MoodDisorder 13

Anxiety Disorder Defined

Anxiety disorders are a group of mental health conditions characterized by significant anxiety and fear that can interfere with daily life. They are categorized into various types, each with unique features and criteria for diagnosis.

Types of Anxiety Disorders

• Generalized Anxiety Disorder (GAD)

• Social Anxiety Disorder

• Specific Phobia

• Panic Disorder (with and without agoraphobia)

• Obsessive-Compulsive Disorder (OCD)

• Posttraumatic Stress Disorder (PTSD)

• Anxiety Secondary to Medical Condition

• Acute Stress Disorder (ASD)

• Substance-Induced Anxiety Disorder

DSM V Criteria for Generalized Anxiety Disorder (GAD)

A. Diagnostic Criteria

A diagnosis of GAD requires:

1. Excessive anxiety and worry occurring more days than not for at least 6 months about various events or activities (e.g., work, school).

2. Difficulty in controlling this worry.

3. At least three of the following six symptoms present more days than not for the past six months:

   • Restlessness or feeling keyed up.

   • Being easily fatigued.

   • Difficulty concentrating or mind going blank.

   • Irritability.

   • Muscle tension.

   • Sleep disturbance.

4. Clinically significant distress or impairment in social, occupational, or other important areas of functioning.

5. Disturbance not attributable to a substance or medical condition.

6. Disturbance not better explained by another medical disorder.

Comorbidity

Up to 60% of individuals with GAD have a comorbid condition, with panic disorder and major depressive disorder being the most common. Panic disorder can also be comorbid with alcohol abuse, leading to an increased risk of suicide. Agoraphobia is commonly associated with panic disorder, reaching comorbidity rates of approximately 40%.

DSM V Criteria for Panic Attack

Definition

A panic attack is characterized by a sudden and intense period of fear or discomfort, peaking within 10 minutes, which includes at least four of the following symptoms:

• Palpitations or accelerated heart rate

• Sweating

• Trembling or shaking

• Shortness of breath or smothering sensations

• Feeling of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Dizziness or feeling faint

• Derealization or depersonalization sensations

• Fear of losing control or dying

• Paresthesias (numbness or tingling)

• Chills or hot flushes

DSM IV-TR Criteria for Panic Disorder

Key Features

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1. Recurrent unexpected panic attacks.

2. At least one attack followed by one month of one or more of the following:

   • Persistent concern about additional attacks.

   • Worry about the implications or consequences of the attacks.

   • Significant behavioral changes related to the attacks.

3. Panic attacks are not due to substance effects or general medical conditions.

4. Not better accounted for by another mental disorder.

DSM V Criteria for Agoraphobia

Diagnostic Criteria

All the following features must be present for a diagnosis:

1. Marked fear in at least two situations (open spaces, public transport, crowded areas).

2. Immediate anxiety response, potentially a panic attack.

3. Recognition of the fear as disproportionate.

4. Avoidance behaviors or significant distress that disrupts normal life.

5. Symptoms lasting at least six months.

6. No underlying conditions that explain the symptoms.

DSM V Criteria for Posttraumatic Stress Disorder (PTSD)

Criterion A: Exposure

Exposure to one or more traumatic events involving death, injury, or sexual violation in different ways, such as directly experiencing, witnessing, or learning about it affecting a close friend or family member.

Criterion B: Intrusive Symptoms

At least one intrusive symptom such as distressing memories, dreams, or dissociative reactions (flashbacks).

Criterion C: Avoidance

Frequent avoidance of reminders associated with the traumatic event.

Criterion D: Negative Changes

At least two negative changes in thoughts and mood following the event (e.g., inability to remember an aspect of the event, persistent negative evaluations).

Criterion E: Changes in Arousal

At least two changes in arousal, such as hypervigilance or sleep disturbances.

Criteria F-H

Symptoms last for more than one month and cause significant distress or impairment, not attributable to other medical conditions or substance use.

DSM V Criteria for Acute Stress Disorder

Criterion A: Exposure

Experience of actual or threatened death, serious injury, or sexual violation in various ways.

Criterion B: Symptoms

Presence of nine or more symptoms from categories such as intrusion, negative mood, dissociation, avoidance, and arousal, beginning following the traumatic event.

Criterion C: Duration

Symptoms lasting from 3 days to 1 month after trauma exposure.

Criterion D: Distress

The disturbance causes clinically significant distress or impairment in functioning.

Criterion E: Not Attributable

Symptoms not due to substance effects or other medical conditions.

DSM V Criteria for Obsessive-Compulsive Disorder (OCD)

A. Presence of Obsessions or Compulsions

Obsessions are recurrent, intrusive thoughts leading to significant anxiety, while compulsions are repetitive behaviors performed to alleviate this anxiety.

1. Obsessions must be intrusive and unwanted, causing distress.

2. Compulsions are actions aimed at reducing anxiety, but are often excessive or unrealistic.

B. Impact

Obsessions or compulsions must be time-consuming or cause significant distress or impairment.

C. Differentiation

Symptoms must not be attributed to substance effects or another medical condition.

D. Distinction from Other Disorders

Disturbance is not better explained by symptoms of another mental disorder.

DSM V Criteria for Specific Phobia

Categories of Specific Phobia

1. Natural: e.g., thunder (astraphobia), water (aquaphobia).

2. Mutilation: e.g., dentist (dentophobia), injections (trypanophobia).

3. Animal: e.g., dogs (cynophobia), snakes (ophidiophobia).

4. Situational: e.g., enclosed spaces (claustrophobia).

DSM-5 Criteria for Specific Phobia Diagnosis

1. Unreasonable: Intense fear triggered by a specific object or situation.

2. Immediate Response: Fear reaction is out of proportion to actual danger.

3. Recognition: Adults do not need to recognize irrational fears for diagnosis.

4. Avoidance: The individual avoids the object/situation or endures it with distress.

5. Life-Limiting: Significantly impacts work, school, or personal life.

6. Duration: Symptoms lasting at least six months.

7. Exclusion: Symptoms must not be caused by another disorder.

DSM V Criteria for Social Anxiety Disorder

Key Features

1. Marked fear in social situations where scrutiny is possible.

2. Fear that one may act in a way that leads to humiliation or rejection.

3. Exposure to feared situations leads to anxiety or panic attacks.

4. The reaction is out of proportion to actual threat.

5. Significant avoidance or distress impacting normal functioning.

6. Duration of at least six months.

7. Exclusion of symptoms from substance effects or other mental disorders.

Anxiety Disorder Defined: Anxiety disorders are mental health conditions characterized by significant anxiety and fear that interfere with daily life. They include various types: GAD, Social Anxiety Disorder, Specific Phobia, Panic Disorder, OCD, PTSD, Acute Stress Disorder, Substance-Induced Anxiety, and Anxiety Secondary to Medical Conditions.

DSM V Criteria Overview:

• Generalized Anxiety Disorder (GAD): Excessive worry for 6 months, with at least 3 symptoms including restlessness, fatigue, and sleep disturbances. Comorbidity with panic disorder and depression is common.

• Panic Attack: Intense fear peaking within 10 minutes, with at least 4 symptoms like palpitations, sweating, and dizziness.

• Panic Disorder: Recurring panic attacks followed by concerns or behavioral changes.

• Agoraphobia: Fear in at least 2 situations, avoidance behaviors, lasting 6 months or more.

• PTSD: Exposure to trauma, with intrusive symptoms, avoidance, and negative mood changes lasting over a month.

• Acute Stress Disorder: Symptoms after trauma lasting 3 days to a month.

• OCD: Obsessions causing anxiety and compulsions aimed at reducing it, affecting daily life.

• Specific Phobia: Intense fear of specific objects or situations lasting at least 6 months, leading to avoidance.

• Social Anxiety Disorder: Fear of social situations leading to possible scrutiny, with avoidance affecting functioning for 6 months.