Anxiety Disorder
        • can demonstrate as generalized anxiety, panic attacks or OCD symptoms.
          • or phobic symptoms in the case of substances