February 21, 2024

Understanding Anxiety Disorders and DSM 5 Criteria

Anxiety Disorders: DSM 5 Criteria

Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure. People with anxiety disorders often experience excessive, irrational fear and dread. Anxiety disorders are the most common mental health disorder in the United States, affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year. Anxiety disorders can be divided into several categories, including generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the United States. The DSM-5 provides criteria for diagnosing anxiety disorders and other mental health conditions.

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is characterized by persistent and excessive worry about a number of different things. People with GAD may anticipate disaster and may be overly concerned about money, health, family, work, or other issues. GAD can cause physical symptoms such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep problems. To be diagnosed with GAD, a person must meet the following criteria:

  • 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).
  • The individual finds it difficult to control the worry.
  • 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):
  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

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

Panic Disorder

Panic disorder is characterized by repeated, unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom. To be diagnosed with panic disorder, a person must meet the following criteria:

  • Recurrent unexpected panic attacks.
  • At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
  • Persistent concern or worry about additional panic attacks or their consequences.
  • A significant maladaptive change in behavior related to the attacks.

Panic Attack Criteria

A panic attack is a period of intense fear or discomfort, typically with an abrupt onset and usually lasting no longer than 30 minutes. Four (or more) of the following symptoms must be present during the attack:

  • Palpitations, pounding heart, or accelerated heart rate.
  • Sweating.
  • Trembling or shaking.
  • Sensations of shortness of breath or smothering.
  • Feelings of choking.
  • Chest pain or discomfort.
  • Nausea or abdominal distress.
  • Feeling dizzy, unsteady, lightheaded, or faint.
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself).
  • Fear of losing control or going crazy.
  • Fear of dying.
  • Paresthesias (numbness or tingling sensations).
  • Chills or hot flushes.

Social Anxiety Disorder

Social anxiety disorder (also known as social phobia) is an excessive fear of social situations. People with social anxiety disorder may fear being judged or scrutinized by others, fear embarrassment, or fear being the center of attention. To be diagnosed with social anxiety disorder, a person must meet the following criteria:

  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).
  • The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.
  • The social situations almost always provoke fear or anxiety.
  • The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
  • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
  • The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specific Phobias

Specific phobias are intense, irrational fears of certain objects or situations, such as snakes, heights, or flying. People with specific phobias may experience extreme fear and anxiety when exposed to the object or situation. To be diagnosed with a specific phobia, a person must meet the following criteria:

  • Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
  • 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.
  • The phobic stimulus is actively avoided or endured with intense fear or anxiety.
  • The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
  • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
  • The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

If you think you may have an anxiety disorder, it is important to seek professional help. A mental health professional can help you to better understand your symptoms and create a treatment plan that is tailored to your needs.

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