Anxiety in the DSM-5
04 Aug 2023The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
The DSM-5 is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association. Following are the classifications of anxiety in the DSM-5.
Generalised Anxiety Disorder (GAD)
Generalised Anxiety Disorder is characterised by excessive and uncontrollable worry about various aspects of life, such as work, health, relationships, and daily situations. This chronic anxiety is often accompanied by restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances. The worry is disproportionate to the actual situation and persists for at least six months.
Panic Disorder
Panic Disorder involves recurrent, unexpected panic attacks — sudden surges of intense fear or discomfort that reach a peak within minutes. These attacks can lead to significant apprehension about future attacks, causing behavioural changes. Physical symptoms during panic attacks may include heart palpitations, sweating, trembling, shortness of breath, and a feeling of impending doom.
Social Anxiety Disorder (SAD)
Also known as social phobia, Social Anxiety Disorder revolves around intense fear of social situations where one might be exposed to scrutiny or evaluation by others. This fear can lead to avoidance of social gatherings, public speaking, or even day-to-day interactions. Physical symptoms often include blushing, trembling, sweating, and nausea.
Specific Phobias
Specific Phobias involve intense, irrational fears of particular objects or situations, such as heights, spiders, flying, or enclosed spaces. Exposure to the feared stimulus provokes immediate anxiety and can lead to avoidance behaviour. Individuals with specific phobias recognise that their fear is excessive, but it’s beyond their control to manage the anxiety.
Agoraphobia
Agoraphobia centers on fear and avoidance of situations where escape might be difficult or help might not be available in the event of a panic attack or other distressing symptoms. This can lead to avoidance of crowded places, public transportation, or being outside the home alone. Agoraphobia is often accompanied by Panic Disorder.
Separation Anxiety Disorder
More commonly seen in children, Separation Anxiety Disorder involves excessive fear or anxiety about separation from home or attachment figures. These individuals may worry excessively about the well-being of their loved ones when apart, leading to distress and avoidance of separation situations.
Selective Mutism
Most often diagnosed in children, Selective Mutism is characterised by consistent failure to speak in specific social situations where there is an expectation to speak, despite speaking in other settings. This condition goes beyond shyness and can significantly impair communication and social interactions.
Substance/Medication-Induced Anxiety Disorder
This type of anxiety is triggered by substance abuse, withdrawal from substances, or exposure to certain medications. The anxiety symptoms closely resemble those of other anxiety disorders. It’s crucial to differentiate whether the anxiety is due to the substance/medication or if it exists independently.
Anxiety Disorder Due to Another Medical Condition
This type of anxiety arises as a result of a medical condition, such as a heart condition, thyroid issues, or neurological disorders. The anxiety symptoms are a direct consequence of the underlying medical condition and may improve with effective management of that condition.
Other Specified and Unspecified Anxiety Disorders
These categories are used when a person’s symptoms do not neatly fit into any of the specific anxiety disorder classifications. Other Specified Anxiety Disorder is applied to atypical presentations, while Unspecified Anxiety Disorder is used when the symptoms do not meet the criteria for any specific subtype.
Summary for Diagnosing Anxiety with the DSM-5
The DSM-5 outlines various types of anxiety disorders, each with its distinct characteristics. Generalised Anxiety Disorder involves chronic and excessive worry, while Panic Disorder encompasses sudden and intense panic attacks. Social Anxiety Disorder centers on the fear of social evaluation, and Specific Phobias involve intense fears of specific objects or situations. Agoraphobia involves fear of situations where escape might be difficult, and Separation Anxiety Disorder is characterised by distress about separation from attachment figures. Selective Mutism pertains to consistent failure to speak in certain social contexts. Substance/Medication-Induced and Medical Condition-Related Anxiety Disorders are triggered by substances, medications, or medical conditions. Other Specified and Unspecified Anxiety Disorders are used for cases that don’t align well with other categories. Recognising these classifications aids in accurate diagnosis and appropriate treatment for individuals experiencing various forms of anxiety.