Anxiety Disorders

1. Anxiety Disorders Symptoms Checklist Presence of symptoms determines the assigning of a diagnosis

2. Panic Attack • Palpitation, 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, lightheaded, or faint • Derealization (feelings of unreality) or depersonalization (being detached from one’s self) • Fear of losing control or going crazy • Fear of dying • Paresthesias (numbness or tingling sensation) • Chills or hot flashes

3. Agoraphobia • Not a codable disorder • Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may both be available in the event of having an unexpected or situationally predisposed panic attack • The situations are avoided or else are endured with marked distress or with anxiety about having a panic attack

4. Panic Disorder without Agoraphobia • Recurrent unexpected panic attacks • Persistent concern about having another panic attack • Absence of agoraphobia

5. Panic Disorder with Agoraphobia • Recurrent unexpected panic attacks • Persistent concern about having another panic attack • Presence of agoraphobia

6. Specific Phobia (formerly simple phobia) • 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) • Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack • The person recognizes that the fear is excessive or unreasonable • The phobic situation is avoided or else is endured with intense anxiety or distress • The avoidance, anxious anticipation, or distress in the feared situations interferes significantly with the person’s normal routine, work, school, social activities, or relationships

7. Social Phobia • A marked or persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he/she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. • Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack. • The person recognizes that the fear is excessive or unreasonable. • The feared social or performance situations are avoided or else are endured with intense anxiety or distress. • Again, there is significant impairment in social, occupational, academic, or relationship functioning

8. Obsessive-Compulsive Disorder • Obsession • Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. • The thoughts, impulses, or images are not simply excessive worries about real-life problems. • The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some or thought or action. • The person recognizes that the obsessional thoughts, impulses or images are a product of his/her own mind (not imposed from without as in thought insertion)

9. Obsessive-Compulsive Disorder • Compulsion • Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly • The behaviors or mental acts are aimed at preventing or reducing distress 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.

10. Obsessive-Compulsive Disorder • At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. • Again, there is significant impairment in social, occupational, academic, or relationship functioning

11. Posttraumatic Stress Disorder • The person has been exposed to a traumatic event in which both of the following were present • 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 • The person’s response involved intense fear, helplessness, or horror.

12. Posttraumatic Stress Disorder • The traumatic event is persistently re-experienced in on or more of the following ways: • Recurrent and intrusive distressing recollections of the event including images, thoughts, or perceptions. • Recurrent distressing dreams of the event. • Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated. • Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. • Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

13. Posttraumatic Stress Disorder • Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three or more of the following: • Efforts to avoid thoughts, feelings, or converstaions associated with the trauma • Efforts to avoid activities, places, or people that arouse recollections of the trauma • Inability to recall an important aspect of the trauma • Markedly diminished interest or participation in significant activities • Feeling of detachment or estrangement from others • Restricted range of affect (e.g., unable to have loving feelings) • Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

14. Posttraumatic Stress Disorder • Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: • Difficulty falling or staying asleep • Irritability or outbursts of anger • Difficulty concentrating • Hypervigilance • Exaggerated startle response

15. Posttraumatic Stress Disorder • Duration of the disturbance is more than one month • The disturbance causes clinically significant distress or impairment in social occupational or other important areas of functioning.

16. Acute Stress Disorder • The person has been exposed to a traumatic event in which both of the following are present • The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others. • The person’s response involved intense fear, helplessness, or horror.

17. Acute Stress Disorder • Either while experiencing or after experiencing the distressing event, the individual has three or more of the following dissociative symptoms • A subjective sense of numbing, detachment, or absence of emotional responsiveness • A reduction in awareness of his/her surroundings (e.g., being in a daze) • Derealization • Depersonalization • Dissociate amnesia

18. Acute Stress Disorder • The traumatic event is persistently re-experienced in at least one of the following ways • Recurrent images • Thoughts • Dreams • Illusions • Flashback episodes • Sense of reliving the experiencing • Distress on exposure to reminders of the traumatic event

19. Acute Stress Disorder • Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, & people) • Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness) • The disturbance causes clinically significant distress or impairment in social occupational, or other important areas of functioning. • The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event. • The disturbance is not due to the direct physiological effects of a substance or a direct medical condition.

20. Generalized Anxiety Disorder • Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities or activities (such as work or school performance) • The person finds it difficult to control the worry

21. Generalized Anxiety Disorder • The anxiety and worry are associated with three (or more) of the following symptoms (for the past 6 months) • Restlessness or feelings keyed up or on edge • Being easily fatigued • Difficulty concentrating or mind going blank • Irritability • Muscle tension • Sleep disturbance (difficulty falling or staying asleep, restless unsatisfying sleep)

22. Generalized Anxiety Disorder • The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning.

23. Other Anxiety Disorders • Anxiety Disorders due to a General Medical Condition • Substance-induced Anxiety Disorder • Anxiety Disorder Not Otherwise Specified