Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distressing but manageable, and the symp- toms result in minor impairment in social or occupational functioning.
Moderate: The number of symptoms. intensity of symptoms, and/or functional impair- ment are between those specified for “mild” and “severe.”
Severe: The number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanage- able, and the symptoms markedly interfere with social and occupational functioning.
Anxiety d isorders include disorders that share features of excessive fear and anxi- ety and related behavioral disturbances. Fear is the emotional response to real or per- ceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap, but they also differ, with fear more often associated with surges of au- tonomic arousal necessary for fight or ﬂight, thoughts of immediate danger, and escape behaviors, and anxiety more often associated with muscle tension and vigilance in prep— aration for future danger and cautious or avoidant behaviors. Sometimes the level of fear or anxiety is reduced by pervasive avoidance behaviors. Panic attacks feature prominently within the anxiety disorders as a particular type of fear response. Panic attacks are not lim- ited to anxiety disorders but rather can be seen in other mental disorders as well.
The anxiety disorders differ from one another in the types of objects or situations that induce fear, anxiety, or avoidance behavior, and the associated cognitive ideation. Thus, while the anxiety disorders tend to be highly comorbid with each other, they can be dif- ferentiated by close examination of the types of situations that are feared or avoided and the content of the associated thoughts or beliefs.
cessive or persisting beyond developmentally appropriate periods. They differ from tran- sient fear or anxiety, often stress—induced, by being persistent (e.g., typically lasting 6 months or more), although the criterion for duration is intended as a general guide with allowance for some degree of ﬂexibility and is sometimes of shorter duration in children (as in sepa- ration anxiety disorder and selective mutism). Since individuals with anxiety disorders typically overestimate the danger in situations they fear or avoid, the primary determina- tion of whether the fear or anxiety is excessive or out of proportion is made by the clinician, taking cultural contextual factors into account. Many of the anxiety disorders develop in childhood and tend to persist if not treated. Most occur more frequently in females than in males (approximately 2:1 ratio). Each anxiety disorder is diagnosed only when the symp— toms are not attributable to the physiological effects of a substance/medication or to another medical condition or are not better explained by another mental disorder.
The chapter is arranged developmentally, with disorders sequenced according to the typical age at onset. The individual with separation anxiety disorder is fearful or anxious about separation from attachment figures to a degree that is developmentally inappro- priate. There is persistent fear or anxiety about harm coming to attachment figures and events that could lead to loss of or separation from attachment figures and reluctance to go away from attachment figures, as well as nightmares and physical symptoms of distress. Al- though the symptoms often develop in childhood, they can be expressed throughout adult— hood as well.
Selective mutism is characterized by a consistent failure to speak in social situations in which there is an expectation to speak (e.g., school) even though the individual speaks in other situations. The failure to speak has significant consequences on achievement in aca- demic or occupational settings or otherwise interferes with normal social communication.