Anxiety Disorders

Specific Phobia – Criterion A (Nature of Fear)

• Marked fear or anxiety about a specific object or situation

  • e.g., flying, heights, animals, injections, seeing blood

• In children: may show crying, tantrums, freezing, or clinging

Specific Phobia – Criterion B (Immediate Reaction)

• The phobic object or situation almost always provokes immediate fear or anxiety

Specific Phobia – Criterion C (Avoidance)

• The phobic object or situation is:

  • Actively avoided, or

  • Endured with intense fear or anxiety

Specific Phobia – Criterion D (Disproportion)

• The fear or anxiety is out of proportion to:

  • The actual danger posed by the object/situation

  • The sociocultural context

Specific Phobia – Criterion E (Duration)

• The fear, anxiety, or avoidance is persistent

• Typically lasts 6 months or more

Social Anxiety Disorder – Criterion A (Feared Situations)

• Marked fear or anxiety about one or more social situations with possible scrutiny by others

• Examples: conversations, meeting unfamiliar people, being watched while eating/drinking, performing (speeches)

• Children: must occur in peer settings, not just with adults

Social Anxiety Disorder – Criterion B (Fear of Negative Evaluation)

• Person fears they will:

  • Act in a way or show anxiety symptoms

  • That will be negatively evaluated (humiliating, embarrassing)

  • Lead to rejection or offending others

Social Anxiety Disorder – Criterion C (Immediate Reaction)

• Social situations almost always trigger fear or anxiety

• Children may show: crying, tantrums, freezing, clinging, shrinking, or not speaking in social situations

Social Anxiety Disorder – Criterion D (Avoidance)

• Social situations are either:

  • Avoided, or

  • Endured with intense fear or anxiety

Social Anxiety Disorder – Criterion E (Disproportion)

• Fear/anxiety is out of proportion to:

  • The actual threat of the situation

  • The sociocultural context

Social Anxiety Disorder – Criterion F (Duration)

• Fear, anxiety, or avoidance is persistent

• Typically lasts ≥ 6 months

Panic Disorder – Criterion A (Panic Attacks)

• Recurrent, unexpected panic attacks

• A panic attack = abrupt surge of intense fear or discomfort

  • Reaches a peak within minutes

  • Occurs from a calm or anxious state

• During the attack, ≥ 4 of:

  1. Palpitations / pounding heart / ↑ heart rate

  2. Sweating

  3. Trembling or shaking

  4. Shortness of breath/smothering

  5. Feelings of choking

  6. Chest pain or discomfort

  7. Nausea or abdominal distress

  8. Dizziness, unsteady, light-headed, or faint

  9. Chills or heat sensations

  10. Paresthesias (numbness or tingling)

  11. Derealization or depersonalization

  12. Fear of losing control or “going crazy”

  13. Fear of dying

• Culture-specific symptoms may occur, but do not count toward the 4 required

Panic Disorder – Criterion B (Aftermath of Attacks)

• At least one attack is followed by ≥ 1 month of one or both:

  1. Persistent concern or worry about:

     • Additional panic attacks, or

     • Their consequences (e.g., losing control, heart attack, “going crazy”)

  2. Significant maladaptive behavior change related to the attacks, e.g.:

     • Avoiding exercise, exertion, or unfamiliar situations

     • Other behaviors aimed at avoiding panic attacks

Panic Attack Specifier – Definition & Symptoms

• Not a disorder itself; used as a specifier (e.g., “PTSD with panic attacks”)

• Can occur in: any anxiety disorder, other mental disorders (e.g., depressive disorders, PTSD, substance use), and some medical conditions

• For panic disorder, panic attacks are part of the core criteria (not a separate specifier)

Definition:

• Abrupt surge of intense fear or intense discomfort

• Reaches a peak within minutes

• Occurs from a calm or anxious state

• During the attack, ≥ 4 of:

  1. Palpitations / pounding heart / ↑ heart rate

  2. Sweating

  3. Trembling or shaking

  4. Shortness of breath/smothering

  5. Feelings of choking

  6. Chest pain or discomfort

  7. Nausea or abdominal distress

  8. Dizziness, unsteady, light-headed, or faint

  9. Chills or heat sensations

  10. Paresthesias (numbness or tingling)

  11. Derealization or depersonalization

  12. Fear of losing control or “going crazy.”

  13. Fear of dying

• Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming/crying) may occur, but do not count toward the 4 required symptoms

Agoraphobia – Criterion A (Feared Situations)

• Marked fear or anxiety about ≥ 2 of:

  1. Using public transportation (cars, buses, trains, ships, planes)

  2. Being in open spaces (parking lots, marketplaces, bridges)

  3. Being in enclosed places (shops, theaters, cinemas)

  4. Standing in line or being in a crowd

  5. Being outside the home alone

Agoraphobia – Criterion B (Reason for Fear)

• Fears or avoids these situations because of thoughts that:

  • Escape might be difficult, or

  • Help might not be available if:

    • Panic-like symptoms develop, or

    • Other incapacitating/embarrassing symptoms occur

      • e.g., fear of falling (elderly), fear of incontinence

Agoraphobia – Criterion C (Immediate Reaction)

• The agoraphobic situations almost always provoke fear or anxiety

Agoraphobia – Criterion D (Avoidance/Endurance)

• Agoraphobic situations are:

  • Actively avoided, or

  • Require the presence of a companion, or

  • Are endured with intense fear or anxiety

Agoraphobia – Criterion E (Disproportion)

• Fear or anxiety is out of proportion to:

  • The actual danger of the situation

  • The sociocultural context

Agoraphobia – Criterion F (Duration)

• Fear, anxiety, or avoidance is persistent

• Typically lasts 6 months or more

Generalized Anxiety Disorder – Criterion A (Excessive Worry)

• Excessive anxiety and worry (apprehensive expectation)

• Occurs more days than not for ≥ 6 months

• About a number of events/activities (e.g., work, school performance)

Generalized Anxiety Disorder – Criterion B (Control of Worry)

• The individual finds it difficult to control the worry

Generalized Anxiety Disorder – Criterion C (Associated Symptoms)

• Anxiety and worry are associated with ≥ 3 of 6 symptoms

  • (≥ 1 symptom required in children)

• Present more days than not for the past 6 months:

  1. Restlessness or feeling keyed up/on edge

  2. Being easily fatigued

  3. Difficulty concentrating or mind going blank

  4. Irritability

  5. Muscle tension

  6. Sleep disturbance (difficulty falling/staying asleep, or restless, unsatisfying sleep)

HiTOP – Anxiety Disorders vs GAD (Internalizing Subfactors)

• In HiTOP, anxiety disorders fall under the Internalizing spectrum.

• Most anxiety disorders (e.g., specific phobia, social anxiety disorder, panic disorder, agoraphobia) load mainly on:

  • Internalizing → Fear subfactor

  • Characterized by: phobic avoidance, panic, and sharp/situational fear.

• Generalized Anxiety Disorder (GAD) loads more strongly on:

  • Internalizing → Distress subfactor

  • Characterized by: chronic worry, tension, negative affect, and overlap with depression.

• So:

  • Classic anxiety disorders → Internalizing–Fear

  • GAD → Internalizing–Distress