Anxiety disorders afflict approximately 40 million Americans at an estimated annual cost of nearly 42 Billion dollars a year. The classifications of adult anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and commonly referred to as the DSM, have been updated and the revisions are reflected in the DSM- 5.
The DSM – 5 reflects significant changes in the way in which anxiety disorders are classified. In 2011, the Anxiety and Depression Association of America submitted a letter to the DSM Task Force . They expressed their concern about the purposed reclassification of anxiety disorders and related conditions and requested rationale that would justify these changes.
The proposed changes would remove Post- Traumatic Stress Disorder (PTSD) from the classification of anxiety disorders as well as Obsessive-Compulsive Disorder (OCD). To learn more, click here: http://www.adaa.org/about-adaa/position-papers/adaas-position-proposed-changes-dsm-5 The proposed revisions, controversy notwithstanding, were published in 2013 and, effective October 1, 2014, will impact how these disorders are diagnosed and subsequently reimbursed by insurance companies. To learn more, click here: http://www.adaa.org/understanding-anxiety/DSM-5-changes
This anxiety disorder can exist with or without agoraphobia . Symptoms include:
- Shortness of breath
- Heart palpitations
- Feelings of unreality
- Shaky limbs
- Gastrointestinal disturbances
- Fear of going insane
- Fear of dying
These, along with other symptoms, can result in dramatic episodes of acute anxiety. Experiencing four or more of these symptoms for more than one month meet the criteria for Panic Disorder.
Agoraphobia – This term which literally means, “Fear of the Marketplace” can be misleading. Agoraphobia is more accurately characterized by an avoidance of certain environments, activities and situations which are likely to precipitate a panic attack. Common places and situations that agoraphobics may avoid include:
- Car washes
- Driving( especially red lights, left turns and traffic)
- Indoor Shopping Malls and Large Buildings
- Underground Parking Structures
- Dental or other appointments which require a long period of sitting
- Ingesting a new medication
- Planes,Trains,Buses, Subways
An individual with agoraphobia usually feels more comfortable with someone familiar and may experience increased anxiety when alone. To understand more about how agoraphobia develops, examine the panic cycle developed by Dr. Lynne Freeman.
- Shortness of Breath
- Feelings of Unsteadiness
- Palpitations or Racing Heart
- Trembling or Shaking
- Sweating or Clammy Hands
- Choking Sensation
- Nausea or Abdominal discomfort
- Feelings of Unreality
- Feelings of Being Out of Control
- Fear of Dying
If you have experienced at least four of these symptoms, you have had a panic attack.
Generalized Anxiety Disorder (GAD)
GAD is characterized by chronic worry initially occurring in adolescence. The worry is typically about the health and safety of oneself or a loved one; financial or job related. Individuals with GAD are sometimes misdiagnosed with Obsessive Compulsive Disorder because they entertain certain thoughts that may appear obsessive or superstitious. The emotional and physical symptoms of GAD include:
- Trembling, twitching, or feeling shaky
- Muscle tension, aches or soreness
- Strong fatigue and depression
- Palpitations or an accelerated heart rate
- Feelings of being on edge or agitated
- Exaggerated startle response
- Difficulty concentrating
Experiencing at least three of these symptoms for a period of six months, may indicate GAD.
A phobia is an irrational fear of a non-threatening object, place or situation. For example, if a woman lives alone and frequently checks to make sure her doors and windows are locked because she is anxious that an intruder may enter her home, she does not necessarily have a phobia. (One in three women may be sexually assaulted in their lifetime). However, if the same woman continually patrols her doors and windows with a can of insecticide fearing a spider might enter, she probably has a phobia – specifically, arachnophobia. Most spiders are not a threat to her survival so her fears are not warranted.
Phobias develop for a variety of reasons. Panic disorder with agoraphobia may include certain phobias such as claustrophobia (fear of small enclosed spaces) and acrophobia (fear of heights) among others.
Post-traumatic Stress Disorder
Post-traumatic Stress Disorder (PTSD) may occur in individuals that have experienced a trauma, such as an auto accident, witnessing or being the victim of a violent crime, or surviving a natural disaster. Symptoms may include:
- Recurrent and intrusive recollections of the event
- Recurrent dreams and/or nightmares of the event
- Intense psychological stress when exposed to any situation that symbolizes or represents the trauma
- Avoidance of situations associated with the trauma
- Difficulty recalling an important aspect of the trauma
- Sense of a foreshortened future
Not all persons who have experienced trauma go on to develop PTSD. Of those that do, some individuals may not develop the first symptoms until six months or later subsequent to the trauma. When this occurs, this is called a ”delayed onset.”
Social Phobia This condition is a persistent fear of one or more situations in which a person feels anxiety for the following reasons:
- Anxiety during public speaking ( circumscribed or limited)
- Anxiety when using a public restroom
- Writing in the presence of others
- Sexual Activity or undressing
- Reviewing conversations and scrutinizing one’s responses
- At gatherings or situations that require engaging others
Physical symptoms may include:
- Shaky Voice
- Heart Racing
- Shaky legs
- Dry mouth
- Nausea or vomiting
- Sexual Dysfunction
Social phobics may be able to socialize and can appear outgoing but internally, it is causing much anxiety and diminishes the pleasure of social interaction. Typically, social phobics have been considered consistently shy since childhood
Obsessive-Compulsive Disorder (OCD)
Obsessive-Compulsive Disorder affects five million Americans. The symptoms of OCD can be broken down into two distinct features: obsessions and compulsions. Obsessions are unwanted and intrusive thoughts that occur repeatedly. Compulsions are the behaviors initiated by those thoughts which are performed in an attempt to minimize anxiety. The symptoms can range from mild to severe and the obsessions and compulsions can be limited or inclusive of multiple themes. Obsessions can include dirt and contamination, sexual themes, the need to arrange objects in a particular order, hoarding, religious themes, illogical obsessions, fear of causing harm to oneself or to another person, superstitious thinking, hypochondriasis. Ritualistic behaviors may include obsessive cleaning, checking repeatedly that doors are locked or ovens are turned off, an excessive desire to ask someone a specific question or make a confession, counting, touching, an overwhelming need to make lists, asking repeatedly for approval from others and perfectionism.
Obsessive compulsive disorder is often accompanied by depression. Similar to GAD, it is often misdiagnosed and even confused with GAD. Engaging in these obsessions and compulsions for at least an hour ever day, or if they significantly impair social or occupational functioning, may indicate the presence of OCD. OCD should not be confused with obsessive compulsive personality disorder which is characterized by rigid behaviors, or OCD spectrum disorders. Compulsive nail biting, skin picking, hair pulling, Olfactory Reference Syndrome (fear of giving off a bad odor) and Body Dysmorphic Disorder,(irrational perception and preoccupation with physical appearance) are examples of OCD spectrum disorders.
Anxiety Disorder Due to a Medical Condition
Until recently, the psychiatric community classified anxiety as a psychological disorder presumably stemming from a psychological cause. In 1994, the American Psychiatric Association published the DSM IV and the diagnostic criteria included a new classification labeled, “Anxiety Disorder Due to a Medical Condition.” The same classification now exists for mood disorders. Anxiety initiated specifically from a particular illness may be considered an Anxiety Disorder Due to a Medical Condition. Learn more.
Please note that the above is not meant to replace a complete and thorough evaluation by a licensed cognitive-behavioral therapist or other qualified mental health professional. Some individuals with anxiety disorders may benefit from medication, and may therefore require a psychiatric evaluation. A psychiatric assessment may be necessary to differentiate between the different anxiety disorders, other psychological conditions and /or medical conditions that mimic anxiety disorders. Likewise, the content on this website is intended for informational purposes only and not designed to replace appropriate treatment by a qualified mental heath professional.