Generalized Anxiety Disorder (GAD)
The DSM-5 criteria for GAD are as follows:
- The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months, and is clearly excessive.
- Excessive worry means worrying even when there is nothing wrong, or in a manner that is disproportionate to actual risk. This typically involves spending a high percentage of waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others.
In adults, the worry can be about job responsibilities or performance, one’s own health or the health of family members, financial matters, and other every day, typical life circumstances. Of note, in children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school).
- The worry is experienced as very challenging to control.
- Worry in both adults and children may shift from one topic to another.
- The anxiety and worry is associated with at least 3 of the following physical or cognitive symptoms (In children, only 1 symptom is necessary for a diagnosis of GAD.):
- Edginess or restlessness.
- Tiring easily; more fatigued than usual.
- Impaired concentration or feeling as though the mind goes blank.
- Irritability (which may or may not be observable to others).
- Increased muscle aches or soreness.
- Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep).
- The anxiety, worry, or associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships, at work, or in other important areas.
- These symptoms are unrelated to any other medical conditions and cannot be explained by the effect of substances including a prescription medication, alcohol or recreational drugs.
- These symptoms are not better explained by a different mental disorder.
A. Recurrent, unexpected panic attacks
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, going crazy).
2. 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).
C. The Panic Attacks are not restricted to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The Panic Attacks are not restricted to the symptoms of another mental disorder, such as Social Phobia (e.g., in response to feared social situations), Specific Phobia (e.g., in response to a circumscribed phobic object or situation), Obsessive-Compulsive Disorder (e.g., in response to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a traumatic event), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
DSM-5 criteria for agoraphobia include:
- Marked and out of proportion fear of the presence or anticipation of a specific situation
- Exposure to the phobic stimulus 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 out of proportion.
- The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
- The avoidance, anxious anticipation or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
Symptoms for all ages must have a duration of at least 6 months.
The anxiety, panic attack, or phobic avoidance associated with the specific situation is not better accounted for by another mental disorder.
Many of the physical symptoms of agoraphobia are also experienced in a panic attack and include nausea, dizziness, sweating, rapid heart rate, stomach upset, chest pains and diarrhea.