Diagnosis of Anxiety Disorders

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Diagnosis: Anxiety Disorders

Diagnosis

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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