Anxiety Disorders

What is the core feature shared by anxiety disorders?

Excessive fear and anxiety and related behavioral disturbances.

Difference between fear and anxiety?

Fear = emotional response to real or perceived imminent threat
Anxiety = anticipation of future threat

What reduces fear/anxiety in many anxiety disorders?

Pervasive avoidance behaviors.

Are panic attacks limited to anxiety disorders?

No. They can occur in other mental disorders.

How are anxiety disorders differentiated from each other?

• Type of feared object/situation

• Associated cognitions (content of fear)

How do anxiety disorders differ from developmentally normative fear?

They are excessive or persist beyond developmentally appropriate periods.

Typical duration requirement for most anxiety disorders?

6 months or more (shorter in some childhood disorders like separation anxiety & selective mutism).

Gender prevalence pattern in anxiety disorders?

More frequent in girls than boys (~2:1)

Core feature of Separation Anxiety Disorder (SepAD)?

Developmentally inappropriate and excessive fear/anxiety about separation from attachment figures.

Minimum number of symptoms required for SepAD?

At least 3.

Duration requirement for SepAD?

• 4 weeks in children/adolescents

• 6+ months in adults

Key symptom themes of SepAD?

• Distress with separation

• Worry about harm/loss

• Refusal to go out/sleep alone

• Nightmares about separation

• Physical complaints when separation anticipated

Important differential diagnoses for SepAD?

ASD, psychotic disorders, agoraphobia, GAD, illness anxiety disorder.

Core feature of Selective Mutism (SM)?

Consistent failure to speak in specific social situations despite speaking in others.

Duration requirement of SM?

At least 1 month (not limited to first month of school).

Must rule out what for SM?

• Lack of language knowledge

• Communication disorder

• Autism spectrum disorder

• Psychotic disorders

Core feature of Specific Phobia (SP)?

Marked fear/anxiety about a specific object or situation.

What happens when exposed to the phobic stimulus for someone with SP?

Immediate fear/anxiety.

Duration requirement for SP?

6+ months.

Types of Specific Phobias?

• Animal

• Natural environment

• Blood-injection-injury

• Situational

• Other

Key differentiation of SP from other anxiety disorders?

Fear is circumscribed to a specific object/situation (not social evaluation, panic recurrence, etc.).

Core fear in Social Anxiety Disorder (SAD)?

Negative evaluation (embarrassment, humiliation, rejection, offending others).

Social situations include?

• Conversations

• Meeting unfamiliar people

• Being observed (eating/drinking)

• Performing in front of others

Duration requirement of SAD?

6+ months.

Specifier for SAD?

Performance only (restricted to public speaking/performing).

Core feature of Panic Disorder (PD)?

Recurrent unexpected panic attacks + 1 month of worry or maladaptive behavior change.

Definition of panic attack?

Abrupt surge of intense fear/discomfort peaking within minutes with ≥4 symptoms.

Examples of panic attack symptoms?

Palpitations, Sweating, Trembling, Shortness of breath, Feelings of choking, Chest pain, Nausea, Dizziness, Chills/Heat sensations, Paresthesias, Derealization/Depersonalization, Fear of losing control, Fear of dying

What is Paresthesias?

Numbness or tingling sensations

Expected vs unexpected panic attacks?

• Expected = trigger present

• Unexpected = no apparent trigger

What must follow at least one panic attack for diagnosis?

1 month of:

• Persistent worry OR

• Maladaptive behavior change

Agoraphobia (AG) diagnostic requirement: fear of how many situations?

Two or more.

The five agoraphobic situations?

• Public transportation

• Open spaces

• Enclosed spaces

• Crowds/lines

• Outside of home alone

Core cognition in Agoraphobia?

Escape might be difficult or help unavailable if panic-like symptoms occur.

AG duration requirement?

6+ months.

Can agoraphobia be diagnosed without panic disorder?

Yes. Diagnose both if criteria for both are met.

Core feature of Generalized Anxiety Disorder (GAD)?

Excessive anxiety and worry about multiple domains.

GAD duration requirement?

More days than not for 6+ months.

GAD control feature?

Individual finds it difficult to control the worry.

Number of required associated GAD symptoms (adults)?

3+

The 6 GAD symptoms?

• Restlessness/on edge

• Easily fatigued

• Difficulty concentrating

• Irritability

• Muscle tension

• Sleep disturbance

Number of required associated GAD symptoms (children)?

1+

Core feature of substance/medication-induced anxiety disorder (SI-AD)

Anxiety or panic due to intoxication, withdrawal, or medication.

What must be established in SI-AD?

• Temporal relationship between symptoms and substance exposure/withdrawal

• Substance capable of causing symptoms

How to rule out independent anxiety disorder over SI-AD?

• Symptoms precede substance use

• Persist ~1 month after cessation

• History of non-substance episodes

Core feature of anxiety disorder due to another medical condition (AD-Med)?

Anxiety is direct physiological consequence of medical condition.

Coding requirement for AD-Med?

Medical condition listed first, then anxiety disorder due to medical condition.

When is “Other Specified Anxiety Disorder” used?

Criteria not fully met but clinician specifies reason.

Examples of Other Specified anxiety disorders?

• Limited-symptom attacks

• GAD occurring less often than “more days than not”

• Cultural syndromes (e.g., khyâl cap, ataque de nervios)

When is “Unspecified Anxiety Disorder” used?

Criteria not fully met and clinician does NOT specify reason

Do anxiety disorders increase suicide risk?

Yes, individuals with anxiety have higher risk of suicidal thoughts, attempts, and death.

Anxiety disorders most associated with transition from suicidal ideation to attempt?

• Panic disorder

• Generalized anxiety disorder

• Specific phobia