Anxiety Disorders

Question 1

This classification of disorders involves a disproportionate fear response and maladaptive behaviors to avoid the cause with symptoms generally lasting more than 6 months.

Answer 1

Anxiety Disorders

Question 2

Anxiety Disorders

The essential feature of this disorder is developmentally inappropriate, excessive, and persistent fear or anxiety concerning separation from attachment figures or home with at least 3 of the following: recurrent excessive distress when anticipating or experiencing separation; persistent and excessive worry about losing attachment figures or possible harm to them; persistent and excessive worry about an untoward event that causes separation; persistent reluctance or refusal to go out because of fear of separation; persistent and excessive fear of or reluctance about being alone; persistent reluctance or refusal to sleep away from home or go to sleep w/o attachment figure; repeated nightmares involving the theme of separation; repeated complaints of physical symptoms when separation occurs or is anticipated. The fear, anxiety, or avoidance is persistent, 4 weeks in children or adolescents and 6 months in adults.

Answer 2

Separation Anxiety Disorder

Question 3

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

This disorder features excessive worry or fear about many different events or activities, whereas fear of separation is predominate in separation anxiety disorder.

Answer 3

Generalized Anxiety Disorder

Question 4

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

While the fear of separation may cause a panic attack, this disorder is marked by unexpected panic attacks accompanied by fears of future panic attacks resulting in maladaptive changes in behavior.

Answer 4

Panic Disorder

Question 5

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

This disorder involves the avoidance of places and situations that provoke disproportionate fear or anxiety, and the possibility of panic symptoms may prevent escape or that help may not be accessible.

Answer 5

Agoraphobia

Question 6

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

In this disorder, the child or adolescent may avoid school and home but not because of anxiety.

Answer 6

Conduct Disorder

Question 7

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

In this disorder, places and situations w/o attachment figures are avoided due to fear of being judged negatively.

Answer 7

Social Anxiety Disorder

Question 8

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

This disorder may involve fear of separation from loved ones, but the central symptoms concern intrusions about, and avoidance of memories associated with an event that caused separation.

Answer 8

Posttraumatic Stress Disorder (F43.10)

Question 9

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

This disorder involves worry about specific medical illnesses for the individual, not for their loved ones as in separation anxiety disorder.

Answer 9

Illness Anxiety Disorder (F45.21)

Question 10

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

The reluctance to leave home may be associated with these 2 disorder categories, but it is due to lack of motivation or desire to engage with the outside world.

Answer 10

Depressive and Bipolar Disorders

Note: Individuals with separation anxiety disorder may become depressed during separation or in anticipation of separation.

Question 11

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

Children or adolescents may express opposition at being separated from attachment figures, but this disorder involves persistent defiance in contexts other than separation.

Answer 11

Oppositional Defiant Disorder

Question 12

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

This disorder involves intense longing, sorrow, and preoccupation over the loss of a loved one rather than the possibility of separation.

Answer 12

Prolonged Grief Disorder

Question 13

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

While unusual perceptual experiences may temporarily occur in separation anxiety disorder, they are a persistent key feature in these disorders.

Answer 13

Psychotic Disorders

Question 14

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

This disorder is characterized by an indiscriminate tendency to rely on others, not just attachment figures.

Answer 14

Dependent Personality Disorder

Question 15

Anxiety Disorders

Separation Anxiety Disorder Differential Diagnosis

Individuals with this disorder fear abandonment by others and struggle with identity, self-direction, interpersonal functioning, and impulsivity.

Answer 15

Borderline Personality Disorder

Question 16

Anxiety Disorders

In children, separation anxiety is highly comorbid with these 2 anxiety disorders:

Answer 16

1. Generalized Anxiety Disorder
2. Specific Phobia

Question 17

Anxiety Disorders

In adults, disorders commonly comorbid with separation anxiety generally fall in these 4 disorder classifications:

Answer 17

1. Anxiety Disorders
2. Depressive Disorders
3. Bipolar Disorders
4. Personality Disorders (specifically Cluster C)

Question 18

Anxiety Disorders

Reticence to speak, not due to ability, in situations where speaking is expected, interfering with functioning; duration at least 1 month.

Answer 18

Selective Mutism

Question 19

Anxiety Disorders

Selective Mutism Differential Diagnosis

If an immigrant child is in the process of learning a new language, there is typically a short period of time when they do not speak known as a:

Answer 19

“silent period.”

If not speaking in both languages persists over time in several settings, a diagnosis of selective mutism may be warranted.

Question 20

Anxiety Disorders

Selective Mutism Differential Diagnosis

When the speech disturbance is not restricted to specific social situations, and the capacity to speak is in question, these general disorders regarding speech should be considered.

Answer 20

Communication Disorders

Question 21

Anxiety Disorders

Individuals may have difficulty in social communication or speak inappropriately in social situations when these 3 types of disorders are present:

Answer 21

1. Neurodevelopmental Disorders (Autism Spectrum Disorder, Intellectual Developmental Disorder)
2. Schizophrenia
3. Other Psychotic Disorders

Question 22

Anxiety Disorders

Selective Mutism is most commonly comorbid with this class of disorders:

Answer 22

Anxiety Disorders

Question 23

Anxiety Disorders

This disorder elicits an almost immediate, disproportionate fear response to specific objects or situations which the individual actively avoids or tolerates with excessive anxiety. Symptoms persist for more than 6 months.

Answer 23

Specific Phobia

Question 24

Anxiety Disorders

Specific Phobia diagnostic codes are based on the phobic stimulus and all codes that apply should be used. List the 5 types of Specific Phobias:

Answer 24

Animal
Natural Environment
Blood-injection-injury
Situational
Other

Question 25

# Anxiety Disorders Social situations are avoided or endured with great anxiety for fear of negative evaluation, fear of behaving in ways deemed inappropriate, or fear of presentation scrutiny. Symptoms persist for at least 6 months.

Answer 25

Social Anxiety Disorder (SAD)

Question 26

# Anxiety Disorders What is the specifier associated with Social Anxiety Disorder?

Answer 26

Performance only: if the fear is restricted to speaking or performing in public.

Question 27

# Anxiety Disorders SAD Differential Diagnosis Social Anxiety Disorder is often comorbid with, but should also be differentiated from disorders in this general classification:

Answer 27

Anxiety Disorders

Question 28

# Anxiety Disorders SAD Differential Diagnosis Concern about being negatively evaluated because they feel they are not worthy of being liked may be symptomatic of this disorder which is often comorbid with SAD:

Answer 28

Major Depressive Disorder

Question 29

# Anxiety Disorders SAD Differential Diagnosis Preoccupation with perceived defects or flaws in physical appearance may cause anxiety and avoidance of social situations but is the key characteristic of this disorder.

Answer 29

Body Dysmorphic Disorder

Question 30

# Anxiety Disorders SAD Differential Diagnosis An individual may fear social rejection or offending others but lack insight regarding the actual threat posed by the social situation to the extent that they believe the threat is real. They may be suffering from this disorder.

Answer 30

Delusional Disorder

Question 31

# Anxiety Disorders SAD Differential Diagnosis An individual may have social anxiety and social communication deficits along with inadequate age-appropriate social relationships and diminished social communication capacity if they have this disorder.

Answer 31

Autism Spectrum Disorder

Question 32

# Anxiety Disorders SAD Differential Diagnosis This personality disorder is more comorbid with social anxiety disorder than any other anxiety disorder. Individuals have a broader avoidance pattern, higher rates of impairment, a strong and pervasively negative self-concept, see rejection as a global evaluation of the self as being of little worth, and since childhood have not felt like they fit in.

Answer 32

Avoidant Personality Disorder (F60.6)

Question 33

# Anxiety Disorders An abrupt surge, from a calm state or an anxious state, of intense fear or intense discomfort that reaches a peak within minutes and during which time at least 4 symptoms are present. This is not a disorder but can be a specifier for many disorders or medical conditions.

Answer 33

Panic Attack Specifier

Question 34

# Anxiety Disorders There are 13 symptoms listed for a panic attack in DSM-5-TR. Name as many as you can.

Answer 34

1. Palpitations, pounding heart, accelerated heart rate. 2. Sweating. 3. Trembling or shaking. 4. Sensations of shortness of breath or smothering. 5. Feelings of choking. 6. Chest pain or discomfort. 7. Nausea or abdominal distress. 8. Feeling dizzy, unsteady, light-headed, or faint. 9. Chills or heat sensations. 10. Paresthesias (numbness or tingling). 11. Derealization or depersonalization. 12. Fear of losing control or “going crazy.” 13. Fear of dying.

Question 35

# Anxiety Disorders Recurrent unexpected panic attacks; at least 1 attack followed by 1 month of persistent concern or worry about additional attacks and/or significant maladaptive change in behavior related to panic attacks.

Answer 35

Panic Disorder

Question 36

# Anxiety Disorders Panic Disorder Differential Diagnosis Panic attacks judged to be a direct physiological consequence of another medical condition, of which there are many to be determined by appropriate medical professionals and exams.

Answer 36

Anxiety Disorder due to Another Medical Condition

Question 37

# Anxiety Disorders Panic Disorder Differential Diagnosis Panic attack is judged to be a direct physiological consequence of a substance. Intoxication with central nervous system stimulants or cannabis and withdrawal from central nervous system depressants can precipitate a panic attack.

Answer 37

Substance/Medication-Induced Anxiety Disorder

Question 38

# Anxiety Disorders Panic Disorder Differential Diagnosis Panic attacks as a symptom of other anxiety disorders are expected and thus do not meet the criteria for Panic Disorder. Panic attacks occur expectedly to specific triggers.

Answer 38

Other Mental Disorders with Panic Attacks as an associated feature

Question 39

# Anxiety Disorders Significant anxiety of at least 2 scenarios: using public transportation, being in open spaces, being in enclosed spaces, being in a crowd, being alone outside one’s home. Scenarios are avoided for fear of being trapped, experiencing panic, or not being able to get help. Scenarios almost always elicit distress and anxiety, require the individual to be accompanied, or are endured while experiencing intense fear. Symptoms persist for at least 6 months.

Answer 39

Agoraphobia

Question 40

# Anxiety Disorders Agoraphobia Differential Diagnosis If the fear and anxiety is limited to one type of scenario and does not involve fear of panic symptoms this disorder may be better suited.

Answer 40

Specific Phobia, situational type. (F40.248)

Question 41

# Anxiety Disorders Agoraphobia Differential Diagnosis If the focus is on fear of detachment from significant others or the home environment and not a fear of panic symptoms or other incapacitating symptoms in a scenario, this disorder may be better suited.

Answer 41

Separation Anxiety Disorder

Question 42

# Anxiety Disorders Agoraphobia Differential Diagnosis The focus of the fear is negative evaluation rather than panic symptoms in social situations.

Answer 42

Social Anxiety Disorder

Question 43

# Anxiety Disorders Agoraphobia Differential Diagnosis When criteria for this disorder are met, agoraphobia should not be diagnosed if the avoidance behaviors associated with panic attacks do not extend to avoidance of 2 or more agoraphobic situations.

Answer 43

Panic Disorder

Question 44

# Anxiety Disorders Agoraphobia Differential Diagnosis If the fear, anxiety, or avoidance is restricted to trauma reminders and avoidance behavior does not extend to 2 or more agoraphobic situations, then one of these 2 disorders may be more appropriate.

Answer 44

Acute Stress Disorder Posttraumatic Stress Disorder

Question 45

# Anxiety Disorders Agoraphobia Differential Diagnosis Individuals may avoid leaving home due to apathy, loss of energy, low self-esteem, and anhedonia rather than fear of panic symptoms if this diagnosis is given.

Answer 45

Major Depressive Disorder

Question 46

# Anxiety Disorders True or False: Whereas other anxiety disorders or PTSD frequently precede the onset of agoraphobia, depressive disorders and substance use disorders typically occur secondary to agoraphobia.

Answer 46

True About 90% of individuals with agoraphobia also have other mental disorders.

Question 47

# Anxiety Disorders Inordinate worry, occurring more days than not, about a variety of scenarios; difficulty not worrying; at least 3 symptoms (1 lasting more than 6 months): agitation, tiredness, difficulty focusing, irritability, muscular tension, difficulty sleeping.

Answer 47

General Anxiety Disorder (GAD)

Question 48

# Anxiety Disorders GAD Differential Diagnosis GAD can be differentiated from other anxiety disorders by the generalized nature of the worry over many situations. What criteria distinguish GAD from Social Anxiety Disorder? What criteria distinguish GAD from Separation Anxiety disorder?

Answer 48

Social Anxiety Disorder: fear of negative evaluation in social situations versus worry regardless of evaluation. Separation Anxiety Disorder: fear of separation from attachment figures versus worry about many concerns.

Question 49

# Anxiety Disorders GAD Differential Diagnosis GAD may cause panic symptoms, but this disorder should not be diagnosed unless fear about panic attacks becomes the predominate worry and causes behavioral changes.

Answer 49

Panic Disorder

Question 50

# Anxiety Disorders GAD Differential Diagnosis The individual’s worry is confined to their own illness.

Answer 50

Illness Anxiety Disorder

Question 51

# Anxiety Disorders GAD Differential Diagnosis Worry focused on somatic symptoms is characteristic for:

Answer 51

Somatic Symptom Disorder

Question 52

# Anxiety Disorders GAD Differential Diagnosis In GAD the focus is the excessiveness of the worry about future events. In ____________-___________ disorder the ______________ are inappropriate ideas that take the form of intrusive and unwanted thoughts, urges, or images that may become ______________.

Answer 52

Obsessive-Compulsive Disorder (F42.2) Obsessions Compulsions

Question 53

# Anxiety Disorders Panic attacks or anxiety that occurs concurrently with or following substance intoxication or withdrawal or following exposure to a medication; the substance/medication can cause severe anxiety.

Answer 53

Substance/Medication-Induced Anxiety

Question 54

# Anxiety Disorders Panic attacks or anxiety are the direct pathophysiological consequence of another medical condition; not explained better by another mental disorder; does not occur exclusively during delirium.

Answer 54

Anxiety Disorder Due to Another Medical Condition Coding Note: F06.4 Anxiety Disorder due to (specific medical condition).

Question 55

# Anxiety Disorders Presentation of symptoms characteristic of an anxiety disorder causing significant distress or impairment in functioning, but do not meet the full criteria for anxiety disorders. Used when clinician chooses to communicate the specific reasons the full criteria are not met.

Answer 55

Other Specified Anxiety Disorder

Question 56

# Anxiety Disorders Presentation of symptoms characteristic of an anxiety disorder causing significant distress or impairment in functioning, but do not meet the full criteria for anxiety disorders. Used when clinician chooses not to communicate the specific reasons the full criteria are not met, as in there is insufficient information to make a complete diagnosis (emergency department settings).

Answer 56

Unspecified Anxiety Disorder