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Diagnosis of an Anxiety Disorder

  • DSM-IV Diagnoses and Criteria
    • Syndromes: not disorders, but "building blocks for disorders" (like the "episodes" in mood disorders)
      • Panic Attacks
        • not a disorder, but a building block for other disorders
          • multiple symptoms (4 or more:)
            • palpitations, pounding heart or increased heart rate
            • sweating
            • trembling or shaking
            • shortness of breath, smothering
            • choking sensation
            • chest pain
            • nausea
            • dizziness
            • derealization (feelings of unreality) or depersonalization
            • feeling of losing control/going crazy
            • fear of dying
            • paresthesias
            • chills
          • starts abruptly, peaks in about 10 minutes
      • Agoraphobia
        • fear and avoidance of places/situations where one cannot escape.
          • usually, the fear is that one might have a panic attack and be without help.
    • The Disorders
      • Panic Disorder, with and without Agoraphobia
        • recurrent Panic Attacks
        • anticipatory anxiety around the attack
        • "Global Criteria".
        • Can be with or without Agoraphobia.
      • Agoraphobia without History of Panic Disorder\
        • Agoraphobia
        • No panic disorder
        • Not due to a medical/substance disorder
      • Specific Phobia
        • excessive fear of an object/situation
        • avoidance of the object/situation or endurance with intense anxiety.
        • "Global Criteria"
        • Specific Types
          • Animal Type
          • Natural Environment Type (heights, storms, water)
          • Blood-Injection-Injury Type
          • Situational Type
          • Other.
      • Social Phobia
        • Excessive fear of a social situation
          • usually a fear of humiliation
        • Has to meet "Global Criteria" (not just normal shyness)
        • Typical: talking, eating, going to bathroom in public.
          • can be generalized to most social situations.
        • Differs From agoraphobia
          • fear is of humiliation, in agoraphobia it is fear of being in a situation where you might be without help or escape.
      • Obsessive-Compulsive Disorder (OCD)
        • either or both:
          • obsessions
            • intrusive thoughts, usually recognized as such.
          • compulsions
            • repetitive behaviors
            • help to reduce anxiety (ex. washing hands to reduce fear of contamination).
        • Good insight
          • differentiates from a delusion
        • "Global Criteria".
      • Posttraumatic Stress Disorder (PTSD)
        • 3 components:
          • a traumatic situation occurred
          • the trauma is reexperienced
            • can range from recollections to nightmares or flashbacks
          • Avoidance behavior, or numbing of general responsiveness
          • Persistent symptoms of increased arousal
        • Social/occupational dysfunction.
        • Can be acute (< 3 months) or chronic.
          • requires more than 1 month of symptoms
      • Acute Stress Disorder
        • Like PTSD, but less than 1 month.
      • Generalized Anxiety Disorder (GAD)
        • This is the disorder for people who are chronically anxious.
        • Excessive worry, more days than nights, for at least 6 months.
        • Associated with at least 3 of these symptoms:
          • restlessness
          • fatigueability
          • difficulty concentrating
          • irritability
          • muscle tension
          • insomnia
        • Anxiety Disorder Due to a General Medical Condition, and Substance-Induced Anxiety Disorder
          • can demonstrate as generalized anxiety, panic attacks or OCD symptoms.
            • or phobic symptoms in the case of substances

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