DSM 5 Anxiety Disorders (A complete guide)

In this brief guide, we will discuss some of the most prominent DSM 5 anxiety disorders and their diagnostic criteria.

DSM 5 Anxiety Disorders

DSM 5 Anxiety disorder include the following disorders:

• Separation Anxiety Disorder
• Selective Mutism
• Specific Phobia
• Social Anxiety Disorder
• Panic Disorder
• Agoraphobia
• Generalized Anxiety Disorder
• Substance/Medication Induced Anxiety Disorder
• Anxiety disorder due to another Medical Condition

There are three disorders included in the DSM 5 anxiety disorders chapter that are not given in the other major classificatory system, which is the ICD 10, or the international classification of disorders.

The ICD 10 also mentions somatoform disorders, obsessive-compulsive disorder, adjust disorder, and mixed anxiety and depression disorder under the classification of anxiety disorders whereas the DSM 5 anxiety disorders chapter does not include these and they may be separate and distinct chapters.

Now that we know what the DSM 5 anxiety disorders are, let us take a look at the diagnostic criteria for each one to understand it better.

Separation Anxiety Disorder

The diagnostic criteria for Separation anxiety disorder in the DSM 5 Anxiety disorders chapter is given as follows:

“Developmentally inappropriate and excessive fear or anxiety concerning separation from

those to whom the individual is attached, as evidenced by at least three of the following:

• Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.

• Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
• Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure. 
• Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
• Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
• Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
• Repeated nightmares involving the theme of separation.
• Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.”

The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.

The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder, or concerns about having an illness in illness anxiety disorder.

Selective Mutism

Selective mutism is another disorder that is present in the DSM 5 anxiety disorders chapter and is included in childhood disorders in the ICD 10, which is because it is diagnosed mostly in children, though it is not impossible for it to not occur in adults.

Selective mutism is similar to Elective mutism, but the two should not be mixed up as the codes and names matter when the questions of insurance or other administrative things are present.

The diagnostic criteria for Selective Mutism in the DSM 5 anxiety disorders chapter are given as follows:

• “Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.
• The disturbance interferes with educational or occupational achievement or with social communication.
• The duration of the disturbance is at least 1 month (not limited to the first month of school).

The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

• The disturbance is not better explained by a communication disorder (e.g. childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.)”

Specific Phobia

Specific Phobia is common to both DSM 5 anxiety disorders as well as ICD 10 Neurotic and Stress-related disorders, and the diagnostic criteria for this category are given below:

• “Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

• Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.

• The phobic object or situation almost always provokes immediate fear or anxiety.

• The phobic object or situation is actively avoided or endured with intense fear or anxiety.

• The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.

• The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).”

In specific phobias, there are Codes based on the phobic stimulus, which go something along these lines:

• “300.29 (F40.218) Animal (e.g., spiders, insects, dogs).

• 300.29 (F40.228) Natural environment (e.g., heights, storms, water).

• 300.29 (F40.23x) Blood-injection-injury (e.g., needles, invasive medical procedures).

• 300.29 (F40.248) Situational (e.g., airplanes, elevators, enclosed places).

• 300.29 (F40.298) Other (e.g., situations that may lead to choking or vomiting; in children, e.g., loud sounds or costumed characters).”

Social Anxiety Disorder

Social anxiety disorder is another category that is common to both DSM 5 anxiety disorders chapter as well as the ICD 10 anxiety disorders.

The diagnostic criteria for Social Anxiety Disorder are as follows:

• “Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drink- ing), and performing in front of others (e.g., giving a speech).

• Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

• Social situations almost always provoke fear or anxiety.

• Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

• The social situations are avoided or endured with intense fear or anxiety.

• The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the socio-cultural context.

• The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

• The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

• If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from bums, or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

• Specify if:

• Performance only: If the fear is restricted to speaking or performing in public.”

Social anxiety disorder is also referred to as a Social Phobia.

Panic Disorder

The diagnostic criteria for Panic disorder in the DSM 5 anxiety disorders chapter are given as follows:

“Recurrent unexpected panic attacks. 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 following symptoms occur:

Note: The abrupt surge can occur from a calm state or an anxious state.

• Palpitations, pounding heart, or accelerated heart rate.
• Sweating.
• Trembling or 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 (feelings of unreality) or depersonalization (being detached from oneself).
• Fear of losing control or “going crazy.”
• Fear of dying.”

“Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

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 (e.g., losing control, having a heart attack, “going crazy”).

• A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).

• The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).

• The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).”

If you’re facing this, it may be a good idea to seek the help of a therapist or other mental health professional. You can find a therapist at BetterHelp who can help you learn how to cope and address it.

Agoraphobia

Agoraphobia is also common to both DSM 5 Anxiety Disorders as well as the ICD 10, and the diagnostic criteria are given below:

“Marked fear or anxiety about two (or more) of the following five situations:

• Using public transportation (e.g., automobiles, buses, trains, ships, planes).
• Being in open spaces (e.g., parking lots, marketplaces, bridges).
• Being in enclosed places (e.g., shops, theaters, cinemas).
• Standing in line or being in a crowd.
• Being outside of the home alone.

The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence).

• Agoraphobic situations almost always provoke fear or anxiety.

• The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

• The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the socio-cultural context.

• The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• If another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly excessive.

• The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder—for example, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder), and are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived defects or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety disorder).”

Generalized Anxiety Disorder

Generalized Anxiety disorder is one of the most common types of anxiety disorders and therefore it is very important to know the diagnostic criteria for this disorder, which according to DSM 5 anxiety disorders are:

“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).

The individual finds it difficult to control the worry.

The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item is required for children.

• Restlessness or feeling keyed up or on edge.
• Being easily fatigued.
• Difficulty concentrating or mind going blank.
• Irritability.
• Muscle tension.
• Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder (social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).”

Anxiety isn’t just suffered by people. Animals also suffer from anxiety and there are various treatment options available over the counter or by prescription for your pets. The Vetpro stress and anxiety treatment is very common for dogs and cats suffering from stress or anxiety.

Substance/Medication Induced Anxiety Disorder

The DSM 5 anxiety disorders category has another disorder that is not found in the ICD 10 category for anxiety disorders, and that is Substance or Medication-induced Anxiety disorder, the diagnostic criteria for which are given below:

“Panic attacks or anxiety are predominant in the clinical picture.

There is evidence from the history, physical examination, or laboratory findings of both

(1) and (2):

The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.

The involved substance/medication is capable of producing the symptoms in Criterion A

The disturbance is not better explained by an anxiety disorder that is not substance/ medication-induced. Such evidence of an independent anxiety disorder could include the following:

• The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced anxiety disorder (e.g., a history of recurrent non-substance/medication-related episodes).

• The disturbance does not occur exclusively during the course of a delirium.

• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Anxiety disorder due to another Medical Condition

The last class in the DSM 5 anxiety disorders category is that of Anxiety disorders due to another medical condition, and the diagnostic criteria for this are:

• “Panic attacks or anxiety are predominant in the clinical picture.

• There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

• The disturbance is not better explained by another mental disorder.

• The disturbance does not occur exclusively during the course of a delirium.

• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Conclusion

In this brief guide, we discussed some of the most prominent DSM 5 anxiety disorders and their diagnostic criteria.

Anxiety disorders can seem threatening and something that a lot of people may not know exactly how to deal with, but gathering information from the DSM 5 anxiety disorder chapters can be a good first step towards reaching a place of transformation.

The idea behind discussing the DSM 5 anxiety disorders is just that, to educate more and more people and discuss ways in which anxiety can be resolved so that no one has to go through the experience of anxiety for no apparent reason.

Anxiety disorders are also subject of many theories such as the multidimensional anxiety theory which refers to sports psychology.

So if you have any questions or comments about anything related to this subject, or if you have further questions about the DSM 5 anxiety disorders discussed here, please feel free to reach out to us.

There are also various organisations such as Nofap who are dealing with social anxiety caused by things you may not even imagine could cause anxiety.

Frequently Asked Questions (FAQs): DSM 5 Anxiety Disorders

Citations

Diagnostic and Statistical Manual 5 (DSM 5)