anxiety disorders.pdf
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ANXIETY DISORDERS
Disorders Signs and Symptoms (Criteria)
Statistics/ Prevalence
A Panic Attack is a discrete period in which there is the sudden onset of
intense Apprehension, fearfulness, or terror,
often associa ted with fee lings of impending
Doom. During these attacks, symptoms such as shortness of breath,
palpitations, Chest pain or discomfort, choking or smothering sensa tions, and fear of
"going crazy" Or losing control are present.
(1) palpitations, pounding heart. Or accelerated heart rate
(2) sweating (3) trembling or shaking
(4) sensati ons of shortness of breath or smothering
(5) feeling of choking (6) chest pain or discomfort
(7) nausea or abdominal distress (8) feeling dizzy, unsteady, lightheaded,
or faint (9) dereali zation (feelings of unreality) or depersonalization (being detached
from Oneself)
(10) fear of losing control or going crazy (11) fear of dying
(12) paresthesias (numbness or tingling sensations)
(13) chi lls or hot f lushes
Although lifetime prevalence rates of Panic Disorder (With or Without Agoraphobia)
In community samples have been reported to be as high as 3.5%, most studies have
Found rates between 1% and 2%. One-year prevalence rates are between 0.5% and
1.5%. The prevalence rates of Panic Disorder in clinical samples are considerably
Higher. For example, Panic Disorder is diagnosed i.n approximately 10% of individuals
Referred for mental health consu ltation . In general medical settings, preva lence
Rates vary from 10% to 30% in vestibular, respiratory, and neurology clinics to as high As 60% in cardiology clinics. Approximately
one-third to one-half of individuals Diagnosed with Panic Disorder in community
samples also have Agoraphobia, although A much higher rate of Agoraphobia is
encountered in clinical samples.
Agoraphobia is anxiety about, or avoidance of, places or situations from
which escape Might be difficult (or embarrassing) or in which help may not be available in the
Event of having a Panic Attack or panic-l ike symptoms.
A. Anxiety about being in places or situations from which escape might be
difficult (or embarrassing) or in which help may not
be available in the event of having an unexpected
or situationally predisposed Panic Attack or panic-l ike symptoms.
Agoraphobic fears typically involve characteristic
clusters of situations that include being outside the home alone; being in a
crowd or standing in a line; being on a bridge;
and traveling in a bus, train, or automobile.
Note: Consider the diagnosis of Specific Phobia if t he avoidance is limited to
one or only a few specific situations, or
Social Phobia if the avoidance is limited to social
situations. B. The situations are avoided (e.g.,
travel is restricted) or else are endured with marked
distress or with anxiet y about having a Panic Attack or panic-like symptoms, or
require
ANXIETY DISORDERS
the presence of a companion. C. The anxiety or phobic avoidance is not better accounted for by another
mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of
fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single
situation like elevators ), ObseSSive-Compulsive
Disorder (e.g., avoidance of dirt in someone
with an obsession about contamination), Posttraumatic Stress
Disorder (e.g., avoidance of stimuli associated with a severe
stressor), or Separation Anxiety Disorder
(e.g., avoidance of leaving home or relatives) .
Panic Disorder Without Agoraphobia is characterized by recurrent tmexpected
Panic Attacks abou t which there is persistentconcem.
.
A. Both (1) and (2): (1) recurrent unexpected Panic Attacks
(see p. 432) (2) at least one of the attacks has been followed by 1 month (or more) of one
(or More) of the following:
(a) persistent concern about having additional attacks
(b) worry about the implications of the attack or its consequences (e.g., losin{J Control, having a heart attack, "going
crazy") (c) a significant change in behavior
related to the attacks B. Absence of Agoraphobia (see p. 433). C. The Panic Attacks are not due to the
direct physiological effects of a substance (e.g.,
A drug of abuse, a medication) or a general medical condition (e.g .,
hyperithyroid·
Ism). D. The Panic Attacks are not better accounted for by another mental
disorder, such as Social Phobia (e.g., occurring on
exposure to feared social situations), Specific Phobia
(e .g., on exposu re to a specific phobic situation). Obsessive·Compulsive
Some cultural or ethnic groups restrict the participation of
women in public life, and this must be distinguished from Agoraphobia. Panic Disorder
Without Agoraphobia is diagnosed twice as often and Panic Disorder With
Agoraphobia three times as often in women as m men.Although lifetime prevalence rates of Panic Disorder (With or Without Agoraphobia) in community samples have been reported to
be as high as 3.5%, most studies have found rates between 1% and 2%. One-year
prevalence rates are between 0.5% and 1.5%. The prevalence rates of Panic Disorder in
clinical samples are considerably higher. For example, Panic Disorder is
diagnosed i.n approximately 10% of individuals referred for mental health consu ltation . In
general medical settings, preva lence rates vary from 10% to 30% in vestibular,
respiratory, and neurology clinics to as high as 60% in cardiology clinics. Approximately one-
third to one-half of individuals diagnosed with Panic Disorder in community
samples also have Agoraphobia, although a much higher rate of Agoraphobia is
encountered in clinical samples.
ANXIETY DISORDERS
Disorder (e.g ., on exposure to dirt in someone
with an obsession about contamination), Posttraumatic
Stress Disorder (e.g., in response to stimuli associated with a severe
stressor), Or Separation Anxiety Disorder (e.g ., in response to being away from home or
Close relatives).
Agoraphobia Without Histo ry of Panic Disorder is characterized by the
presence Of Agoraphobia and panic-like symptoms without a history of
unexpected Panic Attacks.
A. The presence of Agoraphobia (see p. 433) related to fea r of developing
panic-like Symptoms (e.g., dizziness or diarrhea).
B. Crit eri a have never been met for Panic Disorder (see p. 440).
C. The disturbance is not due to t he direct physiological effects of a
substance (e.g., a drug of abuse. A medication) or
a genera l medical condition. D. If an associated general medical
condition is present. The fear described in Criterion A
Is clearly in excess of that usually associated with the cond ition.
Some cultural or ethnic groups restrict the participation of women in public life, and
This must be distinguished from Agoraphobia. This di sorder is diagnosed fa r more often
In females than in males. In clinica l settings, almost all individuals (over
95%) who present with Agoraphobia Also have a current diagnosis (or hislory) of Panic Disorder. In contrast, the prevalence Of agoraphobia Without Hislory of Panic
Disorder in epidemiological samples Has been reporled 10 be higher than that for Panic Disorder With Agoraphobia. However, Problems with assessment appear to have
inflated the rates reported in epidemiological Studies. Recently, indi vidu als who were given
a diagnosis of Agoraphobia Without History of Panic Disorder in an
epidemiological study were reevaluated by Clinicians using standard interview schedules.
The majority were found to have Specific Phobias, but not Agoraphobia.
Panic Disorder With Agoraphobia A. Both (1) and (2): (1) recurrent unexpected Panic Attacks
(see p. 432) (2) at least one of the attacks has been followed by 1 month (or more) of one
(or More) of the following:
(a) persistent concern about having additional attacks
(b) worry about the implications of the attack or its consequences (e.g., losing Control, having a heart attack, "going
crazy" ) (c) a significant change in behavior
related to the attacks B. The presence of Agoraphobia (see p.
433). C. The Panic Attacks are not due to the
direct physiological ehects of a
Some cultural or ethnic groups restrict the participation of women in public life, and
this must be distinguished from Agoraphobia. This di sorder is diagnosed fa r more often
in females than in males.in clinica l settings, almost all individuals (over 95%) who present
with Agoraphobia also have a current diagnosis (or hislory) of
Panic Disorder
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substance (e.g ., A drug of abuse, a medication) or a
general medical condition (e.g., hyperthyroid·
Ism) . D. The Panic Attacks are not better accounted for by another mental
disorder, such as Socia l Phobia (e.g., occurring on
exposure to feared social situations), Specific Phobia
(e.g ., on exposure to a specific phobic situation), Obsessive-Compulsive
Disorder (e.g ., on exposure to dirt in someone
with an obsession about contamination), Posttraumatic
Stress Disorder (e .g ., in response to stimuli associated with a severe
stressor), Or Separation Anxiety Disorder (e.g ., in response to being away from home or
Close relatives).
Specific Phobia is characterized by clinically significant anxiety provoked by
exposure To a specific feared object or situation, often leading to avoidance behavior.
Animal Type. This subtype should be
specified if the fea r is cued by animals Or insects. This subtype generally has a
childhood onset. Natural Environment Type. This subty pe
should be speci fied if the fear is Cued by objects in the namral
environment, such as storms, heights, or water.
This subtype generally has a childhood onset.
Blood-Inj ection-Inju ry Type. Nus subtype should be specified if the fear is Cued by seeing blood or an injury or by receiving an injection or other invasive
Medical procedure. This subtype is highly familial and is often characterized
By a strong vasovagal response. Situation al Type. This sub type should
be specified if the fear is cued by a Specific situation such as public transportation, hmnels, bridges,
A. Marked and persistent fear that is excessive or unreasonable, cued by the
presence Or anticipation of a specific object or
situation (e.g., flying, heights, animals, receiving
An injection, seeing blood). B. Exposure to the phobic stimulus
almost invariably provokes an immediate anxiety response,
Which may take the form of a situationa lly bound or situationally predisposed
Panic Attack. Note: In children, the anxiety may be expressed by crying,
Tantrums, freezing, or clinging. C. The person recognizes that the fear is
excessive or unreasonable. Note: In children,
This feature may be absent. D. The phobic situation(s) is avoided or else is endured with intense anxiety or
distress. E. The avoidance, anxious anticipation,
or distress in the feared situation(s) interferes
Significantly with the person's normal routine, occupational (or academic)
function -
The ratio of women to men with Specific Phobias is approximately 2:1,
Even among the elderly. However, the sex ratio varies across different types of Spe.-
Cific Phobias. Approximately 750/0-90% of individuals with the Animal and Natural
Environment Type are female (except for feilr of heights, where the percentage of
Females is 550/0-70%). Similarly, approximately 75°/0-90% of individuals with the Sit·
Ua tional Type are female. Approximately 55°/0-70% of individua ls with the Blood·
Lnjection·Injury Type are female. Although phobias are common in the general
population, they rarely result in sufficient Impairment or distress to warrant a diagnosis
of Specifi c Phobia. The reported Prevalence may vary depending on the
threshold used to determine impairment or Distress and the number of types of phobias
surveyed. In community samples, cufrent Prevalence rates range from 4% to 8.8%, and
lifetime prevalence rates range from 7.2% to 11.3%. Prevalence rates decline in the
elderly. Also, prevalence estimates vary For different types of Specific Phobias.
ANXIETY DISORDERS
elevators, fi ying, Driving, or enclosed places. This subtype has a bimoda l age-at-onset distribution, With one peak in childhood and another
peak in the mid-20s. Nus Subtype appears to be similar to Panic
Disorder With Agoraphobia in its characteristic
Sex ratios, familial aggregation pattern, and age at onset.
Other Type. This subtype should be specified if the (ear is cued by other
Stimu li. These stimuli might include the fear of choking, vomiting, or contracting
An iuness; "space" phobia (Le., the individual is afraid of falling down if Away from walls or other means of
physical support); and children's fears of Loud sounds or costumed characters.
Ing, or social activities or relationships, or there is marked distress about having
the Phobia.
F. In individuals under age 18 years, the duration is at least 6 months .
•
Social Phobia is characterized by cl inically significant anxiety provoked by
exposure To certain types of social or
performance situa tions, often leading to avoidance
Behavior.
A. A marked and persistent fear of one or more social or performance
situations in which the person is exposed to unfamil
iar people or to possible scrutiny by others.
The individual fears that he or she will act in a way (or show anxiety
symptoms) that will be humil iat ing or embarrassing.
Note: In children, there must be evidence of
the ca pacity for age-appropriate social relationships with familiar people and
the anxiety must occur in peer settings, not
just in interactions with adu lts. B. Exposure to the feared social
situation almost invariably provokes anxiety, which
may t ake the form of a situationally bound or situation ally predisposed
Panic Attack. Note: In children, the anx iety
may be expressed by crying, tantrums, freezing,
or shrinking from social situations wit h unfamiliar people.
C. The person recognizes that the fear is excessive or unreasonable. Note: In
children, this feature may be absent.
In children, crying, tantrums, freezing. Clinging or s taying d ose to a familiar person,
And inhibited interactions to the point of mutism may be present. Young children
May appear excessively timid in unfamiliar social settings, shrink from contact with
O thers, refu se to participate in group play, typically stay on the periphery of social ac·
Ti vil'ies, and attempt to remain dose to familiar adults. Unlike adults, children with
Social Phobia usually do not have the option of avoiding feared situations altogether and may
be unable to identify the nature of their anxiety. There may be a decline in
Classroom performance, school refu sal, or avoidance of age-appropriate socia l activities And dating. To make the diagnosis in children,
there must be evidence of capacity For social relationships with famili ar people
and the social anxiety must occur in Peer settings, not jus t in interactions with
adults. Because of the disorder's earl y onset And chronic course, impairment in child ren tends to take the form of failure to achieve
An expected level of functioning, rather than a decline from an optimal level of functioning.
In contras t, when the onset is in ado lescence, the disorder may lead to decrements In social and academic performance.
Epidemiological and community-based studies suggest tha t Socia l Phobia is more
Common in women than in men. In mos t
ANXIETY DISORDERS
D. The feared socia l or performance situations are avoided or else are
endured with intense anxiety or distress.
E. The avoidance, anxious ant iCipation, or distress in t he feared social or
performance situation(s) interferes significantly with
the person's normal routine, occupational
(academic) functioning, or soc ial activities or relatio nships, or there is
marked dist ress about having the phobia.
F. In ind iv iduals unde r age 1B years, the duration is at least 6 months.
G. The fea r or avoidance is not due to the direct physiolog ical effects of a
substance (e.g., a drug of abuse. a medication) or a
general medical condit ion and is not better
accounted fo r by another mental disorder (e.g ., Panic Disorder With or
Without Agoraphobia. Separation Anx iety
Disorder, Body Dysmorphic Disorder, a Pervasive
Developmental Disorder, or Schizoid Personal ity Disorder).
H. If a genera l medical condition or another mental disorder is present, the
fear in Crite rion A is unrelated to it, e .g., the fea r is
not of Stuttering, t rembling in Parkinson's
disease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia
Nervosa .
Specify if: Generalized: if the fears include most
social situations (also consider the additional
diagnosis of Avoidant Personality Disorder)
clinical samples, however, the sexes are either Equally represented or the majority a re male. Epidemiological and community-based studies
have reported a lifetime prevalence of Social Phobia ranging from 3% to 13%. The
reported prevalence may vary depending on the threshold used to determine distress or
impairment and the number of types of social situations specifically surveyed.
In one study. 20% reported excessive fear of public speaking and performance, but
only about 2% appeared to experience enough impairment or distress 10 warrant a d
iagnOSiS of Social Phobia. In the genera l population, most individuals with Socia l Phobia
fear public speaking, whereas somewhat less than half fear speaking to s trangers or meeting new people. Other performance
fears (e.g., eating, drinking. or writing in public, o r using a public restroom)
appear to be less common. In clinical settings, the vast majority of persons with Social
Phobia fear more than one type of social s itua tion. Social Phobia is rarely the reason for admission to inpatient settings. In
outpatient clinics. ra tes of Social Phobia have ranged between 10% and 20% of individua ls
with Anxiety Disorders, but rales vary widely by site.
Obsessive-Compulsive Diso rder is characterized by obsessions (which
cause Marked anxiety or distress) and / or by compulsions (which serve to neutralize
A. Either obsessions or compulsions: Obsessions as defined by (1), (2), (3),
and (4): (1) recurrent and persistent thoughts,
impulses, or images that are
Community studies have estimated a life time prevalence of 2.5% and a I -year prevalence
of 0.5%- 2.1% in adults. However, methodological problems with the assessment
tool used raise the possibility that the true p
ANXIETY DISORDERS
anxiety). experienced, at some time during the disturbance, as intrusive and inappropriate and that
cause marked anxiety or distress
(2) the thoughts, impulses, or images are not simply excessive worries about
reallife problems
(3) the person attempts to ignore or suppress such thoughts, impulses, or
images, or to neutralize them with some other
thought or action (4) the person recognizes that the obsessional thoughts, impulses, or
images are a product of his or her own mind (not imposed from without as in thought
insertion) Compulsions as defined by (1) and (2):
(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental
acts (e.g., praying, cou nting, repeating
words silently) that the person feels driven
to perform in response to an obsession, or according to rules that must be
applied rigidly
(2) the behaviors or mental acts are aimed at preventing or reduCing dist
ress or preventing some dreaded event or situation;
however, these behaviors or mental acts either are not connected in a realistic way with what they are
designed to neutralize or prevent or are clearly
excessive 8. At some point during the course of
the disorder, the person has recogn ized that the
obsessions or compulsions are excessive or unreasonable. Note : Th is does not
apply to children. C. The obsessions or
compulsions cause marked dist ress, are time consuming (t ake more
than 1 hour a day), or significantly
revalence rates are much lower. Conununity studies of children and adolescents
have estimated a lifetime preva lence of 10/0-2.3% and a I-year prevalence of 0.7%.
Research indicates that prevalence rates of Obsessive-Compulsive Disorder are similar in
many differen t cultures around the world. In ad ults, this disorder is equally
common in males and females. However, in childhood-onset Obsessive-Compulsive
Disorder, the disorder is more common in boys than in girls.
ANXIETY DISORDERS
interfere wit h the person's normal routine, occupational
(or academic) funct ioni ng, or usual socia l activit ies or relat ionships.
D. If another Axis I disorder is present, th e content of t he obsessions or
compulsions is not restricted to it (e.g .. preoccupation with food in the presence of an Eat ing
Disorder; hair pulling in t he presence of Trichoti ll omania; concern with appearance in the presence of Body Dysmorphic Disorder;
preoccupation with drugs in t he presence of
a Subst ance Use Disorder; preoccupation wit h having a serious ill
ness in the presence of Hypochondriasis; preoccupation with
sexual urges or fa ntasies in the presence of
a Paraph ilia; or guilty ruminations in the presence of Major De pressive
Disorder). E. The distu rba nce is not due t o the
direct physiological effects of a substance (e.g .. a
drug of abuse, a medicat ion) or a general medica l condition.
Specify if: With Poor Insight: if, for most of the time during the current e pisode, the
person does not recognize that t he obsessions
and compulsions a re excessive or unreasona
ble
Posttraumatic Stress Disorder is characterized by the reexperiencing of
an extremely Traumatic event accompanied by
symptoms of increased arousal and by Avoidance of stimuli associated with the
trauma.
A. The person has been exposed to a traumatic event in which both of the
following were present:
(1) the person experienced, witnessed, or was confronted with an event or
events that involved actual or threatened
death or serious injury, or a threat to the
physica l integrity of self or others (2) the person's response involved
intense fear, helplessness, or horror. Note: In
In younger children, distressing dreams of the event may, within several weeks,
change into generalized nightmares of monsters, of rescuing others, or of threats to seU or others. Young children usually do not
have the sense that they are reliving the past; rather, the reliving of the trauma may occur through repetitive play (e.g., a child who was involved in a serious automobile accident repeatedly reenacts car crashes
with toy cars).
ANXIETY DISORDERS
children, this may be expressed instead by disorganized or agitated behaviour A. The person has been exposed to a traumatic event in which both of the
following were present:
(1) the person experienced, witnessed, or was confronted with an event or
events that involved actual or threatened
death or serious injury, or a threat to the
physica l integrity of self or others (2) the person's response involved
intense fear, helplessness, or horror. Note: In
children, this may be expressed instead by disorganized or agitated behavior
• Anxiety Disorders
Diagnostic criteria for 309.81 Posttraumatic Stress Disorder
(continued) B. The traumatic event is persirtently reexperienced in one (or more) of the
following ways:
(1) recurrent and intrusive distressing recollections of the event, including
images, thoughts, or perceptions. Note: In you ng children, repetitive play may occur
in which themes or aspects of the trauma are expressed.
(2) recurrent dirtressing dreams of the event. Note: In children, there may be
frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recu rring (i ncludes a sense
of reliving the experience, illusions,
hallucinations, and dissociative flashbac k episodes,
including those that occu r on awakening or when intoxicated). Note:
In young ch ildre n, trauma-specific reenactment may occur.
(4) intense psychological dirtress at exposure to interna l or externa l cues
that symbol
ANXIETY DISORDERS
ize or resemble a n aspect of the traumat ic event
(5) physiological reactivity on exposure to internal or external cues that symbol
ize or resemble an aspect of the traumatic
event C. Persistent avoidance of rtimuli associated with the trauma and
numbing of general responsiveness (not present before the trauma), as indicated by three (or more)
of the follow ing :
(1) efforts to avoid thoughts, fee lings, or conversations associated with the
trauma (2) efforts to avoid activities, places, or people that a rouse recollections of the
trauma (3) inability to recall an important
aspect of the trauma (4) markedly diminished interest or participation in significant activities
(5) fee ling of detachment or ertrangement from ot hers
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career,
mar· riage, chi ldren, or a normal life spa n) D. Persistent symptoms of increased a
rousa l (not present before the trauma), as indicated
by two (or more) of the following: (1) difficulty fall ing or staying asleep (2) irritability or outbursts of anger
(3) diffic ulty concentrating (4) hypervigilance
(5) exaggerated startle response E. Duration of the disturbance
(symptoms in Criteria B, C, and 0 ) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in
social, occupational, or other importa nt areas of fu nct
ioning. Specify if:
Acute: if durat ion of symptoms is less
ANXIETY DISORDERS
than 3 months Chronic: if duration of symptoms is 3
mont hs or more Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the
stressor
Acute Stress Disorder is characterized by symptoms similar to those of
Posttraumatic Stress Disorder that occur immediately
in the aftermath of an extremely traumatic
Event.
A. The person has been exposed to a t raumatic event in which both of the
following were present:
(1) the person experienced, witnessed, or was confronted with an event or
events that involved actual or threatened
death or serious injury, or a threat to the
physical integrity of self or others (2) the person's response involved in tense fea r, helplessness, or horror
B. Either whi le experiencing or after experi encing the distressing event, the
individual has three (or more) of the fol lowing
dissociative symptoms: (1) a subjective sense of numbing,
detachment, or absence of emotional responsiveness
(2) a reduction in awareness of his or her surround ings (e.g., "being in a daze
") (3) derealization
(4) depersona lization (S) dissociative amnesia (i .e., inability to
recall an important aspect of the trauma) C. The traumatic event is
persistently reexperienced in at least one of the following
ways: recurrent images, tho ughts, dreams, illusions, flashba ck episodes,
or a sense of reliving the experience; or d istress on
exposure to reminders of the traumatic event.
D. Marked avoidance of stimuli that arouse reco llections of the trauma (e.g
., thoughts, fee lings, conversations, activities,
places, people). E. Marked symptoms of anxiety o r increased arousa l (e.g., difficulty
The prevalence of Acute Stress Disorder in a population exposed to a seriolls traumatic
stress depends on the severity and persistence of the trauma and the degree of
exposure to it . The prevalence of Acute Stress Disorder in the general population is
not known. In the few available studies, rates ranging from 14% to 33% have been
reported in individuals exposed to severe tralUna (i.e., being in a motor vehicle accident,
being a bystander at a mass shooting).
ANXIETY DISORDERS
sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor
restlessness). F. The disturbance causes clinica ll y significant distress or im pairment in
social, occupationa L or other important areas of
functioning or impairs the individual's ability to
pu rsue some necessary task, such as obtaining nece ssary assistance or mobi
lizing personal resources by t el ling family members
about the t raumatic experience. G. The distu rbance lasts for a minimum
of 2 days and a maximum of 4 weeks and occurs
within 4 weeks of the traumatic event. H. The d ist urbance is not due to the di rect physiological effects of a su bstance
(e.g., a d rug of abuse, a medication) or a
genera l medical condition, is not better account ed
fo r by Brief Psychotic Disorder, and is not merely an exacerbation of a
preexisting Axis I or Axis II disorder.
Generalized Anxiety Disorder is characterized by at least 6 months of
persisten t And excessive anxiety and worry.
A. Excessive anxiety and worry (apprehensive expectation), occurring
more days than not for at least 6 months, about a
number of events or activities (such as work or
school performance). B. The person f inds it difficult to control
the worry. C. The anxiety and worry are associated
with three (or more) of the follow ing six symptoms
(with at least some symptoms present for more days than not for the past 6 months), Note: Only one item is
required in chi ldren. (1) restlessness or feeling keyed up or
on edge (2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
In clinical settings, the disorder is diagnosed somewha t mo re frequently in women than in men (about 550/0-60% of those
presenting with the disorder are female). In epidemiological studies, the sex ratio is approxima tely two-thirds female. In a
community sample, the l -year prevalence ra te for Generalized Anxiety Disorder
was approximately 3%, and the lifetime prevalence rate was 5%. In anxiety disorder
clinics, up to a quarter of the ind ividuals have Generalized Anxiety Disorder as a presenting
or comorbid diagnosis.
ANXIETY DISORDERS
iAmerican Psychiatric Association: Diagnostic and Statistical MaJlJlal of Mf'Jl ta/ Disorders, Fourth Edition, Text Re,rision .. Washington, DC, American Psychiatric Association, 2000
(5) muscle tension (6) sleep disturbance (difficulty fall ing
or staying asleep, or restless unsatisfying
sleep) O. The focus of the anxiety and worry is not confined to features of an Axis I d
isorder, e.g ., the anxiety or worry is not about
having a Panic Attack (as in Panic Disorder),
being embarrassed in public (as in Socia l Phobia), being contaminated (as in
Obsessive ·Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in
Anorexia Nervosa), having multiple physical
complaints (as in Somatization Disorder), or havin g a serious illness (as
in Hypochon· driasis), and the anxiety and worry do
not occur exclusively during Posttraumatic
Stress Disorder. E. The anxiety, worry, or physical
symptoms cause clinically significant distress or impa
irment in social, occu pational, or other important areas of fu nctioning.
F. The disturbance is not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g.,
hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or
a Pervasive Developmental Disorder.