ANXIETY DISORDERS

DISORDER CRITERIA ONSET TREATMENT

Attachment Figure (someone Persistent 4 weeks in children
1. Separation Anxiety
important) will be in danger; with
Disorder
somatic complains to stop separation Typically, 6 months in adults
Persistent failure to speak in social
situations not attributable to lack of
1 month (not limited to 1st month of
knowledge of, or comfort with, the
school)
spoken language; can participate in
2. Selective Mutism
physical activities
Not better explained by a
communication disorder
Speaks normally in the presence of
immediate family members
6 months or more
Average individual: three
objects/situations
Multiple specific phobia that must be
intense or severe that causes clinically
Phobia is an excessive fear of a specific
significant distress
object, circumstance, or situation;
whilst Specific Phobia is a strong
Clinicians should take note of the
3. Specific Phobia (immediate, active avoidance),
following in diagnosing Specific
persisting fear of an identified object or
Phobia in children: (1) expressing
situation (usually with expected panic
fear or anxiety by crying, tantrums,
attack)
freezing or clinging; (2) not able to
understand the concept of avoidance;
(3) assess the degree of impairment
and the duration of the fear, anxiety,
or avoidance, and whether it is typical
for the child’s particular
developmental stage
Can start as early as Pharmacotherapy
preschool and may occur at Psychotherapy:
any time during childhood - Cognitive Behavioral Therapy to
help understand and manage fears
Rarely in Adolescence; - Exposure Therapy by carefully
often develops after life exposing patients to separation
stress - Relaxation Techniques
Usually, <5 years Psychotherapy:
- Behavior Therapy involves
Disturbance may not come gradually exposing a child to
to clinical attention until increasingly difficult speaking
entry into school tasks in the context of a supportive
relationship
May disappear, but
symptoms of Social Anxiety
Disorder may remain
Psychotherapy:
- Behavior Therapy involves
exposing serially to a
predetermined list of anxiety-
provoking stimuli graded in
Develops following a
hierarchy from least to the most
traumatic event (observed,
frightening (systematic
unexpected or informational
desensitization); intensive
transmission)
exposure (flooding)
- Insight- Oriented Therapy
Usually <10 years, mostly
enables patient to understand the
develop in childhood and
origin of the phobia, the
adolescence, but can
phenomenon of secondary gain,
develop at any age
and the role of resistance and
enables them to seek healthy ways
Many individuals with
of dealing with anxiety- provoking
Specific Phobia are unable
stimuli
to recall the onset
- Virtual Therapy exposes patients
on the computer screen to interact
with phobic object or situation
- Other therapeutic modalities such
as hypnosis, to enhance the

Marked fear or anxiety of social
situations due to the individual’s fear of
being negatively evaluation that will
4. Social Anxiety lead to rejection
Disorder
Specify if the fear is restricted to
speaking or performing in public
A. Unidentified and unexpected
following any of the Panic Attack
Specifier:
5. Panic Disorder
B. Persistent concern/worry about
additional panic attacks or their
consequences; significant maladaptive
change in behavior related to the attacks
A. Marked fear or anxiety of specific
situations due to “fear of not able to
escape”
These situations are actively avoided
or may require the presence of a
6. Agoraphobia
companion
: and negative reinforcement,
1. Using public transportations
2. Being in open spaces
3. Being in enclosed places
4. Standing in line or being in crowd
5. Being outside of the home alone
6 months or more
Not attributed to physiological effects
of a substance or another medical
condition
In children, the anxiety must occur in
peer settings, and must take note of
the expression of anxiety/fear
A panic attack is an abrupt surge of
intense fear or intense discomfort that
reaches a peak within minutes, and
during which time four (or more) of
the Panic Attack Specifier occur
Atleast one of the Panic Attack
Specifier has been followed by 1
month (or more) of one of the B
criteria
6 months or more, with 2 or more
symptoms
Reasonable fears and age are different
Exclude short- lived and transient
individuals
therapist’s suggestion that the
phobic object is not dangerous;
self- hypnosis as a method of
relaxation in phobic situations;
family therapy, to help the patient
confront the phobic object by
supporting
Pharmacotherapy
Psychotherapy
- Behavioral and Cognitive methods
Median onset is 13 years such as cognitive retraining,
old. (Usually 8 to 15 years desensitization, rehearsal during
old) sessions and a range of homework
assignments
Pharmacotherapy
Psychotherapy:
- Cognitive Therapy includes
Median onset is 20-24 years
instruction about patient’s false
old; few cases begin in
beliefs and information about
childhood; onset age of 45
panic attacks
years old is unusual, but can
occur
Pharmacotherapy
Psychotherapy:
Majority of the individuals
- Supportive Psychotherapy
with panic disorder showed
involves the use of psychodynamic
signs of agoraphobia and
concepts and a therapeutic alliance
anxiety before the onset of
to promote adaptive coping
panic disorder
- Insight- Oriented Psychotherapy
- Behavior therapy includes positive
Initial onset is 35 years;
mean age is 17 years
systematic desensitization,
flooding, exposure, relaxation,
Age onset w/o panic
self- monitoring
attacks/disorder is 25-29
- Cognitive Therapy
years
- Virtual Therapy
 Excessive anxiety and worry of Pharmacotherapy
almost everything; finds it difficult to The median age is 30 years Psychotherapy:
control the worry - Behavior therapies
Excessive worry and - Cognitive therapies
Associated with these symptoms: anxiety may occur later in - Psychodynamic therapy
Have been present for more days
1. Restlessness/ feeling keyed up or on life, but manifested an
7. Generalized Anxiety than not for atleast 6 months, with 3
edge anxious temperament
Disorder or more associated symptoms in
2. Being easily fatigued
adults and 1 associated symptom in
3. Difficulty concentrating or mind Children and adolescents
children
going blank with GAD worry most that
4. Irritability concerns of their
5.Muscle tension performance
6. Sleep Disturbance
Substance/Medication, Due to Another
8. Other Anxiety
Medical Condition, Other Specified,
Disorders
Unspecified

Panic Attack Specifier Frequency and Severity

1. Palpitations, pounding heart, or accelerated heart - Moderately frequent (1/week)
rate - Short bursts (daily/weeks/months)
2. Sweating - Less frequent (2 per month)
3. Trembling or shaking - Full symptoms (4 or more) *
4. Sensations of shortness of breath or smothering - Limited symptom (<4)
5. Feelings of choking
6. Chest pain or discomfort * Full symptoms is required for the diagnosis of
7. Nausea or abdominal distress panic disorder
8. Feeling dizzy, unsteady, light-headed, or faint
9. Chills or heat sensations
10. Paresthesias (numbness or tingling sensations)
11.Derealization (feelings of unreality) or
depersonalization (being detached from one- self)
12. Fear of losing control or “going crazy”
13. Fear of dying