Comprehensive Guide to Anxiety Disorders: DSM-5 Criteria for Diagnosis

Separation Anxiety Disorder

Excessive fear or anxiety about separation from home or major attachment figures, beyond what is developmentally expected.

Symptoms of Separation Anxiety Disorder

At least 3 of the following: recurrent excessive distress when separation is anticipated or occurs; persistent worry about losing attachment figures or harm coming to them; persistent worry about an event that could cause separation; reluctance or refusal to leave home or attend school; excessive fear of being alone; reluctance to sleep away from home; repeated nightmares involving separation; repeated physical complaints when separation occurs or is anticipated.

Duration for Separation Anxiety Disorder

The fear, anxiety, or avoidance lasts at least 4 weeks in children and adolescents and typically 6 months or longer in adults.

Impact of Symptoms in Separation Anxiety Disorder

The symptoms cause clinically significant distress or impairment in social, academic, occupational, or other important areas.

Exclusion Criteria for Separation Anxiety Disorder

The symptoms are not better explained by another mental disorder, substance, or medical condition.

Selective Mutism

Consistent failure to speak in specific social situations where speaking is expected, despite speaking in other situations.

Impact of Selective Mutism

The lack of speaking interferes with educational or occupational achievement or with social communication.

Duration for Selective Mutism

The disturbance lasts at least 1 month and is not limited to the first month of school.

Knowledge Requirement for Selective Mutism

The failure to speak is not due to a lack of knowledge of, or discomfort with, the language required in that situation.

Exclusion Criteria for Selective Mutism

The disturbance is not better explained by a communication disorder or does not occur exclusively during autism spectrum disorder, schizophrenia, or another psychotic disorder.

Specific Phobia

Marked fear or anxiety about a specific object or situation, such as animals, heights, storms, needles, flying, or enclosed spaces.

Immediate Reaction in Specific Phobia

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

Avoidance in Specific Phobia

The object or situation is actively avoided, or is endured with intense fear or anxiety.

Disproportionate Fear in Specific Phobia

The fear or anxiety is out of proportion to the actual danger and to the sociocultural context.

Duration for Specific Phobia

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

Impact of Symptoms in Specific Phobia

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

Exclusion Criteria for Specific Phobia

The disturbance is not better explained by another mental disorder.

Social Anxiety Disorder

Marked fear or anxiety about one or more social situations in which the person may be scrutinized by others.

Fear of Negative Evaluation in Social Anxiety Disorder

Fear of acting or appearing in a way that will lead to negative evaluation, embarrassment, rejection, or offending others.

Provocation of Fear in Social Anxiety Disorder

The social situations almost always provoke fear or anxiety.

Avoidance in Social Anxiety Disorder

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

Disproportionate Fear in Social Anxiety Disorder

The fear or anxiety is out of proportion to the actual threat and to the sociocultural context.

Duration for Social Anxiety Disorder

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

Impact of Symptoms in Social Anxiety Disorder

It causes clinically significant distress or impairment in social, academic, occupational, or other important areas.

Exclusion Criteria for Social Anxiety Disorder

It is not attributable to the physiological effects of a substance or another medical condition.

Panic Disorder

Recurrent unexpected panic attacks.

Panic Attack

An abrupt surge of intense fear or discomfort that peaks within minutes and includes at least 4 of specified symptoms.

Symptoms of Panic Attack

Palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; shortness of breath or smothering sensations; feelings of choking; chest pain or discomfort; nausea or abdominal distress; dizziness, unsteadiness, light-headedness, or faintness; chills or heat sensations; numbness or tingling; derealization or depersonalization; fear of losing control or 'going crazy'; fear of dying.

Duration of Panic Attack Symptoms

Following at least one attack, there is at least 1 month of persistent concern about additional panic attacks or significant maladaptive change in behavior.

Exclusions for Panic Attack Diagnosis

The disturbance is not attributable to a substance, medication, or another medical condition.

Panic Disorder Criteria

The attacks must be recurrent and unexpected, along with other Panic Disorder criteria.

Panic Attack Specifier

Applies when there is an abrupt surge of intense fear or discomfort that peaks within minutes and at least 4 of the specified symptoms occur.

Limited-Symptom Attack

If fewer than 4 symptoms occur, it is called a limited-symptom attack, not a full panic attack.

Expected vs Unexpected Panic Attacks

Panic attacks may be expected—with an obvious trigger—or unexpected, occurring without an apparent cue.

Agoraphobia Criteria

Marked fear or anxiety about at least 2 of specified situations, such as using public transportation or being in open spaces.

Avoidance in Agoraphobia

The person fears or avoids situations due to beliefs that escape might be difficult or help might not be available.

Provocation of Fear in Agoraphobia

The situations almost always provoke fear or anxiety.

Duration of Agoraphobia Symptoms

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

Generalized Anxiety Disorder Criteria

Excessive anxiety and worry about various events occurring more days than not for at least 6 months.

Difficulty Controlling Worry

The person finds it difficult to control the worry.

Symptoms of Generalized Anxiety Disorder

Associated with at least 3 of the following: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance.

Distress from Anxiety Symptoms

The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in important areas.

Exclusions for Generalized Anxiety Disorder

The disturbance is not attributable to a substance, medication, or another medical condition.

Mental Disorder Exclusions

The symptoms are not better explained by another mental disorder.

Generalized Anxiety Disorder (GAD)

Involves excessive, difficult-to-control worry across multiple areas of life.

Criteria for GAD Diagnosis

1. Excessive anxiety and worry about multiple events or activities for at least 6 months. 2. Difficulty controlling the worry. 3. Associated with at least 3 of 6 symptoms. 4. Causes clinically significant distress or impairment. 5. Not attributable to a substance or medical condition. 6. Symptoms not better explained by another mental disorder.

Symptoms of GAD

Restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance.

Substance/Medication-Induced Anxiety Disorder

Requires panic attacks or anxiety as predominant features, evidence of symptoms developing during or after substance use, and significant distress or impairment.

Criteria for Substance/Medication-Induced Anxiety Disorder

1. Panic attacks or anxiety are predominant. 2. Symptoms developed during or after substance use. 3. Not better explained by an independent anxiety disorder. 4. Not occurring exclusively during delirium. 5. Causes clinically significant distress or impairment.

Anxiety Disorder Due to Another Medical Condition

Requires panic attacks or anxiety as predominant features and evidence that anxiety is a direct physiological consequence of another medical condition.

Criteria for Anxiety Disorder Due to Another Medical Condition

1. Panic attacks or anxiety are predominant. 2. Evidence of anxiety as a direct consequence of another medical condition. 3. Not better explained by another mental disorder. 4. Not occurring exclusively during delirium. 5. Causes clinically significant distress or impairment.

Other Specified Anxiety Disorder

Used when anxiety symptoms characteristic of an anxiety disorder predominate but do not meet full criteria for any specific anxiety disorder.

Criteria for Other Specified Anxiety Disorder

1. Anxiety symptoms cause clinically significant distress or impairment. 2. Symptoms do not meet full criteria for any specific anxiety disorder. 3. Clinician specifies the reason full criteria are not met.

Examples of Other Specified Anxiety Disorder

Limited-symptom attacks, generalized anxiety occurring less often than 'more days than not', Khyâl cap, Ataque de nervios.

Unspecified Anxiety Disorder

Used when anxiety symptoms characteristic of an anxiety disorder predominate but do not meet full criteria for a specific anxiety disorder.

Criteria for Unspecified Anxiety Disorder

1. Anxiety symptoms cause clinically significant distress or impairment. 2. Symptoms do not meet full criteria for a specific anxiety disorder. 3. Clinician does not specify the reason criteria are not met.

Key Difference: Other Specified vs. Unspecified Anxiety Disorder

Other Specified: clinician knows why full criteria are not met. Unspecified: clinician does not specify the reason or lacks sufficient information.