Anxiety Disorders (DSM-5 TR)

Definition of Separation Anxiety Disorder

Developmentally inappropriate and excessive fear of anxiety concerning separation from those to whom the individual is attached.

(The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning)

Diagnostic Criteria for Separation Anxiety Disorder (MUST HAVE AT LEAST 3 OF THE FOLLOWING TO APPLY) (1 of 2)

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.

2. Persistent and excessive worry about losing major attachment figures or about possibly harm to them, such as illness, injury, disasters, or death.

3. Persistent and excessive worry about experiencing an untoward event (getting lost, being kidnapped, having an accident, becoming ill) that causes separation from major attachment figure.

4. Persistent reluctance or refusal to go out, away from home, to school, to work, or else where because of fear of separation.

Diagnostic Criteria for Separation Anxiety Disorder (MUST HAVE AT LEAST 3 OF THE FOLLOWING TO APPLY) (2 of 2)

5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.

6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.

7. Repeated nightmares involving the theme of separation.

8. Repeated complaints of physical symptoms (headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

Time Frame for Separation Anxiety Disorder

Fear, anxiety, or avoidance is persistent, lasting at least 4 WEEKS in children and adolescent and typically 6 MONTHS or more in adults.

Separation Anxiety Disorder is not better explained by another mental disorder such as.....

- Refusing to leave home because of excessive resistance to change in autism spectrum disorder.

- Delusions or hallucinations concerning separation in psychotic disorders

- Refusal to go outside without a trusted companion in agoraphobia

- Worries about ill health or other harm befalling significant others in generalized anxiety disorder

- Concerns about having an illness in illness anxiety disorder.

Risk and Prognostic Factors for Separation Anxiety Disorder

Environmental & Genetic/Physiological.

Environmental - Develops after life stress (especially loss), being bullied during childhood, in adolescence leaving parental home, entering into romantic relationships, becoming a parent, or even parental overprotection and intrusiveness.

Genetic/Physiological - Heritable (73%), aggregate in families.

Definition of Specific Phobia

Marked fear or anxiety about a specific object or situation (ex: flying, heights, animals, receiving an injection, seeing blood).

In children, the fear of anxiety of this phobia can be expressed by crying, tantrums, freezing, or clinging.

Diagnostic Criteria for Specific Phobia (MUST HAVE AT LEAST 1)

1. The phobic object or situation almost always provokes immediate fear or anxiety.

2. The phobic object or situation is actively avoided or endured with an intense fear of anxiety.

3. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.

4. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Time Frame for Specific Phobia

The fear, anxiety, or avoidance is persistent, typically lasting 6 MONTHS OR MORE.

Specific Phobia is not better explained by another mental disorder such as.....

The disturbance of fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia), objects or situations related to obsessions (as in obsessive-compulsive disorder), reminders of traumatic events (as in post-traumatic stress disorder), separation from home or attachment figures (as in separation anxiety disorder), or social situations (as in social anxiety disorder).

Specific Phobia Codes

F40.218 Animal (spiders, insects, dogs)

F40.228 Natural Environment (heights, storms, water)

F40.23x Blood-injection-injury (needles, invasive medical procedures).

F40.248 Situational (airplanes, elevators, enclosed places.

F40.298 Other (situations that may lead to choking or vomiting; in children, for example, loud sounds or costumed characters).

Specific Phobia Risk and Prognostic Factors

Temperamental, Environmental, & Genetic/Physiological.

Temperamental- negative affectivity (neuroticism) or behavioral inhibition.

Environmental- parental overprotectiveness, parental loss or separation, and physical/sexual abuse. Negative or traumatic encounters with feared objects/situations sometimes precede the development of a specific phobia.

Genetic/Physiological- genetic susceptibility.

Definition of Social Anxiety Disorder (F40.10)

Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.

Example: social interactions (having conversation, meeting unfamiliar people), being observed (eating or drinking) and performing in front of others (giving a speech).

Diagnostic Criteria for Social Anxiety Disorder (1 of 2)

1. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (humiliated or embarrassed).

2. The social situations almost always provoke fear or anxiety.

3. The social situations are avoided or endured with intense fear or anxiety.

4. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

Diagnostic Criteria for Social Anxiety Disorder (2 of 2)

5. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

6. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (drug of abuse, medication) or another medical concern.

Time Frame for Social Anxiety

The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

Social Anxiety is not better explained by another mental disorder such as.....

Panic disorder, body dysmorphic disorder, or autism spectrum disorder.

If Parkinson's disease, obesity, disfigurement from burns or injury is present, then the fear is clearly unrelated.

Social Anxiety Code

F40.10

Social Anxiety Risk and Prognostic Factors

Temperamental, environmental, and genetic and physiological.

Temperamental - behavioral inhibition, harm avoidance and fear of negative evaluation.

Environmental - negative social experiences (specifically peer victimization), childhood maltreatment/adversity, ethnic discrimination and racism as well.

Genetic and Physiological - Strongly genetically influenced (subject to gene-environment interaction). Heritable.

Definition of Panic Disorder

Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes.

Diagnostic Criteria for Panic Disorder

Four or more of the following...

- Palpitations

- Sweating

- Trembling

- Shaking

- Sensations of shortness of breath

- Feeling of choking

- Chest pain

- Nausea

- Feeling dizzy

- Chills

- Paresthesias

- Derealization

- Fear of losing control

- Fear of dying

Time Frame for Panic Disorder

One of the following attacks has been followed by 1 month (or more) of one or both of these.

1. Persistent concern or worry about additional panic attacks or their consequences (ex: losing control, having heart attack, etc).

2. Significant maladaptive change in behavior related to the attacks (ex: avoidance of exercise or unfamiliar situations)

Panic Disorder is not better explained by another mental disorder such as.....

Social anxiety, specific phobia, obsessive compulsive disorder, post-traumatic stress disorder, or separation anxiety.

Panic Disorder Code

F41.0

Risks and Prognostic Factors of Panic Disorder

Temperamental, environmental, and genetic and physiological.

Temperamental - neuroticism, anxiety sensitivity, behavioral inhibition, and harm avoidance. Fearful spells (limited symptom attacks that do not meet full criteria for a panic attack).

Environmental - Negative experience with illicit or prescription drugs, disease, or death in the family. Chronic life stress, parental overprotection, and low emotional warmth.

Genetic and Physiological - Increased risk for panic disorder among offspring of parents with anxiety, depressive, and bipolar disorders.

Definition of Agoraphobia

Marked fear or anxiety for 2 or more of the 5 situations...

- Using public transportation

- Being in open spaces

- Being in enclosed places

- Standing in line or being in a crowd

- Being outside of the home alone

Diagnostic Criteria for Agoraphobia

1. The individual fears or avoids these situations because of thoughts that escape might be difficult, or help might not be available when developing panic-like symptoms or other incapacitating or embarrassing symptoms.

2. The agoraphobic situations almost always provoke fear or anxiety.

3. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

4. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.

5. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Time Frame for Agoraphobia

6 months or more.

Agoraphobia is not better explained by another mental disorder such as.....

The symptoms are not confined to specific phobia (situational type), social anxiety disorder, obsessive-compulsive disorder, body dysmorphic disorder, post-traumatic disorder, and separation anxiety disorder.

Risk and Prognostic Factors for Agoraphobia

Temperamental, environmental, and genetic and physiological.

Temperamental - Behavior inhibition, neuroticism, anxiety sensitivity, and trait anxiety.

Environmental - Negative events in childhood (separation, death of parent) and other stressful events (being attacked or mugged) are associated with this. Reduced warmth and increased overprotection were also described.

Genetic and Physiological - Heritability and family history of anxiety disorders.

Definition of Generalized Anxiety Disorder

An individual finds it difficult to control a worry

Time Frame for Generalized Anxiety Disorder

Excessive worry and anxiety occurring more days than not for at-least 6 months...

Diagnostic Criteria for Generalized Anxiety Disorder

Six of these symptoms must occur...

- Restlessness or feeling on edge

- Being easily fatigued

- Difficulty concentrating or mind going blank

- Irritability

- Muscle tension

- Sleep disturbance

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

Generalized Anxiety Disorder is not better explained by another mental disorder such as.....

Obsessive-compulsive disorder, panic disorder, social anxiety, separation anxiety, post-traumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, appearance flaws in body dysmorphic disorder, illness anxiety disorder, schizophrenia, or delusional disorder.

Code for Generalized Anxiety Disorder

F41.1

Risk and Prognostic Factors for Generalized Anxiety Disorder

Temperamental, environmental, genetic and physiological.

Temperamental - behavioral inhibition, neuroticism, harm avoidance, reward dependence, and attentional bias to threat.

Environmental - Childhood adversities and parenting practices (overprotective, overcontrol, reinforcement of avoidance).

Genetic and Physiological - genetic factors that overlap with neuroticism.