Anxiety Disorder Descriptions

Generalized Anxiety Disorder (GAD)

Diagnostic Criteria

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


  2. The person finds it difficult to control the worry.


  3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item 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 disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)


  4. The focus of the anxiety and worry is not confined to features of another disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.


  5. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.


  6. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

How Common Is GAD?

Generalized Anxiety Disorder affects approximately 3-5% of people in the United States in any given year. The chance that any given person in the United States will develop it over a lifetime is estimated at 8% to 9%. More than 10% of people seen in anxiety treatment clinics are diagnosed with GAD, which affects more women (60%) than men (40%).

What Treatments Are Available for GAD?

During the past several decades, there has been increasing enthusiasm for more focused, time-limited therapies that address ways of coping with anxiety symptoms more directly rather than exploring unconscious conflicts or other personal vulnerabilities.

Research has shown the effectiveness of cognitive-behavioral therapy (CBT), and group therapy in treating Generalized Anxiety Disorder. This is most effective when combined with medications. Those typically used to treat anxiety disorders are the benzodiazepines, SSRI's, and BuSpar (buspirone).

    

Acute Stress Disorder

Acute stress disorder refers to the anxiety and behavioral disturbances that develop within the first month after exposure to an extreme trauma. Generally, the symptoms of an acute stress disorder begin during or shortly following the trauma. The symptom of dissociation, which reflects a perceived detachment of the mind from the emotional state or even the body, is a critical feature. Dissociation also is characterized by a sense of the world as a dreamlike or unreal place and may be accompanied by poor memory of the specific events, which in severe form is known as dissociative amnesia.

Diagnostic Criteria

  1. The person has been exposed to a traumatic event in which both of the following were present:


    1. the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.


    2. the person's response involved intense fear, helplessness, or horror.


  2. Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:


    1. a subjective sense of numbing, detachment, or absence of emotional responsiveness


    2. a reduction in awareness of his or her surroundings (e.g., "being in a daze")


    3. derealization -- an alteration in the perception or experience of the external world so that it seems strange or unreal (e.g., people may seem unfamiliar or mechanical).


    4. depersonalization -- feelings of unreality or strangeness concerning either the environment, the self, or both.


    5. dissociative amnesia (i.e., inability to recall an important aspect of the trauma)


  3. The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.


  4. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people).


  5. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hyper-vigilance, exaggerated startle response, motor restlessness).


  6. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.


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


  8. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting disorder.
    

Post-Traumatic Stress Disorder (PTSD)

(see above - Acute Stress Disorder - for Diagnostic Criteria)

If the symptoms and behavioral disturbances of the acute stress disorder (see above) persist for more than 1 month, and if these features are associated with functional impairment or significant distress to the sufferer, the diagnosis is changed to: post-traumatic stress disorder.

Post-traumatic stress disorder is further defined in DSM-IV as having three sub forms:

  1. acute (less than 3 months' duration)


  2. chronic (greater than 3 months' duration)


  3. delayed onset (symptoms began at least 6 months after exposure to the trauma).

By virtue of the more sustained nature of post-traumatic stress disorder (relative to acute stress disorder), a number of changes, including decreased self-esteem, loss of sustained beliefs about people or society, hopelessness, a sense of being permanently damaged, and difficulties in previously established relationships, are typically observed. Substance abuse often develops, especially involving alcohol, marijuana, and sedative-hypnotic drugs.

What Treatments Are Available for Acute Stress Disorder & PTSD?

Research has demonstrated the effectiveness of cognitive-behavioral therapy (CBT), group therapy, and exposure therapy, in which the patient repeatedly relives the frightening experience under controlled conditions to help him or her work through the trauma. Studies have also shown that medications help ease associated symptoms of depression and anxiety, and can help promote sleep.

Some studies show that debriefing people very soon after a catastrophic event may reduce some of the symptoms of PTSD. A study of 12,000 schoolchildren who lived through a hurricane in Hawaii found that those who got counseling early on were doing much better 2 years later than those who did not.

    

Obsessive-Compulsive Disorder (OCD)

Diagnostic Criteria

  1. Either obsessions or compulsions:

    Obsessions as defined by:

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


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


    3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action


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

    Compulsions as defined by:

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


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


  2. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.


  3. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.


  4. If another disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).


  5. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify if: With Poor Insight: if, for most of the time during the current episode the person does not recognize that the obsessions and compulsions are excessive or unreasonable

How Common Is OCD?

About 2.3% of the U.S. population ages 18 to 54 deal with Obsessive-Compulsive Disorder in a given year.

Obsessive-Compulsive Disorder affects men and women equally.

Obsessive-Compulsive Disorder typically begins during adolescence or early childhood; at least one-third of the cases of adult OCD began in childhood.

What Treatments Are Available for OCD?

Treatments for Obsessive-Compulsive Disorder have been developed, which combine medications and behavioral therapy (a specific type of psychotherapy), and are often effective.

Several medications have been proven effective in helping people with OCD. If one drug is not effective, others should be tried.

A type of behavioral therapy known as "exposure and response prevention" is very useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts, and then is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety.

    

Panic Disorder

Diagnostic Criteria

  1. Recurrent unexpected Panic Attacks


    2. Criteria for Panic Attack:
    A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly, and reached a peak within 10 minutes:

    1. palpitations, pounding heart, or accelerated heart rate
    2. sweating
    3. trembling or shaking
    4. sensations of shortness of breath or smothering
    5. feeling of choking
    6. chest pain or discomfort
    7. nausea or abdominal distress
    8. feeling dizzy, unsteady, lightheaded, or faint
    9. derealization (feelings of unreality)
    10. depersonalization (being detached from oneself)
    11. fear of losing control or going "crazy"
    12. fear of dying
    13. paresthesias (numbness or tingling sensations)
    14. chills or hot flushes


  2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:


    1. persistent concern about having additional attacks


    2. worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")


    3. a significant change in behavior related to the attacks


  3. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).


  4. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).

How Common Is Panic Disorder?

About 1.7% of the adult U.S. population ages 18 to 54 - approximately 2.4 million Americans - has panic disorder in a given year.

Women are twice as likely as men to develop panic disorder.

Panic disorder typically strikes in young adulthood. Roughly half of all people who have panic disorder develop the condition before age 24.

What Treatments Are Available for Panic Disorder?

Treatment for panic disorder includes medications and cognitive-behavioral therapy (CBT), which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety.

Appropriate treatment can reduce or prevent panic attacks in 70% to 90% of people with panic disorder. Most people show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode.

    

Social Anxiety Disorder (formerly "social phobia")

Diagnostic Criteria

  1. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.


  2. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.


  3. The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.


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


  5. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.


  6. In individuals under age 18 years, the duration is at least 6 months.


  7. The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).


  8. If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of Stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa.

Specify if: Generalized: if the fears include most social situations (also consider the additional diagnosis of Avoidant Personality Disorder)

How Common Is Social Anxiety Disorder?

About 3.7% of the U.S. population ages 18 to 54 has social anxiety disorder in any given year.

Social anxiety disorder occurs in women twice as often as in men, although a higher proportion of men seeks help for this disorder.

The disorder typically begins in childhood or early adolescence and rarely develops after age 25.

What Treatments Are Available for Social Anxiety Disorder?

Research has shown that there are two effective forms of treatment available for social anxiety disorder: certain medications and cognitive-behavioral therapy (CBT). Medications include selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and benzodiazepenes. Some people with a form of social anxiety disorder called performance phobia have been helped by beta-blockers, which are more commonly used to control high blood pressure.

Cognitive-behavioral therapy is also very useful in treating social anxiety disorder. The central component of this treatment is exposure therapy, which involves helping patients gradually become more comfortable with situations that frighten them. The exposure process often involves three stages. The first involves introducing people to the feared situation. The second level is to increase the risk for disapproval in that situation so people build confidence that they can handle rejection or criticism. The third stage involves teaching people techniques to cope with disapproval. In this stage, people imagine their worst fear and are encouraged to develop constructive responses to their fear and perceived disapproval

Cognitive-behavioral therapy for social anxiety disorder also includes anxiety management training - for example, teaching people techniques such as deep breathing to control their levels of anxiety. Another important aspect of treatment is called cognitive restructuring, which involves helping individuals identify their misjudgments and develop more realistic expectations of the likelihood of danger in social situations.

Supportive therapy such as group therapy, or couples or family therapy to educate significant others about the disorder, is also helpful. Sometimes people with social anxiety disorder also benefit from social skills training.

    

Agoraphobia

Diagnostic Criteria

  1. The presence of Agoraphobia related to fear of developing panic-like symptoms.


    1. Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.


      2. Note: Consider the diagnosis of Specific Phobia if the avoidance is limited to one or only a few specific situations, or social anxiety disorder if the avoidance is limited to social situations.
    2. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.


    3. The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social anxiety disorder (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).


  2. Criteria have never been met for Panic Disorder.


  3. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.


  4. If an associated general medical condition is present, the fear described in Criterion A is clearly in excess of that usually associated with the condition.

How Common Is Agoraphobia?

Approximately 1.8 million American adults age 18 and over, or about 0.8 percent of people in this age group in a given year, have agoraphobia without a history of panic disorder.

The median age of onset of agoraphobia is 20 years of age.

What Treatments Are Available for Agoraphobia?

Cognitive-behavioral therapy has been shown to be very useful in treating agoraphobia. One method of treatment is called: systematic desensitization, which involves helping people gradually become more comfortable with the places or situations that produce anxiety. Treatment can also include anxiety management training - for example, teaching people techniques such as deep breathing to control their levels of anxiety. Another important aspect of treatment is called cognitive restructuring, which involves helping individuals identify their misjudgments and develop more realistic expectations of the likelihood of danger in situations or places.

    

Phobias

Diagnostic Criteria

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


  2. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.


  3. The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.


  4. The phobic situation(s) is avoided or else is endured with intense anxiety or distress.


  5. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.


  6. In individuals under age 18 years, the duration is at least 6 months.


  7. The anxiety, Panic Attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder.

Specific Type:

How Common are Phobias?

Approximately 12.5 percent of Americans have, or have expereinced a phobia. Phobias can be acquired by conditioning, modeling, or traumatic experience.

What Treatments Are Available for Phobias?

The treatment will depend on the specific phobia, the level of distress produced, and the method of acquisition.

The techniques of Cognitive-behavioral therapy are often applied to treat a phobia. If the level of distress is significant, medications can be used on a short term basis to reduce the distress level (e.g., the use of a benzodiazipene prior to flying).

    

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