Anxiety Disorders Flashcards
Separation Anxiety Disorder Criteria
Developmentally inappropriate and excessive fear/anxiety concerning separation from attachment figures as evidence by 3 of the following
- Recurrent excessive distress when anticipating or experiencing separation from home/major attachment figures
- Persistent and excessive worry about losing major attachment figures or possible harm to them
- Persistent and excessive worry about experiencing an event that causes separation (getting lost/kidnapped)
- Persistence reluctance or refusal to go out, away from the home, to school/work due to separation
- Persistent excessive fear of or reluctance about being alone
- Persistent reluctance to sleep away from home
- Repeated nightmares involving the theme of separation
- Repeated complaints of physical symptoms (headaches, stomachaches, nausea, or vomiting) when away from major attachment figure
Separation Anxiety Disorder Criteria: How long do the symptoms need to last for children and adolescents vs adults?
At least 4 weeks for children and adolescents
Typically 6 months or more in adults
Separation Anxiety Disorder Differential Diagnoses:
- Generalized Anxiety Disorder*
- Panic Disorder*
- Agoraphobia*
- Conduct Disorder*
- SAD*
- PTSD*
- Depressive and Bipolar Disorders*
- Personality Disorders*
- GAD
- Anxiety and worry are about separation and not general worry
- Panic Disorder
- Anxiety around separation from attachment figures and worry about events happening to them, not an unexpected panic attack.
- Agoraphobia
- Not anxious about being trapped or tight places
- Conduct Disorder
- School avoidance is common in conduct disorder, but anxiety about separation is not responsible for school absences.
- SAD
- School refusal may be due to social anxiety due to a fear of being negatively judged rather than worry about separation from attachment figures.
- PTSD
- Central symptoms of PTSD concern intrusions and avoidance of memories of a traumatic event. While Separation Anxiety is due to avoidance and worry over well-being of attachment figures
- Depressive and bipolar disorders
- These disorders lead to low motivation to engage with the outside world while separation anxiety is concerned with fear or worry yep the attachment figures. People with separation anxiety can become depressed
- Personality Disorders
- Dependent personality disorder: Relying on others rather than concern for safety of attachment figures
- Borderline Personality Disorders: Fear of abandonment by loved ones and interpersonal problems rather than anxiety around separation
Selective Mutism Criteria
- Failure to speak in situations where there is an expectation for speaking
- Interference with educational/occupational performance
- 1 month duration at least
- Failure to speak is not due to education or knowledge or comfort of language
- Not better explained by a communication disorder
Selective Mutism: What is the minimum duration of the disturbance?
1 month
Selective Mutism Differential Diagnoses
Communication Disorders
Neurodevelopmental Disorders
Social Anxiety Disorder
- Communication Disorders are not limited to a specific social situation
- Neurodev disorders can impact communication, selective mutism should be diagnosed with there is an established capacity to speak
- Social anxiety and selective mutism can be diagnosed together if both criteria are met
Specific Phobia Criteria
- Marked fear/anxiety about a specific object/situations
- Object almost always provokes immediate fear/anxiety
- Fear/Anxiety is out of proportion to actual danger
- Phobic object/situation is actively avoided or endured with intent fear/anxiety
- Fear/anxiety/avoidance causes clinically sig distress
- Fear/anxiety lasts for 6 months or more
- Disturbance is not better explained by another mental disorder
Specific Phobia Specifiers
- Animal
- Natural environment (heights, storms, water)
- Blood-injection-injury (needles, invasive procedures)
- Situational (airplanes, elevators)
- Other (e.g., situations that may lead to choking or vomiting)
Specific Phobia: Differential Diagnoses
Difference between Specific Phobia and Agoraphobia
- Situational-specific phobia may resemble agoraphobia; however, the quantity of feared situations matters. If it is only one feared situation, then a situational-specific phobia diagnosis is warranted. If it is two or more, then an agoraphobia diagnosis is warranted.
Specific Phobia Differential Diagnosis:
Difference between Specific Phobia and Social Anxiety Disorder?
Situations where the fear is due to potential negative evaluation should be diagnosed as Social Anxiety Disorder
Specific Phobia Differential Diagnoses:
Difference between Separation Anxiety Disorder and Specific Phobia?
- If the fear is due to separation from a primary caregiver than a diagnoses of Separation Anxiety Disorder should be given
Specific Phobia Differential Diagnosis:
Difference between Panic Disorder and Specific Phobia?
Specific Phobia would be given if the panic attacks ONLY occurred in response to a specific object/situation. Panic Disorder is given if panic attacks are unexpected.
Specific Phobia Differential Diagnosis:
Difference between OCD and Specific Phobia
OCD should be diagnosed if the fear/anxiety of an object is a result of obsessions and if other diagnostic criteria for OCD are met.
Specific Phobia Differential Diagnosis
Difference between Specific Phobia and Trauma- and stressor-related disorders?
PTSD should be considered if fear/phobia follows a traumatic event.
Specific Phobia Differntial Diagnosis
Difference between Eating Disorders and Specific Phobia?
You do not diagnose Specific Phobia if the avoidance behavior is EXCLUSIVE to food and food-related cues.
Specific Phobia Differential Diagnosis:
Difference between Specific Phobia and Schizophrenia Spectrum and other Psychotic Disorders
If the fear/phobia is due to delusional thinking then you do not diagnose Specific Phobia.
Social Anxiety Disorder Criteria
- Fear or anxiety in one or more social situations where the individual is exposed to possible scrutiny
- Fear of acting in a way or show anxiety symptoms that will be negative evaluated
- Social situations almost always provoke fear or anxiety
- Social situations are avoided or endured with fear/anxiety
- Fear/anxiety causes clinically sig distress
- Fear/anxiety last for at least 6 months
- Fear/anxiety not attributable to physiological effects of a substance
- It is not related to or in excess with other medical conditions (burns, obesity)
- SPECIFY: Performance Only: Fear is restricted to speaking or performing in public
Social Phobia Differential Diagnoses:
Normative Shyness
Social Anxiety Disorder should be diagnosed if there is a significant impact on functioning
Social Anxiety Disorder Differential Diagnoses:
Difference between Agoraphobia and SAD
Social Anxiety Disorder’s criteria of being fearful of scrutiny by others differ than those with Agoraphobia where the fear may be due to difficulty escaping
Social Anxiety Disorder Differential Diagnoses:
Panic Disorder vs Social Anxiety Disorder
Panic attacks may be a part of Social Anxiety disorder; however, they are attributed to the fear of negative evaluation. Panic disorder involves the fear of the panic attacks themselves.
Social Anxiety Differential Diagnoses:
Difference between Generalized Anxiety Disorder and Social Anxiety?
Social anxiety is common in GAD however the focus in on the ongoing relationship rather than being negatively evaluated
Social Anxiety Disorder Differential Diagnoses:
Difference between Separation Anxiety Disorder and Social Anxiety Disorder
Those with Separation Anxiety Disorder are generally comfortable in social settings with their attachment figures.
Social Anxiety Disorder Differential Diagnoses:
Difference between Specific Phobias and Social Anxiety Disorder
Individuals with Specific Phobias generally do not fear negative evaluations in social situations
Social Anxiety Disorder Differential Diagnoses:
Difference between Selective Mutism and Social Anxiety Disorder
Individuals with Selective Mutism do not fear negative evaluation in social situations where no speaking is required, whereas those with Social Anxiety Disorder still fear those settings.
Social Anxiety Disorders Differential Diagnoses:
Difference between MDD and Social Anxiety Disorder
There is a difference in fear of being negatively evaluated:
MDD: concern over being negatively evaluated due to feeling they are bad or not worthy of being like
SAD: concern over being negatively evaluated due to certain social behaviors or physical symptoms
Social Anxiety Differential Diagnoses:
Difference between Body Dysmorphic Disorder and Social Anxiety Disorder?
Individuals with Body Dysmorphic Disorder are preoccupied with perceived defects or flaws that are not observable. This preoccupation causes social anxiety and avoidance. If their fears are caused by their beliefs about their appearance than a separate diagnosis of SAD is not warranted.
Social Anxiety Disorder Differential Diagnoses:
Difference between Delusional Disorder and Social Anxiety Disorder
Many individuals with Social Anxiety Disorder have good insight that their beliefs are out of proportion to the actual threat posed by the social situations, which contradicts a Delusional Disorder diagnosis based on poor insight.
Social Anxiety Disorder Differential Diagnoses:
Difference between Autism Spectrum Disorder and Social Anxiety Disorder?
Social anxiety and communication deficits are hallmarks of Autism Spectrum Disorder. The difference is that individuals with Social Anxiety Disorder generally have age-appropriate social relationships and communication capacity.
Social Anxiety Disorder Differential Diagnoses:
Difference between Social Anxiety Disorder and Personality Disorders?
Individuals with avoidant personality disorder have a broader avoidance pattern than those with Social Anxiety Disorder
Social Anxiety Disorder Differential Diagnoses:
Difference between Social Anxiety Disorder and Other Medical Conditions
Medical conditions may produce symptoms that may be embarrassing (trembling from Parkinson’s). When fear of negative evaluation due to other medical conditions is excessive, a diagnosis of social anxiety disorder should be considered.
Social Anxiety Disorder Differential Diagnoses:
Difference between Social Anxiety Disorder and Oppositional Defiant Disorder
Refusal to speak due to opposition rather than failure to speak due to fear differentiates these two.
Panic Disorder Criteria A
- Recurrent and unexpected panic attacks (abrupt surge of intense fear or intense discomfort) in which 4 or more of the following occur:
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling/Shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesias (numbness or tingling sensations)
- Derealization or depersonalization (being detached from oneself)
- Fear of losing control
- Fear of dying
Panic Disorder Criteria B-D
B: At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
- Persistent concern or worry about additional panic attacks or their consequences
- A significant maladaptive change in behavior related to the attack
C: The disturbance is not attributable to the physiological effects of a substance
D: The disturbance is not better explained by another mental disorder
Panic Disorder Differential Diagnoses:
Difference between other specified anxiety disorder or unspecified anxiety disorder and Panic Disorder
Panic disorder should not be diagnosed if full-symptom (unexpected) panic attacks have never been experienced.
Panic Disorder Differential Diagnoses:
Difference between Panic Disorder and Anxiety Disorder due to Another Medical Condition
Panic disorder is not diagnosed if there is a direct physiological cause of the panic disorder as part of a medical condition
Panic Disorder Differential Diagnoses:
Difference between Panic Disorder and Substance/Medication-Induced Anxiety Disorder
Panic Disorder is not diagnosed if the panic attacks are judged to be a direct physiological consequence of a substance.
Panic Disorder Differential Diagnoses:
Difference between Panic Disorder and Other Mental Disorders with Panic Attacks as an Associated Feature
Panic attacks that occur as a symptom of other anxiety disorders are expected and thus do not meet the criteria for panic disorder. If the panic attacks occur only in response to specific triggers, then only the relevant anxiety disorder is assigned. HOWEVER if the individual experiences unexpected panic attacks and shows persisted concern/worry or behavioral change due to the attacks, then a diagnoses of panic disorder should be considered.
Panic Attack (Specifier) Criteria
Panic Attack Specifier is added to another diagnosis and is not the same as a Panic Disorder Diagnosis.
A. An abrupt surge of intense fear or intense discomfort reaching a peak within minutes
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations or shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal disress
- Dizziness, light-headed, unsteady
- Chill or heat sensations
- Numbness or tingling sensations
- Derealization or depersonalization
- Fear of losing control “going crazy”
- Fear of dying
Panic Attack Specifier Differential Diagnoses:
Difference between Panic Attacks and Other Paroxysmal Episodes (e.g., anger attacks)
Panic Attacks should only be diagnosed if there is an abrupt surge of intense fear/intense discomfort rather than an emotional state.
Panic Attack Specifier Differential Diagnosis:
Difference between Panic Attacks and Anxiety Disorder due to Another Medical Condition
Some medical conditions can be misdiagnosed as panic attacks including, hyperthyroidism, hyperparathyroidism, seizure disorders, and cardiopulmonary conditions (asthma, arrhythmias, etc.)
Panic Attack Specifier Differential Diagnoses:
Difference between Panic Attacks and substance/medication-induced anxiety disorder
Intoxication with stimulants (cocaine, amphetamines, caffeine) or cannabis and withdrawal from depressants (alcohol) can lead to a panic attack. A detailed history should be used to determine if the individual has panic attacks prior to excessive substance use
Panic Attack Specifier Differential Diagnosis:
Difference between Panic Attacks and Panic Disorder
Panic attacks are required for a panic disorder but are not alone sufficient for its diagnosis.
Agoraphobia Criteria
A: Marked fear or anxiety about 2 or more of the following situations
- Using public transportation
- Open spaces
- Closed speaces
- In line or in a crowd
- Being outside of the home alone
B: Fear or avoidance of these situations is due to thoughts of inability to escape or lack of help
C: These situations almost always provoke fear/anxiety
D: These situations are actively avoided or endured with intense fear or anxiety
E: Fear/anxiety is out of proportion to the actual danger
F: Fear/anxiety/avoidance lasts for 6 months
G: Causes clinically significant distress
H: If another medical condition is present, the fear/anxiety/avoidance is clearly excessive
I: Fear/anxiety/avoidance is not better explained by another mental disorder
AGORAPHOBIA and PANIC DISORDER can be both diagnosed if criteria is met
Agoraphobia Differential Diagnoses:
Difference between Specific Phobia, Situational Type and Agoraphobia
Specific phobia, situational type should be diagnosed if the fear/anxiety/avoidance is limited to one situation. If the situations are 2 or more than you diagnose agoraphobia
Agoraphobia Differential Diagnoses:
Difference between Agoraphobia and Separation Anxiety Disorder
Separation anxiety disorder is differentiated by looking at thoughts. Separation anxiety disorder involves fears of detachment from significant others/home environment. Agoraphobia is where the focus is on panic-like symptoms in the feared situation.
Agoraphobia Differential Diagnoses:
Difference between Agoraphobia and Panic Disorder
When criteria for panic disorder are met, agoraphobia should not be diagnosed if the avoidance behaviors associated with the panic attacks do not extend to avoidance of two or more agoraphobic situations.
Agoraphobia Differential Diagnoses:
Difference between Agoraphobia and Acute Stress Disorder and PTSD
If the fear/anxiety/avoidance is restricted to trauma reminders and is not extended to two or more agoraphobic situations then it is PTSD/Acute Stress
Agoraphobia Differential Diagnoses:
Difference between Agoraphobia and Major Depressive Disorder
An individual may avoid leaving home due to apathy/loss of energy. If avoidance is unrelated to panic-like symptoms than agoraphobia should not be diagnosed.
Agoraphobia Differential Diagnoses:
Difference between Agoraphobia and Other Medical Conditions
If avoidance of situations is judged to be a physiological consequence of a medical condition then agoraphobia should not be diagnosed.
Generalized Anxiety Disorder (GAD) Criteria
A. Excessive anxiety and worry, occurring more days than not for at least 6 months.
B. Difficulty controlling worry
C. Anxiety and worry are associated with 3 or more:
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentration
- Irritablity
- Muscle Tension
- Sleep Disturbance
D. Anxiety/Worry/Physical Symptoms cause clinically significant distress.
E. The disturbance is not attributable to the physiological effects of a substance
F. Disturbance is not better explained by another mental disorder
Generalized Anxiety Disorder Differential Diagnoses
Difference between GAD and Anxiety Disorder due to Another Medical Condition
If the individual’s anxiety/worry is due to another medical condition based on history, lab findings, etc. then diagnose that one.
Generalized Anxiety Disorder Differential Diagnoses
Difference between GAD and Substance/Medication-Induced Anxiety Disorder
If the substance/medication is etiologically related to the anxiety then it is a Substance/Medication-Induced Anxiety Disorder
GAD Differential Diagnoses:
Difference between GAD and Social Anxiety Disorder
Individuals with social anxiety disorder often have anticipatory anxiety that is focused on upcoming social situations in which they must perform/be evaluated; whereas individuals with generalized anxiety disorder worry if they are being evaluated or not.
GAD Differential Diagnoses:
Difference between GAD and OCD
In GAD the focus of the worry is on forthcoming problems and the excessiveness of the worry is abnormal. In OCD the obsessions are inappropriate ideas that take the form of intrusive and unwanted thoughts, urges, or images
GAD Differential Diagnoses:
Difference between GAD and PTSD and Adjustment Disorders
Anxiety is going to be present in PTSD. GAD is not diagnosed if anxiety/worry are better explained by PTSD. The difference in Adjustment Disorder is that the anxiety occurs in response to a stressor within 3 months of onset and does not persist for more than 6 months after termination of the stressor.
GAD Differential Diagnoses:
Difference between GAD and Depressive/bipolar and psychotic disorders
Generalized anxiety/worry is common in depressive, bipolar, and psychotic disorders and should not be diagnosed separately if the worry occurred during the course of one of these conditions.
Substance/Medication-Induced Anxiety Disorder Criteria
A. Panic attacks/anxiety are predominant in the clinical picture
B. There is evidence from history/physical examination/lab findings of both
- Symptoms in Criterion A developed during or soon after intoxication/withdrawal or after exposure to a medication.
- The involved substance/medication is capable of producing symptoms in Criterion A
C. The disturbance is not better explained by an anxiety disorder not substance-induced which may include the following:
- Symptoms precede the onset of the substance/medication use
D. The disturbance does not occur during the course of a delirium
E. The disturbance causes clinically significant distress or impairment
Substance/Medication-Induced Anxiety Disorder Specifiers
With onset during intoxication: This specifier should be used if criteria are met for intoxication with the substance/medication and symptoms develop during the intoxication period
With onset during withdrawal: Used if criteria are met during withdrawal from the substance and symptoms developed during or shortly after discontinuation
With onset after medication use: Symptoms appear after onset of medication or change in use
Substance/Medication-Induced Anxiety Disorder Differential Diagnoses
Difference between Substance/Medication-Induced Anxiety Disorder and Substance Intoxication and Substance Withdrawal
Substance/Medication-Induced Anxiety Disorder should be made in addition when the panic or anxiety symptoms are predominant in the clinical picture
Substance/Medication-Induced Anxiety Disorder Differential Diagnoses:
Difference between Substance/Medication-Induced Anxiety Disorder and Anxiety Disorder
onset, course, and other factors are based on substance/medication use/intoxication/withdrawal. Other anxiety disorders do not have that criteria
Substance/Medication-Induced Anxiety Disorder Differential Diagnoses:
Difference with ^^ and Delirium
If panic/anxiety symptoms occur during a delirium then they are to be considered a feature of that delirium episode.
Substance/Medication-Induced Anxiety Disorder Differential Diagnoses
Difference between ^^ and Anxiety Disorder due to Another Medical Condition
Diagnose Anxiety due to Another Medical Condition if the panic or anxiety symptoms are attributed to the physiological consequences of a medical condition.
Other Specified or Unspecified Anxiety Disorder Criteria
An anxiety disorder that causes clinically significant distress or impairment but does not meet full criteria for any other anxiety disorder.
A. Examples of presentations that can be specified using the “other specified” designation include the following:
- Limited-symptom attacks
- Generalized anxiety not occurring more days than not
- Khyâl cap (wind attacks): In Cambodians “wind attacks” include palpitations, shortness of breath, dizziness, and cold extremities.
- Ataque de nervous (attack of nerves): In Hispanic individuals, ataque de nervios is a cultural syndrome used frequently to describe symptoms of intense emotional upset including acute anxiety, anger or grief, screaming and shouting uncontrollably, attack so crying, trembling, feeling of heat in the chest rising into the head, and verbal physical aggression
Other Specified or Unspecified Anxiety Disorder:
Khyâl Cap
In Cambodians, “Khyâl attacks” (khyâl cap) or “wind attacks” include palpitations, shortness of breath, dizziness, and cold extremities. Individuals also have other symptoms of anxiety and autonomic arousal such as neck soreness and tinnitus
Other Specified or Unspecified Anxiety Disorder
Ataque de nervious
In Hispanic individuals, ataque de nervios (“attack of nerves”) is a cultural syndrome used frequently to describe symptoms of intense emotional upset including acute anxiety, anger, or grief, screaming and shouting uncontrollably, attacks of crying, trembling, feeling of heat in the chest rising into the head, and verbal and physical aggression. Some individuals may even report dissociative episodes.
Unspecified Anxiety Disorder
Applies to presentations in which symptoms characteristic of an anxiety disorder causes clinically significant distress AND the clinician chooses not to specify the reason that the criteria are not met
