Anxiety Disorders Flashcards
Separation Anxiety Disorder Diagnostic Criteria
A. Developmentally inappropriate and excessive fear/anxiety concerning separation from those to whom the individual is attached, as evidenced by ≥3 of the following:
1. Recurrent excessive distress when anticipating/experiencing separation from home or major attachement figures
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them (e.g.m illness, injury, disasters, death)
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost or kidnapped, having an accident, becoming ill) that causes separation from the major attachment figure
4. Persistent reulctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation
5. Persistent and excessive fear or reluctance about being alone without major attachment figrues at home or in other settings
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure
7. Repeated nightmares involving the theme of separation
8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs/is anticipated
B. Fear/anxiety/avoidance is persistent, lasting ≥4 weeks in children/teens and ≥6 months in adults
C. Causes clinically significant distress/functional impairment
D. Not better explained by another disorder (e.g., excessive resistance to change in autism; delusions or hallucinations; agoraphobia; GAD; illness anxiety disorder)
Selective Mutism Diagnostic Criteria
A. Consistent failure to speak in specific social situations where there’s an expectation for it (e.g., school), despite speaking in other situations
B. Interferes with educational/occupational achievement or social communication
C. Lasts ≥1 month (i.e., not jsut the first month of school)
D. Not attributable to lack of knowledge of, or comfort with, the spoken language
E. Not better explained by a communication disorder and does not occur exclusively in the context of ASD or psychotic disorders
Specific Phobia Diagnostic Critera
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, injections, blood)
B. The phobic object/situation almost always provokes fear/anxiety
C. The phobic object/situation is actively avoided or endured with intense fear/anxiety
D. Fear/anxiety is disproportionate to actual danger posed and/or to sociocultural context
E. Fear/anxiety/avoidance is persistent, usually lasting ≥6 months
F. Causes clinically significant distress/functional impairment
G. Not better explained by symptoms of another mental disorder (e.g., fear of situations that could induce panic symptoms in agoraphobia/panic disorder; objects/situations relating to obsessions in OCD; reminders of traumatic events in PTSD; separation in separation anxiety disorder; social situations in social anxiety disorder)
Specific Phobia Specifiers
Code based on the phobic situmulus:
* Animal
* Natural environment (e.g., heights, storms, water)
* Blood-injection injury (e.g., needles, invasic procedures)
* Situational (airplains, elevators, enclosed spaces)
* Other (e.g., situations that may lead to choking/vomiting; loud sounds; clowns)
If the fear/anxiety is the result of delusional thinking, specific phobia is not warranted as a diagnosis
Social Anxiety Disorder Diagnostic Criteria
A. Marked fear/anxiety about ≥1 social situations which may expose the individual to scrutiny by others (e.g., social interactions, being observed, performing in front of others; in children, must not occur only in front of adults)
B. Individual fears that they will behave or show anxiety symptoms such that they will be negatively evaluated
C. The social situations almost always provoke fear or anxiety
D. Social situations are avoided or endured with intense fear or anxiety
E. The fear or anxiety is dispropotionate to the actual threat posed and to sociocultural context
F. The fear/anxiety/avoidance is persistent, typically lasting ≥6 months
G. Causes clinically significant distress/functional impairment
H. Not attributable to substances/medication/another medical condition
I. Not better explained by another mental disorder
J. If another medical condition is present, the fear/anxiety/avoidance is clearly unrelated or excessive
Specify if:
* Performance only: If the fear is restricted to public speaking/peforming
Differentiation of Social Anxiety Disorder from normative shyness
- SAD diagnosis is given only if there is a significant impact on important areas of functioning
- Note that only 12% of self-identified shy individuals meet criteria for SAD
Panic Disorder Diagnotic Criteria
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear/discomfort that reaches a peak within minutes, when ≥4 of the following occur:
1. Palpitations, pounding hear, accelerated HR
2. Sweating
3. Trembling/shaking
4. Shortness of breath/smothering sensation
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea/abdominal distress
8. Feeling dizzy, unsteady, lightheaded, faint
9. Chills or heat sensation
10. Paresthesias (numbess/tingling)
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or “going crazy”
13. Fear of dying
B. ≥1 of the attacks has been followed by ≥1 month of one/both of the following:
1. Persistent concern/worry about additional panic attacks and their consequences (e.g., losing control, having a heart attack, going crazy)
2. A significant maladaptive change in behaviour related to the attacks (e.g., behaviours designed to avoid having panic attacks like avoiding exercise or unfamiliar situations)
C.Not attributable to substances/medication/another medical condition
D. Not better explained by another mental disorder
Differentiation of Panic Disorder from other disorders involving panic attacks
- If the panic attacks occur only in response to triggers related to an anxiety disorder (e.g., a phobic stimulus), then it’s not panic disorder
- Panic attacks in panic disorder are always unexpected
Agoraphobia Diagnostic Criteria
A. Marked fear/anxiety about ≥2 of the following 5:
1. Using public transport
2. Being in open spaces
3. Being in enclosed spaces
4. Standling in line or being in a crowd
5. Being outside of the home alone
B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating/embarrassing symtpoms (e.g., fear of falling in older adults; fear of incontinence)
C. Agoraphobic situations almost always provoke fear or anxiety
D. Agoraphobic situations are actively avoided, require a companion, or are endured with intense fear/anxiety
E. Fear/anxiety is disproportionate to actual danger posed by the situation and to sociocultural context
F. Fear/anxiety is persistent, typically lasting ≥6 months
G. Causes clinically significant distress/functional impairment
H. If another medical condition is present, the fear/anxiety/avoidance is clearly excessive.
I. Not better explained by another mental disorder
Agoraphobia is diagnosed irrespective of the presence of panic disorder. If a person’s presentation meets criteria for both, then both diagnoses should be given.
Differentiating Agoraphobia from specific phobia, situational type
- Specific phobia should be diagnosed if fear/anxiety/avoidance is limited to one kind of agoraphobic situation (i.e., if ≥2 situations, it’s likely agoraphobia)
- Specific phobia fears have more to do with being harmed, rather than having panic-like or embarrassing/incapacitating symptoms in front of others
Differentiating Agoraphobia from panic disorder
When criteria for panic disorder are met, agoraphobia should not be diagnosed if the avoidance behaviours associated with the panic attacks to not extent to avoidance of ≥2 agoraphobic situations.
* Avoidance in panic disorder also seems to be motivated by the fear of having a panic attack at all, whereas in agoraphobia it’s motivated by a lack of an escape route or help in the event of a panic attack
Generalized Anxiety Disorder Diagnostic Criteria
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not, for ≥6 months, about a number of events/activities
B. The individual finds it difficult to control the worry.
C. The anxiety/worry are associated with ≥3 of the following 6 (with at least some having been present for more days than not; only 1 is required in children):
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep distubrance
D. Causes clinically significant distress/functional impairment
E. Not due to substances/medication/another medical condition
F. Not better explained by another mental disorder
Substance/Medication-Induced Anxiety Disorder Diagnostic Criteria
A. Panic attacks/anxiety are/is predominant in the clinical picture
B. Evidence from history/examination/lab findings of both:
1. Symptoms developed during or soon after substance/medication use/withdrawal
2. Substance/medication is capable of producing the symptoms
C. Not better explained by another anxiety disorder
D. Does not occur only in the context of delirium
E. Causes clinically significant distress/functional impairment
Specify if:
* With onset during intoxication
* With onset during withdrawal
* With onset after medication use
Examples of Other Specified Anxiety Disorder presentations
- Limited-symptom panic attacks (i.e., don’t meet full panic attack criteria)
- Generalized anxiety occurring less often than “more days than not”
- Khyal cap (wind attacks): Syndrome found among Camobdian individuals; similar to panic attack, characterized by catastrophic cognitions that a wind substance (khyal) will rise out of the body and cause physical harm
- Attaque de nervios (attack of nerves): Syndrome found among Spanish-speaking Caribbean individuals; similar to panic attack, characterized by uncontrolled bouts of screaming/crying, trembling, sensations of heat rising in the head, physical aggression.
