DSM 5 Anxiety Disorders (A comprehensive guide)

This comprehensive guide will provide the details of the most significant DSM anxiety disorders and the diagnostic criteria for each anxiety disorder.

DSM 5 Anxiety Disorders

Anxiety disorders include the disorders which share the characteristics of excessive anxiety and fear and additional behavioral disturbances. 

DSM 5 includes the following anxiety disorders:

  • Selective Mutism 
  • Separation Anxiety Disorder
  • Obsessive-Compulsive Disorder (OCD)
  • Generalized Anxiety Disorder (GAD)
  • Panic Disorder
  • Agoraphobia
  • Social Phobia or Social Anxiety Disorder
  • Substance or Medication Induced Anxiety Disorder
  • Anxiety Disorder Due to Other Medical Condition

Anxiety is a normal stress response and sometimes is beneficial in certain situations. It helps in alerting people of some dangers and helps them prepare and focus on the way out.

However, anxiety disorders differ from the normal feelings of anxiousness and nervousness, as it includes excessive anxiety and fear.

Anxiety disorders are the most common type of mental disorder and influence almost 30 % of adults at some stage of their lives. 

Anxiety disorders can cause people to avoid triggering situations or places or things that worsen the symptoms. These disorders can influence job performance, school productivity, and personal relationships.

Let’s now delve into the details of DSM 5 anxiety disorders and their diagnostic criteria.

Selective Mutism 

The DSM 5 categories selective mutism as an anxiety disorder. Selective Mutism is a childhood disorder and is differentiated by the inability to speak in specific situations, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).  When the child is in any social environment, like a classroom, in which he is expected to speak up, he may find it difficult to do so. Nonetheless, he may talk effortlessly and smoothly at home. Children with selective mutism usually stay undiagnosed with the disorder until they are in schools, at about 5 to 6 years of age.

The DSM 5 does not associate selective Mutism with trauma, abuse, or neglect. It is not the condition known as traumatic Mutism that may happen suddenly in response to a traumatic event, like losing a loved one.

Signs of Selective Mutism

  • Extreme shyness
  • Emotional outbursts
  • Social isolation; the child does not want to meet and talk to other people.
  • The behavior lasts for at least a month.
  • The child is typically talkative at home with the family members, but they resort to communicating with one-word answers or gestures when in social gatherings.
  • The child is extremely attached to the parents.
  • A determination is made if the condition is resulting in a negative effect on academic and co-curricular activities.
  • The health professionals should rule out the possibility of other disorders, like stuttering or lack of verbal communication in a psychotic disorder.
  • The health professional should rule out the possibility that the child is unable to speak the language or lacks knowledge of the subject.

Separation Anxiety Disorder

The diagnosis of separation anxiety disorder is made according to the following criteria:

  • The child observes excessive or irrational fear or anxiety because of separation from the attachment figure, as shown by three or more of the following conditions:
  1. Regular uncontrollable distress when separated from home or specific people.
  2. Regular uncontrolled worry after losing those people or about them being injured or harmed.
  3. Regular worry about involving an unfortunate event (being lost or sick) that may cause separation from the attachment figures.
  4. Persistent refusal or reluctance to go anywhere or do anything due to the fear of separation.
  5. Persistent refusal or reluctance to sleep away from attachment figures or home.
  6. Frequent nightmares about separation.
  7. Frequent concerns of physical symptoms, like headaches or nausea,  when they are separated from attachment figures or anticipating the separation.
  • The person’s fear and anxiety are persistent, staying at least a month in children and adolescents and at least six months or more in adults.
  • The person’s excessive fear of separation can’t be characterized by other mental disorders.
  • The separation anxiety or fear causes clinically induced distress or changes in essential areas of life.

Some people may also grow extremely uncomfortable when separated from home or attachment figures. According to their age, they may fear the dark, monsters, kidnappers, illness, and other circumstances that can be threatening to them and their close ones.

Obsessive -Compulsive Disorder (OCD)

The diagnostic criteria for obsessive-compulsive disorder according to the DSM-5 is given below:

  1. The occurrence of obsessions and compulsions, or both

Obsessions can be defined as 1 and 2.

  1. Recurring and persistent ideas, thoughts, urges, or impulses that are observed, at some stage during the disturbance, as unwanted and intrusive, and that in most people induce significant distress or anxiety.
  2. The person tries to suppress or ignore these urges, thoughts, or images or dilute them with other actions or thoughts (i.e., by compulsion).

Compulsions can be defined as 1 and 2.

  1. Repetitive behaviors (ordering, hand washing, checking) or mental acts (praying, repeating words silently, counting, etc.) that the person feels necessary to perform in response to an obsession or according to rules should be strictly done.
  2. Behaviors or mental acts aim to minimize or prevent distress or anxiety or prevent some dreaded situation or event; nonetheless, these mental acts or behaviors are not associated in a pragmatic way with what they are programmed to minimize or prevent or are visibly excessive.

It is important to note that young children may not be able to communicate the aims of the mental acts or behaviors.

  1. The obsessions or compulsions are time consuming (i.e., take more one hour per day) or cause clinically significant distress or change in occupational, social, or other important areas of functioning.
  2. The obsessive-compulsive symptoms are not characterized by the psychological impacts of a substance (drug abuses, medications) or other medical conditions.
  3. “The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).”

Generalized Anxiety Disorder (GAD)

DSM-5 diagnostic criteria for generalized anxiety disorder (GAD) include the following:

  • Extreme fear or anxiety induced by the actual or forecasted exposure to two or more of the following conditions:
  1. Being in closed-off places.
  2. Being alone outside of the house.
  3. Standing in line or a crowd.
  4. Being in open areas.
  5. Using public transportation.
  • They avoid the situations because the person believes they may feel stuck or help might be unavailable in the situation, that the person begins to panic.
  • The above-mentioned situations usually induce anxiety or fear.
  • The situations are avoided, require help from a loved one, or are endured with a strong fear.
  • The fear is out of proportion to the possibility of danger.
  • The avoidance or fear is persistent, as it stays for at least six or more months.
  • The avoidance or fear causes significant distress.
  • If another medical condition occurs along with the disorder, the fear or avoidance is undeniably excessive. 

Panic Disorder

DSM-5 categorises the approach by classifying panic attacks by offering just two categories: expected and unexpected panic attacks.

Expected panic attacks are linked with a particular fear like that of flying. Unexpected panic attacks have no visible trigger or cue and they may seem to happen suddenly.

According to DSM-5, a panic attack is attributed to 4 or more of the following symptoms:

  • Sweating
  • Shaking or trembling
  • Palpitations, rapid heart rate, pounding heart,
  • Sensations of shortening of breath.
  • Choking sensation
  • Chest pain
  • Dizziness, lightheadedness, or fainting
  • Nausea  or abdominal distress
  •  Derealization or depersonalization
  • Fear of loss of control
  • Fear of dying
  • Chills or hot flushes
  • Numbness or tingling feeling (Paresthesias).

Agoraphobia

DSM-5 diagnostic criteria for agoraphobia include the following:

  • Extreme fear or anxiety induced by the actual or forecasted exposure to two or more of the following conditions:
  1. Being in closed off places.
  2. Being alone outside of the house.
  3. Standing in line or a crowd.
  4. Being in open areas.
  5. Using public transportation.
  • They avoid the situations because the person believes they may feel stuck or help might be unavailable in the situation that the person begins to panic.
  • The above mentioned situations usually induce anxiety or fear.
  • The situations are avoided, require help from a loved one, or are endured with a strong fear.
  • The fear is out of proportion to the possibility of danger.
  • The avoidance or fear is persistent, as it stays for at least six or more months.
  • The avoidance or fear causes significant distress.
  • If another medical condition occurs along with the disorder, the fear or avoidance is undeniably excessive. 

Social Phobia or Social Anxiety Disorder

DSM-5 criteria for social anxiety disorder include the following:

  • Persistent fear or anxiety about certain social situations due to the fear of being judged, humiliated, or embarrassed.
  • Excessive anxiety that is out of proportion
  • Avoidance of anxiety-inducing social environments or attending to them extreme anxiety or fear.
  • Anxiety or fear that impacts daily living.
  • Fear or anxiety that can’t be explained by another medical condition, drug abuse, or medication.

Substance or Medication Induced Anxiety Disorder

The DSM-5 diagnostic criteria for substance/medication-induced anxiety disorder are similar to those of the other anxiety disorders; predominantly anxiety, panic, or fear; obsessions and compulsions should not be prevalent as the  OCD has a separate category.

Symptoms must develop during or within a month of intoxication or drug use or within a month of withdrawal, causing anxiety as a result of delirium. The drug must be specified.

Anxiety Disorder Due to Other Medical Condition

When a person experiences anxiety disorder due to other medical conditions, the existence of that medical condition directly leads to the experienced anxiety. Anxiety is a significant feature and may exhibit in the form of panic attacks, Obsessive-compulsive behavior, or generalized anxiety.

Conclusion

This comprehensive guide provided the details of the most significant DSM anxiety disorders and the diagnostic criteria for each anxiety disorder.

Do you have any of the DSM-5 anxiety disorders, let us know how you manage your condition.

Frequently Asked Questions (FAQs): DSM 5 Anxiety Disorders

What are the anxiety disorders in DSM 5?

DSM 5 mentioned some of the prominent anxiety disorders, which are listed below:

  • Selective Mutism 
  • Separation Anxiety Disorder
  • Obsessive-Compulsive Disorder (OCD)
  • Generalized Anxiety Disorder (GAD)
  • Panic Disorder
  • Agoraphobia
  • Social Phobia or Social Anxiety Disorder
  • Substance or Medication Induced Anxiety Disorder
  • Anxiety Disorder Due to Other Medical Condition

What are the symptoms of chronic anxiety?

Some of the common anxiety signs and symptoms are as follow:

  • Nervousness, restlessness, or tension.
  • The sensation of impending doom, panic, danger.
  • Rapid heart rate
  • Hyperventilation
  • Sweating
  • Shaking and trembling
  • Tiredness and fatigue
  • Trouble in concentrations and lack of focus.
  • Trouble in sleeping
  • Excessive worries
  • Gastrointestinal problems

What is high functioning anxiety?

People with high functioning anxiety are usually able to achieve tasks and apparently function well in social setups, but internally they are feeling all the symptoms of anxiety disorder that includes severe feelings of impending doom, anxiety, fear, rapid heart rate, and gastrointestinal problems. 

How do psychiatrists diagnose anxiety?

Psychiatrists may diagnose anxiety by performing a physical examination, inquiring about symptoms, recommending a blood test to rule out the chances of other medical conditions, like hypothyroidism. The doctor may also need to know whether you are taking other medications that could be resulting in similar symptoms.

Citations

https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm05

https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders