Anxiety Disorders

Generalized Anxiety Disorder (GAD)

Excessive anxiety/worry about various events/activities lasting > 6 months. Associated with 3+ symptoms:

• Difficulty concentrating the worry

• Restlessness/feeling on edge

• Fatigue

• Impaired concentration

• Irritability

• Muscle tension

• Insomnia

Panic Disorder

Recurrent, unexpected panic attacks (2+) that may or may not be related to a trigger. At least one of the following must occur for at least 1 month:

• Panic attacks often followed by persistent concern about future attacks

• Persistent worry about the implications of the attacks

• Significant maladaptive behavior related to the attacks

-Symptoms are not due to substance use, medical condition, or other mental disorder

Specific Phobia

> 6 months of persistent, excessive fear elicited by a specific situation or object, which is out of proportion to any actual danger/threat

• Exposure triggers immediate response

• Avoided when possible or tolerated with intense anxiety

• Typicals include animals, situation, natural environment, and blood-injection injury

Agoraphobia

Intense fear/anxiety of 2+ situations due to concerns of difficulty escaping, obtaining help in case of panic, or other embarrassing sx. Most common instances include:

• Outside home alone

• Open spaces (bridges)

• Enclosed spaces (stores)

• Public transportation

• Crowds/lines

-Agoraphobic situations always provoke fear/anxiety that is out of proportion to actual danger posed

-Situations are avoided, require a companion, or endured with fear and anxiety for > 6 months

Social Anxiety Disorder

Fear/anxiety about 1+ social situations in which individual is exposed to possible scrutiny by others, lasting > 6 months

• Fears they will act in a way or show anxiety sx that will be negatively evaluated

• Feel humiliated, embarrassed, rejected

• Social situation always provokes fear or anxiety that is out of proportion to actual threat posed

• Social situations avoided or endured with intense fear/anxiety

Selective Mutism

Consistent failure to speak in select social situations where speaking is expected, like school, despite speaking in other situations lasting > 1 month

• Not attributable to language difficulty or communication disorder

• Interferes with educational/occupational achievement or social communication

• Symptom onset typically during childhood

Separation Anxiety Disorder

Fear/anxiety/avoidance lasting > 4 weeks (children/adolescents) or > 6 months (adults) that causes distress or impairment in important areas of functioning, with 3+ of the following symptoms:

• Excessive distress when anticipating/experiencing separation from attachment figure

• Worry about loss of/harm to attachment figure

• Worry about experiencing event causing separation

• Reluctance/refusal to leave home, attend school or work, or go out due to fear of separation

• Fear of/reluctance about being alone

• Reluctance/refusal to sleep alone/away from home

• Nightmares about separation

• Repeated physical complaints during separation (N/V, HA, stomachache)

Reactive Attachment Disorder

Characterized by a pattern of markedly disturbed and developmentally inappropriate attachment behaviors, in which a child rarely/minimally turns preferentially to an attachment figure for comfort, support, protection, and nurturance. Seen as:

• Inhibited, emotionally withdrawn behavior → child rarely seeks comfort when distressed and rarely responds to comfort when distressed

• Social and emotional disturbance (2+) → minimal social/emotional responsiveness to others, limited positive affect, episodes of unexplained irritability/sadness/fearfulness evident even during nonthreatening interactions with adult caregivers

• Extremes of insufficient care (1+) → social neglect/deprivation via persistent lack of emotional needs for comfort/stimulation/affect met by adult caregivers, repeated changes of primary caregivers, and rearing in unusual settings

Disinhibited Social Engagement Disorder

Pattern of behavior that involves culturally inappropriate, overly familiar behavior with relative strangers, violating social boundaries of culture. Characterized by approaching unfamiliar adults (2+) and extremes of insufficient care (1+):

• Reduced/absent reticence in approaching/interacting with unfamiliar adults

• Overly familiar verbal/physical behavior that is inconsistent with cultural/age-appropriate boundaries

• Diminished/absent checking back with adult caregiver after venturing away, even in unfamiliar settings

• Willingness to go off with unfamiliar adults with minimal to no hesitation

PTSD

The development of multiple symptoms after exposure to 1+ traumatic events with symptoms lasting > 1 month. The following are required:

• Exposure (1+) → directly experienced, witnessed in person, learning trauma occurred to family/friend, repeated/extreme exposure to aversive details of trauma

• Intrusion (1+) → memories, dreams, flashbacks, internal/external cues that results in psychological/physiological distress or reactions

• Avoidance (1+) → memories, thoughts, feelings, external reminders

• Negative alterations in cognition/mood (2+) → memory loss, persistent negative beliefs/expectations of oneself/others/the world, distorted cognitions about cause/consequence of trauma leadings to blaming of self/others, persistent negative emotional state, diminished interest in significant activities, feelings of detachment, inability to experience positive emotions

• Alterations in arousal/reactivity (2+) → irritable/angry outbursts, reckless/self-destructive, hypervigilance, exaggerated startle response, concentration problems, sleep disturbance

Acute Stress Disorder

Diagnosed in patients who experience a major traumatic event and suffer from similar symptoms at PTSD but for a shorter duration. Trauma occurred < 1 month ago, sx last < 1 month. Characterized by the following and 9+ sx from any of the 5 of the categories:

• Exposure (1+) → directly experienced, witnessed in person, learning trauma occurred to family/friend, repeated/extreme exposure to aversive details of trauma

• Intrusion → memories, dreams, flashbacks, psychological distress/physiological reactions

• Negative mood → inability to experience positive emotions

• Dissociative → depersonalization/derealization, memory loss

• Avoidance → memories/thoughts/feelings, external reminders

• Arousal → sleep disturbance, irritable/angry outburst, hypervigilance, concentration problems, exaggerated startle response

Adjustment Disorder

Occur when behavioral or emotional symptoms develop after a non-life threatening, stressful life event that may occur at any age within 3 months of the stressor-onset. Characterized by:

• Marked distress that is out of proportion to the severity or intensity of stressor

• Significant impairment in social, occupational, or other important areas of functioning

• Symptoms resolve in 6 months after stressor or its consequences have terminated