Anxiety Disorders Overview

Anxiety Disorders

• Panic Disorders: Discrete periods of intense fear or discomfort (10 minutes). Requires 4/13 symptoms, including palpitations, sweating, trembling, shortness of breath, choking, chest pain, dizziness, depersonalization, fear of losing control, or dying. Can be expected (cued) or unexpected (uncued). Cued by exposure to fear object/situation or anticipation. Uncued have no trigger. Diagnosis involves recurrent, unexpected panic attacks, and a month of concern about additional attacks or implications.
• Agoraphobia: Fear of being in public spaces/situations where escape is difficult. Often accompanies panic disorder.
• Generalized Anxiety Disorder: Excessive worry about potential threats, catastrophes, uncertainties, and risks. Excessive time worrying and feeling anxious, not confined to other disorders. Symptoms include restlessness, feeling keyed up, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbances.
• Social Anxiety Disorder: Persistent fear of social/performance situations where embarrassment might occur. Exposure to/anticipation of feared situations provokes anxiety and fear. Feared situations are avoided or endured with significant distress.
• Specific Phobias: Persistent fear of discernible, circumscribed objects/situations. Exposure/anticipation triggers anxiety/fear. Subtypes recognized by DSM-5 include animals, natural environment, blood-injection-injury, situational, and other.

Obsessive-Compulsive & Related Disorders

• Obsessive-Compulsive Disorder (OCD): Obsessions and compulsions that consume more than an hour per day or cause significant distress/impairment. Obsessions are recurrent/persistent thoughts, urges, or images. Compulsions are repetitive behaviors or mental acts to prevent/reduce anxiety.
• Body Dysmorphic Disorder (BDD): Excessive preoccupation with perceived physical flaws. DSM-5 requires repetitive behaviors/mental acts due to perceived flaws, comparing, camouflaging, mirror checking, grooming, touching, reassurance seeking, changing clothes, skin picking, dieting, tanning, and excessive exercise. Discomfort related to "incompleteness."
• Hoarding Disorder: Persistent difficulty parting with possessions, causing distress/impairment. Associated with perceived need to save items.
• Trichotillomania (Hair-Pulling Disorder): Recurrent hair pulling resulting in hair loss. Sense of relief. Negative affective states: perceived unattractiveness, secretiveness, shame, irritability, and low self-esteem.
• Excoriation Disorder (Skin-Picking Disorder): Recurrent skin picking resulting in skin lesions.

Trauma & Stress-Related Disorders

• Posttraumatic Stress Disorder (PTSD): Resulting from a life-threatening event. Requires a history of exposure to a traumatic event, resulting in symptoms across four clusters: intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. Additional criteria concern duration, functioning, and differential diagnosis. Criterion A details a traumatic event. Criterion B-E encompasses each cluster. Intrusion involves involuntary memories, nightmares, dissociative reactions, etc. Avoidance concerns thought/feeling avoidance and avoidance of people, places, activities, reminders. Negative alterations involve distorted self/world views, persistent emotions, estrangement, and lack of interest in previous activities. Arousal/reactivity involves irritability/aggression, self-destructive behaviors, sleep issues, hypervigilance, and concentration problems. Diagnosis necessitates a symptom from each cluster for 1 month and at least 2 symptoms from criterion D and 2 from criterion E. "With dissociative symptoms" and "delayed expression" are additional specifiers.
• Acute Stress Disorder: Requires antecedent traumatic event (Criterion A). Within three months of exposure. Symptoms mirror PTSD criteria (B-E). Criteria include negative mood, intrusive thoughts, dissociation, avoidance, anxiety. Symptoms duration (C), functioning (D), co-occurring conditions are details. Symptoms must be accompanied by significant distress/impairment and aren't about normal bereavement. Symptoms do not persist for more than 6 months after the stressor ends.

Mood Disorders: Depressive Disorders

• Major Depressive Disorder (MDD): Characterized by at least one major depressive episode (MDE) without a prior history of mania. MDE is associated with depressed mood or lack of interest (anhedonia). Includes 3/9 possible symptoms: depressed mood, anhedonia, changes in appetite and sleep, psychomotor agitation and slowing, loss of energy, decreased concentration, thoughts of death or suicide, and feelings of worthlessness.
• Persistent Depressive Disorder (Dysthymia): Less severe than MDD, requiring fewer symptoms over a longer period (2 years). Symptoms must be present for two years, minimal two months symptom-free. Might include MDE but no mania.

Mood Disorders: Bipolar Disorders

• Bipolar Disorders (Bipolar I and II): Defined by manic symptoms (excessive elation, grandiosity, hyperactivity), with varying degrees of severity. DSM-5 manic episodes last a week and involve decreased need for sleep, racing thoughts, rapid speech, inflated self-esteem, and impulsive reckless behavior. Hypomania has similar symptoms but lasts four days or more. Other mood symptoms from MDDs (depression) might occur simultaneously causing mixed features and co-occurring symptoms.

Other Disorders

• Eating Disorders:
  • Anorexia Nervosa (AN): Characterized by low weight, distorted body image, and lack of recognition of seriousness of low body weight.
  • Bulimia Nervosa (BN): Involves recurrent binge-eating episodes followed by compensatory behaviors like vomiting or laxative misuse.
  • Binge Eating Disorder (BED): Persistent binge-eating episodes with a sense of lack of control.
• Cyclothymic Disorder: Characterized by 2+ years of frequent alternating hypomanic and depressive symptoms that don't meet full BD criteria.
• Unspecified Bipolar Disorder: Patients who meet some but not all bipolar disorder criteria.
• Other Specified Feeding or Eating Disorder (OSFED): symptoms characteristic of a feeding or eating disorder but do not meet full criteria for any specific disorder.

Schizophrenia

• Schizophrenia: Diagnostic considerations include work, social, or self-care impairments. Positive symptoms (hallucinations, delusions, disorganized speech/behavior) and negative symptoms (flat affect, apathy, lack of motivation) for at least 6 months. Delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior, and negative symptoms are part of the diagnosis.