DSM-5 Anxiety Disorders Separation Anxiety Disorder 309.21 (F93.0) Panic Disorder 1. Developmentally inappropriate and excessive fear/anxiety concerning separation from those to whom the individual is attached (3 or more of the following). following ). • Recurrent distress when anticipating separation from home or attachment figures. • Persistent & excessive worry about losing attachment figures or harm coming to them • Persistent & excessive worry about experiencing event that causes separation • Persistent reluctance to go out, to school, work, or elsewhere because of fear of separation • Persistent & excessive fear about being alone w/o attachment figures • Persistent reluctance or refusal to sleep away from home or w/o attachment figures • Repeated nightmares involving the theme of separation • Repeated complaints of physical symptoms (headaches, stomaches) while separated from, or anticipating separation from attachment figure 2. The fear, reluctance, or avoidance is persistent (Children/adolescents 4+ months, Adults 6+ months). months). 3. Causes clinically significant distress or impairment in social, academic, occupational, or other areas of functioning. 4. Not better explained by other mental disorder(ASD, Anxiety, Psychosis, etc). Risk Factors: Genetics (suspected), major life change/stress Usual Age of Onset: Before 12 years Selective Mutism 312.23 (F94.0) Risk Factors: Genetics (suspected), overprotective/controlling parenting Usual Age of Onset: Before 5 years Codes Vary 1. Fear of anxiety about a specific object or situation. 2. Object/situation almost always provokes immediate fear/anxiety. 3. Object/situation actively avoided or endured with intense fear/anxiety. 4. Fear/anxiety out of proportion to actual danger and to sociocultural context. 5. Fear/anxiety persists 6+ months. 6. Clinically significant distress/impairment in areas of functioning. 7. Not better explained by another mental disorder (social anxiety, separation, etc). Risk Factors: Female, genetics, parental overprotectiveness, parental loss, abuse Usual Age of Onset: 7-11 years Social Anxiety Disorder 300.23 (F40.10) 1. Fear/anxiety about social situations in which the individual is exposed to possible scrutiny by others (with children must be with peers, not just adults). 2. Individual fears they will act in a way that will lead to negative evaluation. 3. Social situations almost always provokes fear/anxiety. 4. Social situations are avoided or endured with intense fear/anxiety. 5. Fear/anxiety out of proportion to threat posed by situation/socio-cultural context. 6. Fear/anxiety persists 6+ months. 7. Clinically significant distress/impariments in areas of functioning. 8. Not better explained by substance use, a medical condition, or another mental disorder. Risk Factors: Genetics, childhood maltreatment/adversity Usual Age of Onset: 8-15 years (13 median age) 1. Recurrent unexpected panic attacks, abrupt surge of intense fear/ discomfort. (4 or more of the following). • Palpatations, pounding heart, or accelerated heart rate • Sweating • Trembling or shaking • Sensations of shortness of breath • Feelings of choking • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, unsteadly, light-headed or faint • Chills or heat sensations • Paresthesias (numbness or tingling) • Derealization (unreality) or Depersonalization (detached) • Fear of losing control • Fear of dying 2. At least one of the attacks has been followed by 1+ month of one or both of the following. • Persistent concern or worry about more panic attacks or consequences of attacks • Significant maladaptive change in behavior related to attacks (i.e. behaviors to avoid attacks) 3. Not better explained by a medical condition, or another mental disorder. Risk Factors: Female, genetic (suspected), recent stressors, abuse, smoking Usual Age of Onset: Post puberty to early/mid adulthood Agoraphobia 300.22 (F40.00) 1. Fear/Anxiety about being in certain situations (2 or more of the following) 1. Consistent failure to speak in social situations with expectation to speak. 2. Interferes with educational, occupational or social functioning. 3. Symptoms persist for 1+ month. 4. Not attributable to lack of knowledge or comfort with spoken language. 5. Not better explained by another mental disorder (communication, ASD, etc). Specific Phobia 300.01 (F41.0) • Using public transporation • Being in open spaces • Being in enclosed spaces • Standing in line or being in a crowd • Being outside of the home alone 2. Individual fears or avoids these situations because of thoughts that escape might not be possible in panic-like or embarassing reactions occur. 3. Situations almost always produce fear or anxiety. 4. Situations actively avoided, require a companion, or are endured with intense fear/anxiety. 5. Fear/anxiety out of proportion to threat posed by situation/socio-cultural context. 6. Fear/anxiety persists 6+ months. 7. Clinically significant distress/impariments in areas of functioning. 8. Not better explained by a medical condition or another mental disorder. Risk Factors: Female, genetic (suspected), recent stressors, abuse, smoking Usual Age of Onset: 17 years, common throughought adolescence/early adulthood Generalized Anxiety Disorder Substance/Medication-Induced Anxiety Disorder Codes Vary 1. Panic attacks or anxiety predominantly in clinical picture 2. Evidence from history, physical, or lab findings of both of the following • Symptoms developed during or soon after substance intoxication/withdrawal or after exposure to a medication • Involved substance/medication is capable of producing anxiety/panic symptom 3. Not better explained by other anxiety disorder 4. Does not occur exclusively during delirium 5. Clinically significant distress/impariments in areas of functioning. Anxiety Disorder Due to Another Medical Condition 293.84 (F40.00) Other Specificied Anxiety Disorder 300.02 (F41.1) 1. Same as above 2. Evidence from history, physical, or lab findings that symptoms are the direct pathophysiological consequence of another medical condition 3- 5. Same as above Symptoms characteristic of an anxiety disorder cause clinically significant distress/impariments in areas of functioning but do not meet full diagnostic criteria for another anxiety disorder. The other specified anxiety disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific anxiety disorder. Unspecified Anxiety Disorder 300.00 (F41.9) Symptoms characteristic of an anxiety disorder cause clinically significant distress/impariments in areas of functioning but do not meet full diagnostic criteria for another anxiety disorder. The unspecified anxiety disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met and includes presentations where there is insufficient information to make a more specific diagnosis 300.02 (F41.1) 1. Excessive worry and anxiety occuring more days than not about a number of events. Anxiety persists 6+ months. 2. Individual finds it difficult to control the worry 3. Anxiety/worry is associated with 3 or more of the following (with symptoms being present more days than not over past 6 months) months) • Restless or feeling on edge • Being easily fatigued • Difficulty concentrating • Irritability • Muscle tension • Sleep disturbance 4. Clinically significant distress/impariments in areas of functioning. 5. Not better explained by substance use, a medical condition, or another mental disorder. Risk Factors: Female, childhood adversity, parental overprotection Usual Age of Onset: 30 years Specifiers listed on the back DSM-5 Anxiety Disorders Specific Phobia 1. 2. 3. 4. 5. 6. 7. 8. Specifiers Codes Vary Animal (spiders, insects, dogs). [300.29, F40.218] Natural Environment (heights, storms, water). [300.29, F40.228] Fear of Blood [300.29, F40.230] Fear of Injections/Infusions [300.29, F40.231] Fear of Medical Care [300.29, F40.232] Fear of Injury [300.29, F40.233] Situational (Airplanes, elevators, enclosed places). [300.29, F40.248] Other (loud sounds, costumed characters). [300.29, F40.298] Social Anxiety Disorder 300.23 (F40.10) 1. Performance only Substance/Medication-Induced Anxiety Disorder Codes Vary 1. With onset during intoxication 2. With onset during withdrawal (or shortly after withdrawal) 3. With onset after medication use (or after a modification/change in use) Anxiety Disorder Due to Another Medical Condition 1. Anxiety disorder due to (list medication condition) 293.84 (F40.00)