Individuals with specific phobia are fearful or anxious about or avoidant of circum- scribed objects or situations. A specific cognitive ideation is not featured in this disorder, as it is in other anxiety disorders. The fear, anxiety, or avoidance is almost always imme- diately induced by the phobic situation, to a degree that is persistent and out of proportion to the actual risk posed. There are various types of specific phobias: animal; natural envi- ronment; blood—injection—injury; situational; and other situations.
In social anxiety disorder (social phobia), the individual is fearful or anxious about or avoidant of social interactions and situations that involve the possibility of being scruti- nized. These include social interactions such as meeting unfamiliar people, situations in which the individual may be observed eating or drinking, and situations in which the in- dividual performs in front of others. The cognitive ideation is of being negatively evalu- ated by others, by being embarrassed, humiliated, or rejected, or offending others.
In panic disorder, the individual experiences recurrent unexpected panic attacks and is behavior in maladaptive ways because of the panic attacks (e.g., avoidance of exercise or of unfamiliar locations). Panic attacks are abrupt surges of intense fear or intense discomfort that reach a peak within minutes, accompanied by physical and / or cognitive symptoms.
Limited—symptom panic attacks include fewer than four symptoms. Panic attacks may be expected, such as in response to a typically feared object or situation, or unexpected, meaning that the panic attack occurs for no apparent reason. Panic attacks function as a marker and prognostic factor for severity of diagnosis, course, and comorbidity across an array of dis- orders, including, but not limited to, the anxiety disorders (e.g., substance use, depressive and psychotic disorders). Panic attack may therefore be used as a descriptive specifier for any anxiety disorder as well as other mental disorders.
Individuals with agoraphobia are fearful and anxious about two or more of the follow- ing situations: using public transportation; being in open spaces; being in enclosed places; standing in line or being in a crowd; or being outside of the home alone in other situations.
The individual fears these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other inca- pacitating or embarrassing symptoms. These situations almost always induce fear or anx- iety and are often avoided and require the presence of a companion.
The key features of generalized anxiety disorder are persistent and excessive anxiety and worry about various domains, including work and school performance, that the indi- vidual finds difficult to control. In addition, the individual experiences physical symptoms, centrating or mind going blank; irritability; muscle tension; and sleep disturbance.
Substance/ medication-induced anxiety disorder involves anxiety due to substance in- toxication or withdrawal or to a medication treatment. In anxiety disorder due to another medical condition, anxiety symptoms are the physiological consequence of another med- ical condition.
Disorder-specific scales are available to better characterize the severity of each anxiety disorder and to capture change in severity over time. For ease of use, particularly for in- dividuals with more than one anxiety disorder, these scales have been developed to have the same format (but different focus) across the anxiety disorders, with ratings of behav- ioral symptoms, cognitive ideation symptoms, and physical symptoms relevant to each disorder.
Diagnostic Criteria 309.21 (F93.0)
A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following: 1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about pos- sible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.