DSM-5 Criteria for Diagnosing Anxiety Disorders

NUR 484, Mental Health Nursing, Mrs. Bryant

what is the body’s physical and emotional reaction to challenges or threats that disrupt a person’s balance or well-being?

stress

what is a feeling of worry, nervousness, or fear about something with an uncertain outcome. It can range from mild unease to intense distress.

anxiety

what is a group of mental health conditions where a person experiences excessive, persistent worry, fear, or nervousness that interferes with daily life and activities?

anxiety disorders

what are some diagnostic tools?

• GAD-2

• GAD-7

what is adjustment disorder?

a stress-related condition caused by identifiable life stressors

what is adjustment disorder characterized by?

emotional or behavioral symptoms

_____ _____ is development of emotional or behavioral symptoms in response to an identifiable stressor

adjustment disorder

what are some examples of stressors?

• job loss

• divorce

• relocation

symptoms must develop within _____ months of the onset of the stressor and resolve within _____ months after the stressor

3; 6

what are some symptoms of adjustment disorder?

• sadness

• tearfulness

• feelings of hopelessness

• anxiety

• nervousness

• difficulty functioning in daily life (like in social, occupational, or other important areas of functioning)

_____ is the first-line treatment for managing adjustment disorder

psychotherapy

how else can adjustment disorder be managed?

• stress management techniques

• medications for symptom relief if necessary

A 35-year-old patient presents to the clinic with symptoms of insomnia, difficulty concentrating, and feelings of sadness after going through a divorce six weeks ago. The patient reports that these symptoms are interfering with their work performance but denies suicidal ideation or previous mental health issues. Which characteristic is essential for diagnosing Adjustment Disorder in this patient?

  A. Symptoms are a reaction to an identifiable stressor and occur within 3 months of the event.
  B. Symptoms persist for at least 12 months after the stressor has resolved.
  C. Symptoms meet the criteria for Major Depressive Disorder.
  D. Symptoms are unrelated to a specific external stressor.

A

what is a common anxiety disorder characterized by persistent and excessive worry/anxiety about multiple events or activities?

generalized anxiety disorder (GAD)

GAD affects daily functioning and quality of life. GAD is diagnosed using criteria outlined in the _____

DSM-5

excessive anxiety and worry (apprehensive expectation) about multiple events or activities have to occur more days than not for at least _____ months

6

DSM-5 Criteria

*Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

*The individual finds it difficult to control the worry.

*The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.

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)

•Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

•Examples: difficulty maintaining work performance or personal relationships.

•The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

A 42-year-old patient presents with excessive worry about their job, finances, and family, which they describe as uncontrollable. The patient reports experiencing restlessness, fatigue, muscle tension, and difficulty sleeping for the past seven months. Which statement by the nurse demonstrates an accurate understanding of Generalized Anxiety Disorder (GAD)?

A. "Your symptoms must last for at least one year to meet the criteria for GAD."
B. "GAD is diagnosed when excessive worry and associated symptoms persist for at least six months."
C. "GAD is characterized by recurrent panic attacks in addition to excessive worry."
D. "A specific trigger or traumatic event must be identified to diagnose GAD."

B

what is a type of anxiety disorder characterized by recurrent, unexpected panic attacks?

panic disorder

panic disorder is often accompanied by fear of _____ _____ and changes in _____ to avoid them

future attacks; behavior

panic disorder is using criteria outlined in the _____

DSM-5

a _____ _____ is an abrupt surge of intense fear or discomfort that reaches a peak within minutes

panic attack

a panic attack Includes _____ or more of the following symptoms:

•Palpitations, pounding heart, or accelerated heart rate.

•Sweating.

•Trembling or shaking.

•Sensations of shortness of breath or smothering.

•Feelings of choking.

•Chest pain or discomfort.

•Nausea or abdominal distress.

•Feeling dizzy, unsteady, lightheaded, or faint.

•Chills or heat sensations.

•Paresthesia (numbness or tingling sensations).

•Derealization (feelings of unreality) or depersonalization (being detached from oneself).

•Fear of losing control or ".going crazy."

•Fear of dying

4

at least _____ month of one or both of the following after a panic attack

• persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack)

• significant maladaptive changes in behavior related to the attacks (e.g. avoidance of situations)

1

panic disorder differs from GAD by worrying is more generalized, not episodic panic

panic disorders differ from specific phobias because the panic occurs only in response to a specific trigger

panic disorder differs from PTSD because the panic is linked to trauma reminders

A patient experiencing a panic attack presents with chest tightness, hyperventilation, and feelings of impending doom. Which nursing intervention should the nurse implement first?

  A. Encourage the patient to discuss the underlying cause of their anxiety.
  B. Provide a calm and quiet environment to reduce external stimuli.
  C. Demonstrate deep breathing techniques to help slow the patient’s breathing.
  D. Administer prescribed anti-anxiety medication immediately.

C

what involves intense fear of social situations due to the risk of embarrassment or negative evaluation?

social anxiety disorder (social phobia)

*affects daily functioning and quality of life

•Marked fear or anxiety about one or more social situations where the person is exposed to possible scrutiny (e.g., conversations, being observed, performing).

•

•Fear of acting in a way or showing symptoms that will be negatively judged (embarrassment, rejection).

•Social situations almost always trigger fear or anxiety.

•These situations are avoided or endured with intense fear/anxiety.

•Fear is out of proportion to the actual threat and context.

•

•Fear, anxiety, or avoidance lasts 6 months or more.

•Causes clinically significant distress or impairment in functioning.

•Not due to a substance, medical condition, or another mental disorder.

•If a medical condition is present, the fear is clearly unrelated or excessive.

*Performance only: Fear is limited to public speaking or performing.

•Social situations are:

•Avoided entirely, or

•Endured with intense fear or anxiety.

•Disproportionate Fear

•The anxiety experienced is excessive relative to the actual threat.

social anxiety disorder impacts life by providing significant distress or impairment in social life and occupational performance

what is the treatment options for social anxiety disorder?

• desensitization - re-exposure therapy

• therapy to learn new coping techniques

• medications - antianxiety, antidepressants, beta-blockers (Propranolol/Inderal), benzodiazepines

A patient with social anxiety disorder is starting desensitization therapy. During the session, the nurse notices the patient expressing fear about giving a presentation in a small group. What is the most appropriate nursing action to support the patient in this stage of therapy?

  A. Encourage the patient to immediately practice presenting to a large audience.
  B. Suggest the patient avoid situations that provoke anxiety until they feel fully prepared.
  C. Gradually expose the patient to anxiety-provoking situations, starting with smaller challenges.
  D. Discuss the patient’s fear and delay further therapy until they feel less anxious.

C

what is a mental health condition characterized by persistent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions)?

OCD

*these symptoms significantly interfere with daily life

the DSM-5 provides detailed criteria to diagnose OCD, focusing on _____, _____, and their impact

obsessions, compulsions

what are obsessions?

•Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and typically cause anxiety or distress.

•The individual tries to ignore or suppress these thoughts, urges, or images, or to neutralize them with another thought or action (i.e., performing a compulsion).

what are compulsions?

•Repetitive behaviors (e.g., handwashing, checking) or mental acts (e.g., counting, praying) that the person feels driven to perform in response to an obsession or according to rigid rules.

•These behaviors or mental acts are aimed at reducing anxiety or preventing a feared event, but they are not realistically connected to the outcome or are clearly excessive.

obsessions or compulsions are _____-_____

time-consuming

obsessions and compulsions cause significant distress or impairment in _____, _____, or other important areas of functioning

social, occupational

what is good or fair insight?

The person recognizes that their obsessive-compulsive beliefs are definitely or probably not true.

what is poor insight?

The person thinks their obsessive-compulsive beliefs are probably true.

what is absent insight/delusional beliefs?

The person is completely convinced that their obsessive-compulsive beliefs are true, despite evidence to the contrary.

what is psychotherapy?

Cognitive Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP).

what are some medications to manage OCD?

•Selective Serotonin Reuptake Inhibitors (SSRIs)

•Combination therapy for severe cases.

A patient with obsessive-compulsive disorder (OCD) explains, "I have to check the locks on my doors ten times every night before I can go to bed." The nurse understands that the primary reason for the patient’s compulsive behavior is:

  A. To gain control over intrusive thoughts and reduce anxiety.
  B. To ensure the patient’s safety by preventing harm.
  C. To follow personal habits developed over time.
  D. To avoid punishment from others for incomplete tasks.

A

what are anxiety disorders?

• persistent and excessive fear or worry

• interference with daily functioning

what are the types of anxiety disorders?

•Generalized Anxiety Disorder (GAD)

•Social Anxiety Disorder (SAD)

•Panic Disorder, etc.

what are the goals of treatment for anxiety disorders?

• reduce symptoms

• improve quality of life

• enhance daily functioning

what is cognitive behavioral therapy (CBT)?

•Identify and challenge negative thoughts

•Gradual exposure to feared situations (Exposure Therapy)

what is acceptance and commitment therapy (ACT)?

•Embrace anxiety rather than avoid it

•Align actions with personal values

what is dialectical behavior therapy (DBT)?

•Combine mindfulness and emotional regulation

what are selective serotonin reuptake inhibitors (SSRIs)?

first-line treatment (e.g. sertraline, fluoxetine)

what are serotonin-norepinephrine reuptake inhibitors (SNRIs, e.g. venlafaxine, duloxetine) effective for?

GAD

what are benzodiazepines used for?

short-term relief for acute anxiety

what are beta-blockers (Propanolol (Inderal) used to control?

physical symptoms in situational anxiety/performance anxiety

what is buspirone specifically used for?

GAD

regular _____ reduces anxiety symptoms

exercise

what are some mindfulness and relaxation techniques?

meditation, deep breathing, progressive muscle relaxation

what does sleep hygiene mean?

consistent sleep schedule and calming bedtime routine

what are some dietary changes one can make to manage anxiety?

limit caffeine and alcohol, eat balanced meals

what are some supportive interventions?

•Support Groups:

•Share experiences and strategies with peers

•Education:

•Understanding anxiety to empower patients

•Gradual Exposure:

•Reintroduce feared or avoided activities

what are some complementary approaches?

•Yoga:

•Combines physical and mental relaxation

•Acupuncture:

•May help reduce stress and tension

•Aromatherapy:

•Essential oils like lavender for relaxation

A 32-year-old patient with generalized anxiety disorder (GAD) is prescribed a medication for long-term management of their anxiety symptoms. The nurse understands that the first-line pharmacological treatment for this condition typically involves which of the following?

  A) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
  B) Benzodiazepines
  C) Selective Serotonin Reuptake Inhibitors (SSRIs)
  D) Beta-Blockers

C

A 28-year-old patient with generalized anxiety disorder (GAD) is seeking treatment options. The nurse explains that cognitive-behavioral therapy (CBT) is one of the most effective forms of psychotherapy for managing anxiety disorders. Which of the following best describes the goal of CBT in treating anxiety?

  A) To provide a space for the patient to express their feelings without judgment.
  B) To help the patient confront and change irrational thoughts and behaviors contributing to anxiety.
  C) To help the patient recall and process past traumatic events that trigger anxiety.
  D) To create a supportive environment where the patient can explore unconscious conflicts.

B