The Classification and Diagnosis of Anxiety Disorders
Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.image by Wonderlane Wonderlane (lic)So far, we've distinguished normal anxiety from anxiety disorders. Next, we learned how anxiety disorders are developed and maintained. Now it's time to review the specific anxiety disorders and to define the symptoms that lead to each diagnosis.
If you have done any research on anxiety disorders, or any other mental disorders, you most likely have come across references to the DSM. DSM is the abbreviation for the Diagnostic and Statistical Manual of Mental Disorders. The DSM is often referred to as the "bible" of mental disorders. First published in 1952 by the American Psychiatric Association, the DSM describes and categorizes mental disorders for use by mental health researchers and clinicians. The DSM has undergone several revisions since then. At the time of this writing, the most recent version is the DSM-5 (APA 2013). DSM-5 includes the latest research and statistical information regarding psychiatric disorders.
The DSM lists different categories of disorders. One of these categories is anxiety disorders. Each disorder is applicable to both children and adults. However, some disorders are more common in children and adolescents (e.g. Separation Anxiety Disorder). Many of these disorders develop during childhood, and persist into adulthood untreated. While both adults and children may experience anxiety, children may display different symptoms. Children may also describe their symptoms differently. In order to meet the diagnostic criteria, the duration of children's symptoms may differ from adults. The dissimilarities between adults and children will be described in the explanation of each disorder when applicable.
Anxiety disorders are fairly common. According to the National Institute of Mental Health (NIMH, 2008), approximately 40 million American adults (i.e., 18.1 %) have an anxiety disorder in a given year. On average, the first episode occurs before the age of 21.5. This prevalence rate is really quite astonishing. Roughly one in five persons will have experienced an anxiety disorder during that year. The most commonly occurring anxiety disorders are Social Anxiety Disorders and Specific Phobias.
As we have discussed, anxiety and fear are normal human emotions. Anxiety disorders differ from normal these normal emotions in terms of degree and duration. The fear is excessive and continues beyond developmentally appropriate periods. For instance, it is developmentally normal for infants to become highly distressed upon separation from their caregiver. It is not developmentally normal for a 7 year old to behave in the same manner.
In order to be diagnosed with an anxiety disorder, the DSM criteria require that symptoms must cause a person significant distress or impairment. Therefore, just because someone is experiencing some symptoms of anxiety, it does not mean they meet the requirements for a mental disorder unless their symptoms are highly distressing to them, and/or cause significant problems in their functioning.
Culture plays a predominant role in all anxiety disorders. For instance, there is a great deal of cultural variation in terms of what is considered an acceptable and normative attachment between adults and their offspring. Likewise, there are cultural variations in normative reactions to separation of children from their caregivers. Similarly, panic attacks are a prominent symptom of many anxiety disorders. However, panic attacks may be presented and described differently across cultures. Therefore, cultural interpretation needs to be included in the diagnostic process.
The DSM establishes a symptom criteria set for each disorder. From this symptom set a certain number of symptoms must be met for diagnosis. Because it is not necessary to have every symptom in the criteria set, people with the same disorder may not have the exact same set of symptoms. For instance, someone might experience chest pain as the primary symptom of a panic attack. Another person may feel lightheaded. Both of these symptoms are part of the set of symptoms for panic attack (see next section).
Resources
-
Articles
- What is Anxiety?
-
The Biopsychosocial Model of Anxiety
- The Biopsychosocial Model: Causes of Pathological Anxiety
- Biological Explanations of Anxiety Disorders
- Biological Explanations of Anxiety: Part II
- Biological Explanations of Anxiety: Part III
- Biological Explanations of Anxiety: Part IV
- Psychological Explanations of Anxiety Disorders
- Psychological Explanations: Part II
- Social Explanations of Anxiety Disorders
- Development & Maintenance of Anxiety Disorders
-
Classification & Diagnosis of Anxiety Disorders
- The Classification and Diagnosis of Anxiety Disorders
- Panic Attacks: A Classic Symptom of Several Anxiety Disorders
- Panic Disorder
- Separation Anxiety Disorder
- Selective Mutism
- Agoraphobia
- Specific Phobias and Social Anxiety Disorder (Social Phobia)
- Generalized Anxiety Disorder (GAD)
- Other Anxiety-Related Disorders
- Anxiety and Other Psychiatric Disorders
-
Anxiety Disorder Theories and Therapies
- Anxiety Disorders: Theories and Therapies
- Behavioral Learning Theory and Associated Therapies
- Operant Conditioning
- Operant Conditioning and Avoidance Learning
- Contemporary Views of Behavioral Learning Theory
- Behavioral Therapies for Anxiety Disorders
- Cognitive Theory and Associated Therapies
- Cognitive Therapy
- Cognitive-Behavioral Therapy
- Adjunct Therapies
- Pharmacologic Treatments (Medication)
-
Treatment of Anxiety Disorders
- Treatment for Separation Anxiety Disorder
- Treatment for Selective Mutism
- Treatment for Panic Disorder
- Treatment for Specific Phobias and Treatment for Social Anxiety Disorder (Social Phobia)
- Treatment for Generalized Anxiety Disorder (GAD)
- Treatment for Obsessive-Compulsive Spectrum Disorders (OCSDs)
- Conclusion
- Anxiety Disorder References & Additonal Resources
-
News
-
Questions and Answers
- Anxious About Opinions
- Possible OCD and Anxiety issues
- Fear
- Stay in Therapy Because I Like it?
- Is My Anxiety a Normal Reaction?
- What am I Supposed to do With a Hypochondriac Step Daughter?
- Need Help
- Husband Continually Annoyed/Angry With Me
- How Can I Overcome my Debilitating Shyness and Fear of Life?
- Really Desperate..Please Help
-
111 more
- OCD and Trauma?
- Depression
- I Don't Care For Anything, I Feel as Though I'm Wasting my Life.
- Unwanted Thoughts
- Anxiety Has Taken Over My Life...
- CBT Therapy and Transference
- Transference II
- OCD
- 19 Yr Old Naive Daughter
- Fear of Choking
- Help
- Should I be Worried?
- Too Much Time doing Homework
- Falling Apart
- Can't Stand Noise
- What Is Intimacy, Exactly?
- Is She Ill?
- Social Anxiety, Depression and More...
- Do I Have Just Social Anxiety or Other Diagnoses Combined with SA?
- Need To Ask Someone
- False Memories
- Help! Please!
- Two Year Old Son Wandered
- Infections and The Brain
- Are Personality Disorders For Life?
- I am Terrified of Death.
- Anhedonia
- Our 23 Year Old Son Refuses to Get Help for His Anxiety Attacks and Depression.
- Anxiety
- Anxiety Disorder vs. Personality Disorder: Differences?
- Restroom Phobia
- I'm Afraid I'm Going Crazy
- Post Brain Surgery Mental Problems
- Would Medication Help?
- obsessive strange thoughts about life and existentialism
- Am I Crazy?
- Is it Anxiety? Is it Normal to Be Like That?
- Depressed 19 year old college student
- Depression helps to contribute to my unemployment! - Paula
- Relationship Anxiety
- Disconnected
- I'm Scared
- Please help fix my mom. - Kenny
- OCD?
- Saving my Son
- Scary thoughts, dark feelings, help?
- Swallowing fear
- Is there something wrong with me?
- I have PTSD and I feel nothing
- OCD Cure
- Repressed Memory
- I have OCD. Will this increase my child's chance of developing Autism?
- Crazy Thoughts
- 20 Year Old Female: no friends, depressed, what should I do?
- unwanted thoughts!
- crazy thoughts... all the time
- A very low threshold for stress tolerance
- Why can't I get gross images out of my head?
- fear of expiration
- SPECIFIC PHOBIA
- anxiety or going crazy?
- OCB
- visions of what could have been
- about depersonalization
- obsessive compulsive disorder
- OCD/ANXIETY while pregnant
- Amnesia
- Social Phobia
- Constant Counting Disorder
- Anxiety
- Is this OCD?
- Worried about my therapist
- No Friends
- Teenager...angst vs. mental health issue
- phobia regarding uncertainty
- Obsessed with running out of things
- Do I Have OCD?
- Do environmental factors hold a person back?
- Never Had a Relationship
- Shy Rural Student
- Nursing Student's Anxiety
- I'm Afraid They Are Judging Me
- Part Time Work and Stress
- Anxiety
- Panic
- Bathroom Phobia
- Anxiety?
- Mastery Of Anxiety And Panic
- Very Determined Panicker In The South
- Panicking Boyfriend
- Alternatives For Anxiety Treatment
- Is Anxiety A Hereditary Factor?
- Unable To Keep Eye Contact
- Is It Really Panic? And How Do We Get Help
- A Cure For Claustrophobia?
- Panic Attacks
- Shyness And The Post Partum Blues
- Klonopin
- Alternative Treatment
- Can't Afford Therapy
- Driving Phobia
- Indecisive
- Agoraphobia?
- Social Fear
- A Cure For Anxiety?
- Panic Attacks
- Fear of Driving
- Shy Guy
- Anxiety?
- Social Anxiety
- Linda writes:
-
Book & Media Reviews
- 8 Keys to Stress Management
- A Brief History of Anxiety
- Anxiety
- Anxiety
- Anxiety Disorders
- Anxiety, Phobias, and Panic
- Been There, Done That? DO THIS!
- Calm Beneath the Waves
- Elsewhere
- Exercise for Mood and Anxiety
-
31 more
- Getting Control
- Helping Students Overcome Depression and Anxiety
- Just Checking
- Mind-Body Workbook for Anxiety
- Monkey Mind
- My Age of Anxiety
- Overcoming School Anxiety
- Panic Disorder
- Passing for Normal
- Phobic and Anxiety Disorders in Children and Adolescents
- Repressed Spaces
- Self-Coaching
- Stress
- Stress Survival Guide
- Textbook of Anxiety Disorders
- The 10 Best Anxiety Busters
- The Age of Anxiety
- The Anxieties of Affluence
- The Dutiful Worrier
- The Emotional Eater's Repair Manual
- The Male Stress Survival Guide
- The Places That Scare You
- The Stress Cure
- The SuperStress Solution
- Treating Affect Phobia
- Under Pressure and Overwhelmed
- Viniyoga Therapy for Anxiety
- When Words Are Not Enough
- Wish I Could Be There
- Yoga for Anxiety
- Yoga Journal's Yoga for Stress
-
Self-Help Groups
-
Links
-
Videos
- How to Manage ADHD and Anxiety
- What You Need to Know about Students with ADHD and Anxiety
- How To Make Room For Gratitude In An Anxious Brain
- How to Stay Calm When You Know You'll Be Stressed
- Anxiety and Teen Girls with Lisa Damour, PhD
- Is it Anxiety or a Heart Condition?
- Identifying and Treating Anxiety in Kids and Teens
- Child Anxiety, It’s Real
- Helping Children Cope with Anxiety
- Anxiety, Trauma and How Prolonged Exposure Therapy Works For PTSD
-
26 more
- OCD, Phobias and Anxiety
- How Weighted Blankets May Lift Anxiety
- Controlling Anxiety
- Too Scared: Social Anxiety Disorder
- Panic Disorders Video
- Phobias Video
- Treating Anxiety Disorders: A Unified Protocol
- Treating Youth Anxiety and Social Phobia
- Overcoming Anxiety in Children and Teens
- Treating Anxiety in Children and Teens with ASD
- Back-to-School Anxiety
- No More Shame: My life with Anxiety and Depression
- Adolescent Depression and Anxiety
- What is Social Anxiety Disorder?
- Living Without Fear
- What is Generalized Anxiety Disorder?
- What is Generalized Anxiety Disorder?
- School Anxiety! Activities To Help Kids and Teens Manage It
- Recognizing and Treating Problematic Fear and Anxiety in Children
- How To Stop Overthinking When You Have Anxiety
- My Anxiety Is Making Me Anxious!
- Evidence-Based Treatment Planning for Generalized Anxiety Disorder Video
- Managing Anxiety in Youth: More Action Than Talk
- Treatment of Social Anxiety Disorder
- Cognitive Behavioral Therapy for Anxiety
- Recent Advances in Anxiety - Children/Adolescents
-
More Information
- Wise Counsel Interview Transcript: An Interview with David Barlow, Ph.D. on the Nature and Treatment of Anxiety and Panic Disorders
- Wise Counsel Interview Transcript: An Interview with Dr. Michelle Craske on Anxiety Disorders Research and Treatment
- Wise Counsel Interview Transcript: An Interview with Richard Heimberg, Ph.D. on Anxiety Research and Treatment
Topics
-
Related Topic Centers
-
Addictions
-
Aging & Elder Care
-
Assessments & Interventions
-
Career & Workplace
-
Emotional Well-Being
-
Life Issues
-
Parenting & Child Care
-
Abuse
-
ADHD: Attention Deficit Hyperactivity Disorder
-
Adoption
-
Autism
-
Child & Adolescent Development: Overview
-
Child & Adolescent Development: Puberty
-
Child Development & Parenting: Early (3-7)
-
Child Development & Parenting: Infants (0-2)
-
Child Development & Parenting: Middle (8-11)
-
Child Development & Parenting:Adolescence (12-24)
-
Child Development Theory: Adolescence (12-24)
-
Child Development Theory: Middle Childhood (8-11)
-
Childhood Mental Disorders and Illnesses
-
Childhood Special Education
-
Divorce
-
Family & Relationship Issues
-
Intellectual Disabilities
-
Learning Disorders
-
Oppositional Defiant Disorder
-
Parenting
-
Self Esteem
-
-
Psychological Disorders
-
Anxiety Disorders
-
Bipolar Disorder
-
Conversion Disorders
-
Depression: Depression & Related Conditions
-
Dissociative Disorders
-
Domestic Violence and Rape
-
Eating Disorders
-
Impulse Control Disorders
-
Intellectual Disabilities
-
Mental Disorders
-
Obsessive-Compulsive Spectrum Disorders
-
Personality Disorders
-
Post-Traumatic Stress Disorder
-
Schizophrenia
-
Sexual Disorders
-
Somatic Symptom and Related Disorders
-
Suicide
-
Tourettes and other Tic Disorders
-