Anxiety DisordersAnxiety Disorders

Symptoms ChecklistSymptoms ChecklistPresence of symptoms Presence of symptoms

determines the assigning of a determines the assigning of a diagnosisdiagnosis

Panic AttackPanic Attack• Palpitation, pounding heart, or accelerated heart ratePalpitation, pounding heart, or accelerated heart rate• SweatingSweating• Trembling or shakingTrembling or shaking• Sensations of shortness of breath or smotheringSensations of shortness of breath or smothering• Feelings of chokingFeelings of choking• Chest pain or discomfortChest pain or discomfort• Nausea or abdominal distressNausea or abdominal distress• Feeling dizzy, unsteady, lightheaded, or faintFeeling dizzy, unsteady, lightheaded, or faint• Derealization (feelings of unreality) or depersonalization (being Derealization (feelings of unreality) or depersonalization (being

detached from one’s self)detached from one’s self)• Fear of losing control or going crazyFear of losing control or going crazy• Fear of dyingFear of dying• Paresthesias (numbness or tingling sensation)Paresthesias (numbness or tingling sensation)• Chills or hot flashesChills or hot flashes

AgoraphobiaAgoraphobia• Not a codable disorder Not a codable disorder • Anxiety about being in places or situations Anxiety about being in places or situations

from which escape might be difficult (or from which escape might be difficult (or embarrassing) or in which help may both be embarrassing) or in which help may both be available in the event of having an unexpected available in the event of having an unexpected or situationally predisposed panic attackor situationally predisposed panic attack

• The situations are avoided or else are endured The situations are avoided or else are endured with marked distress or with anxiety about with marked distress or with anxiety about having a panic attackhaving a panic attack

Panic Disorder without Panic Disorder without AgoraphobiaAgoraphobia• Recurrent unexpected panic attacksRecurrent unexpected panic attacks

– Persistent concern about having another Persistent concern about having another panic attackpanic attack

• Absence of agoraphobiaAbsence of agoraphobia

Panic Disorder with Panic Disorder with AgoraphobiaAgoraphobia• Recurrent unexpected panic attacksRecurrent unexpected panic attacks

– Persistent concern about having another Persistent concern about having another panic attackpanic attack

• Presence of agoraphobiaPresence of agoraphobia

Specific Phobia Specific Phobia (formerly simple phobia)(formerly simple phobia)

• Marked and persistent fear that is excessive or unreasonable, Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, situation (e.g., flying, heights, animals, receiving an injection, seeing blood)seeing blood)

• Exposure to the phobic stimulus almost invariably provokes Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic a situationally bound or situationally predisposed panic attackattack

• The person recognizes that the fear is excessive or The person recognizes that the fear is excessive or unreasonableunreasonable

• The phobic situation is avoided or else is endured with The phobic situation is avoided or else is endured with intense anxiety or distressintense anxiety or distress

• The avoidance, anxious anticipation, or distress in the feared The avoidance, anxious anticipation, or distress in the feared situations interferes significantly with the person’s normal situations interferes significantly with the person’s normal routine, work, school, social activities, or relationshipsroutine, work, school, social activities, or relationships

Social PhobiaSocial Phobia• A marked or persistent fear of one or more social or A marked or persistent fear of one or more social or

performance situations in which the person is exposed to performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The unfamiliar people or to possible scrutiny by others. The individual fears that he/she will act in a way (or show anxiety individual fears that he/she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. symptoms) that will be humiliating or embarrassing.

• Exposure to the feared social situation almost invariably Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack.bound or situationally predisposed panic attack.

• The person recognizes that the fear is excessive or The person recognizes that the fear is excessive or unreasonable.unreasonable.

• The feared social or performance situations are avoided or The feared social or performance situations are avoided or else are endured with intense anxiety or distress.else are endured with intense anxiety or distress.

• Again, there is significant impairment in social, occupational, Again, there is significant impairment in social, occupational, academic, or relationship functioningacademic, or relationship functioning

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder• ObsessionObsession

– Recurrent and persistent thoughts, impulses, or images Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the that are experienced, at some time during the disturbance, as intrusive and inappropriate and that disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.cause marked anxiety or distress.

– The thoughts, impulses, or images are not simply The thoughts, impulses, or images are not simply excessive worries about real-life problems.excessive worries about real-life problems.

– The person attempts to ignore or suppress such The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them thoughts, impulses, or images, or to neutralize them with some or thought or action.with some or thought or action.

– The person recognizes that the obsessional thoughts, The person recognizes that the obsessional thoughts, impulses or images are a product of his/her own mind impulses or images are a product of his/her own mind (not imposed from without as in thought insertion)(not imposed from without as in thought insertion)

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder• CompulsionCompulsion

– Repetitive behaviors (e.g., hand washing, Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the counting, repeating words silently) that the person feels driven to perform in response to an person feels driven to perform in response to an obsession, or according to rules that must be obsession, or according to rules that must be applied rigidlyapplied rigidly

– The behaviors or mental acts are aimed at The behaviors or mental acts are aimed at preventing or reducing distress or preventing preventing or reducing distress or preventing some dreaded event or situation, however, these some dreaded event or situation, however, these behaviors or mental acts either are not connected behaviors or mental acts either are not connected in a realistic way with what they are designed to in a realistic way with what they are designed to neutralize or prevent or are clearly excessive. neutralize or prevent or are clearly excessive.

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder• At some point during the course of At some point during the course of

the disorder, the person has the disorder, the person has recognized that the obsessions or recognized that the obsessions or compulsions are excessive or compulsions are excessive or unreasonable.unreasonable.

• Again, there is significant impairment Again, there is significant impairment in social, occupational, academic, or in social, occupational, academic, or relationship functioningrelationship functioning

Posttraumatic Stress Posttraumatic Stress DisorderDisorder• The person has been exposed to a The person has been exposed to a

traumatic event in which both of the traumatic event in which both of the following were presentfollowing were present– The person experienced, witnessed, or was The person experienced, witnessed, or was

confronted with an event or events that confronted with an event or events that involved actual or threatened death or serious involved actual or threatened death or serious injury, or a threat to the physical integrity of injury, or a threat to the physical integrity of self or othersself or others

– The person’s response involved intense fear, The person’s response involved intense fear, helplessness, or horror.helplessness, or horror.

Posttraumatic Stress Posttraumatic Stress DisorderDisorder• The traumatic event is persistently re-experienced in The traumatic event is persistently re-experienced in

on or more of the following ways:on or more of the following ways:– Recurrent and intrusive distressing recollections of the event Recurrent and intrusive distressing recollections of the event

including images, thoughts, or perceptions.including images, thoughts, or perceptions.– Recurrent distressing dreams of the event.Recurrent distressing dreams of the event.– Acting or feeling as if the traumatic event were recurring Acting or feeling as if the traumatic event were recurring

(includes a sense of reliving the experience, illusions, (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated.those that occur on awakening or when intoxicated.

– Intense psychological distress at exposure to internal or Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the external cues that symbolize or resemble an aspect of the traumatic event.traumatic event.

– Physiological reactivity on exposure to internal or external Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic cues that symbolize or resemble an aspect of the traumatic event.event.

Posttraumatic Stress Posttraumatic Stress DisorderDisorder• Persistent avoidance of stimuli associated with the trauma Persistent avoidance of stimuli associated with the trauma

and numbing of general responsiveness (not present before and numbing of general responsiveness (not present before the trauma), as indicated by three or more of the following:the trauma), as indicated by three or more of the following:– Efforts to avoid thoughts, feelings, or converstaions associated Efforts to avoid thoughts, feelings, or converstaions associated

with the traumawith the trauma– Efforts to avoid activities, places, or people that arouse Efforts to avoid activities, places, or people that arouse

recollections of the traumarecollections of the trauma– Inability to recall an important aspect of the traumaInability to recall an important aspect of the trauma– Markedly diminished interest or participation in significant Markedly diminished interest or participation in significant

activitiesactivities– Feeling of detachment or estrangement from others Feeling of detachment or estrangement from others – Restricted range of affect (e.g., unable to have loving feelings)Restricted range of affect (e.g., unable to have loving feelings)– Sense of a foreshortened future (e.g., does not expect to have Sense of a foreshortened future (e.g., does not expect to have

a career, marriage, children, or a normal life span)a career, marriage, children, or a normal life span)

Posttraumatic Stress Posttraumatic Stress DisorderDisorder• Persistent symptoms of increased arousal Persistent symptoms of increased arousal

(not present before the trauma), as (not present before the trauma), as indicated by two (or more) of the indicated by two (or more) of the following:following:– Difficulty falling or staying asleepDifficulty falling or staying asleep– Irritability or outbursts of angerIrritability or outbursts of anger– Difficulty concentratingDifficulty concentrating– HypervigilanceHypervigilance– Exaggerated startle responseExaggerated startle response

Posttraumatic Stress Posttraumatic Stress DisorderDisorder• Duration of the disturbance is Duration of the disturbance is moremore

than one monththan one month• The disturbance causes clinically The disturbance causes clinically

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

Acute Stress DisorderAcute Stress Disorder• The person has been exposed to a The person has been exposed to a

traumatic event in which both of the traumatic event in which both of the following are presentfollowing are present– The person experienced, witnessed, or was The person experienced, witnessed, or was

confronted with an event or events that confronted with an event or events that involved actual or threatened death or serious involved actual or threatened death or serious injury, or threat to the physical integrity of self injury, or threat to the physical integrity of self or others.or others.

– The person’s response involved intense fear, The person’s response involved intense fear, helplessness, or horror.helplessness, or horror.

Acute Stress DisorderAcute Stress Disorder• Either while experiencing or after Either while experiencing or after

experiencing the distressing event, the experiencing the distressing event, the individual has three or more of the following individual has three or more of the following dissociative symptomsdissociative symptoms– A subjective sense of numbing, detachment, or A subjective sense of numbing, detachment, or

absence of emotional responsivenessabsence of emotional responsiveness– A reduction in awareness of his/her surroundings A reduction in awareness of his/her surroundings

(e.g., (e.g., being in a dazebeing in a daze))– DerealizationDerealization– DepersonalizationDepersonalization– Dissociate amnesiaDissociate amnesia

Acute Stress DisorderAcute Stress Disorder• The traumatic event is persistently re-The traumatic event is persistently re-

experienced in at least one of the following experienced in at least one of the following waysways– Recurrent imagesRecurrent images– ThoughtsThoughts– DreamsDreams– IllusionsIllusions– Flashback episodesFlashback episodes– Sense of reliving the experiencingSense of reliving the experiencing– Distress on exposure to reminders of the traumatic Distress on exposure to reminders of the traumatic

eventevent

Acute Stress DisorderAcute Stress Disorder• Marked avoidance of stimuli that arouse recollections of the Marked avoidance of stimuli that arouse recollections of the

trauma (e.g., thoughts, feelings, conversations, activities, trauma (e.g., thoughts, feelings, conversations, activities, places, & people)places, & people)

• Marked symptoms of anxiety or increased arousal (e.g., Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor hypervigilance, exaggerated startle response, motor restlessness)restlessness)

• The disturbance causes clinically significant distress or The disturbance causes clinically significant distress or impairment in social occupational, or other important areas impairment in social occupational, or other important areas of functioning.of functioning.

• The disturbance lasts for a minimum of 2 days and a The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the maximum of 4 weeks and occurs within 4 weeks of the traumatic event.traumatic event.

• The disturbance is not due to the direct physiological The disturbance is not due to the direct physiological effects of a substance or a direct medical condition.effects of a substance or a direct medical condition.

Generalized Anxiety Generalized Anxiety DisorderDisorder• Excessive anxiety and worry Excessive anxiety and worry

(apprehensive expectation), (apprehensive expectation), occurring more days than not for at occurring more days than not for at least 6 months, about a number of least 6 months, about a number of events or activities or activities (such events or activities or activities (such as work or school performance)as work or school performance)

• The person finds it difficult to control The person finds it difficult to control the worrythe worry

Generalized Anxiety Generalized Anxiety DisorderDisorder• The anxiety and worry are associated with The anxiety and worry are associated with

three (or more) of the following symptoms three (or more) of the following symptoms (for the past 6 months)(for the past 6 months)– Restlessness or feelings keyed up or on edgeRestlessness or feelings keyed up or on edge– Being easily fatiguedBeing easily fatigued– Difficulty concentrating or mind going blankDifficulty concentrating or mind going blank– IrritabilityIrritability– Muscle tensionMuscle tension– Sleep disturbance (difficulty falling or staying Sleep disturbance (difficulty falling or staying

asleep, restless unsatisfying sleep)asleep, restless unsatisfying sleep)

Generalized Anxiety Generalized Anxiety DisorderDisorder• The anxiety, worry, or physical The anxiety, worry, or physical

symptoms cause clinically significant symptoms cause clinically significant distress or impairment in social, distress or impairment in social, occupational, or other areas of occupational, or other areas of functioning.functioning.

Other Anxiety DisordersOther Anxiety Disorders• Anxiety Disorders due to Anxiety Disorders due to a General a General

Medical ConditionMedical Condition• Substance-induced Anxiety DisorderSubstance-induced Anxiety Disorder• Anxiety Disorder Not Otherwise Anxiety Disorder Not Otherwise

SpecifiedSpecified