ANXIETY DISORDERS

Disorders Signs and Symptoms (Criteria)

Statistics/ Prevalence

A Panic Attack is a discrete period in which there is the sudden onset of

intense Apprehension, fearfulness, or terror,

often associa ted with fee lings of impending

Doom. During these attacks, symptoms such as shortness of breath,

palpitations, Chest pain or discomfort, choking or smothering sensa tions, and fear of

"going crazy" Or losing control are present.

(1) palpitations, pounding heart. Or accelerated heart rate

(2) sweating (3) trembling or shaking

(4) sensati ons of shortness of breath or smothering

(5) feeling of choking (6) chest pain or discomfort

(7) nausea or abdominal distress (8) feeling dizzy, unsteady, lightheaded,

or faint (9) dereali zation (feelings of unreality) or depersonalization (being detached

from Oneself)

(10) fear of losing control or going crazy (11) fear of dying

(12) paresthesias (numbness or tingling sensations)

(13) chi lls or hot f lushes

Although lifetime prevalence rates of Panic Disorder (With or Without Agoraphobia)

In community samples have been reported to be as high as 3.5%, most studies have

Found rates between 1% and 2%. One-year prevalence rates are between 0.5% and

1.5%. The prevalence rates of Panic Disorder in clinical samples are considerably

Higher. For example, Panic Disorder is diagnosed i.n approximately 10% of individuals

Referred for mental health consu ltation . In general medical settings, preva lence

Rates vary from 10% to 30% in vestibular, respiratory, and neurology clinics to as high As 60% in cardiology clinics. Approximately

one-third to one-half of individuals Diagnosed with Panic Disorder in community

samples also have Agoraphobia, although A much higher rate of Agoraphobia is

encountered in clinical samples.

Agoraphobia is anxiety about, or avoidance of, places or situations from

which escape Might be difficult (or embarrassing) or in which help may not be available in the

Event of having a Panic Attack or panic-l ike symptoms.

A. Anxiety about being in places or situations from which escape might be

difficult (or embarrassing) or in which help may not

be available in the event of having an unexpected

or situationally predisposed Panic Attack or panic-l ike symptoms.

Agoraphobic fears typically involve characteristic

clusters of situations that include being outside the home alone; being in a

crowd or standing in a line; being on a bridge;

and traveling in a bus, train, or automobile.

Note: Consider the diagnosis of Specific Phobia if t he avoidance is limited to

one or only a few specific situations, or

Social Phobia if the avoidance is limited to social

situations. B. The situations are avoided (e.g.,

travel is restricted) or else are endured with marked

distress or with anxiet y about having a Panic Attack or panic-like symptoms, or

require

ANXIETY DISORDERS

the presence of a companion. C. The anxiety or phobic avoidance is not better accounted for by another

mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of

fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single

situation like elevators ), ObseSSive-Compulsive

Disorder (e.g., avoidance of dirt in someone

with an obsession about contamination), Posttraumatic Stress

Disorder (e.g., avoidance of stimuli associated with a severe

stressor), or Separation Anxiety Disorder

(e.g., avoidance of leaving home or relatives) .

Panic Disorder Without Agoraphobia is characterized by recurrent tmexpected

Panic Attacks abou t which there is persistentconcem.

.

A. Both (1) and (2): (1) recurrent unexpected Panic Attacks

(see p. 432) (2) at least one of the attacks has been followed by 1 month (or more) of one

(or More) of the following:

(a) persistent concern about having additional attacks

(b) worry about the implications of the attack or its consequences (e.g., losin{J Control, having a heart attack, "going

crazy") (c) a significant change in behavior

related to the attacks B. Absence of Agoraphobia (see p. 433). C. The Panic Attacks are not due to the

direct physiological effects of a substance (e.g.,

A drug of abuse, a medication) or a general medical condition (e.g .,

hyperithyroid·

Ism). D. The Panic Attacks are not better accounted for by another mental

disorder, such as Social Phobia (e.g., occurring on

exposure to feared social situations), Specific Phobia

(e .g., on exposu re to a specific phobic situation). Obsessive·Compulsive

Some cultural or ethnic groups restrict the participation of

women in public life, and this must be distinguished from Agoraphobia. Panic Disorder

Without Agoraphobia is diagnosed twice as often and Panic Disorder With

Agoraphobia three times as often in women as m men.Although lifetime prevalence rates of Panic Disorder (With or Without Agoraphobia) in community samples have been reported to

be as high as 3.5%, most studies have found rates between 1% and 2%. One-year

prevalence rates are between 0.5% and 1.5%. The prevalence rates of Panic Disorder in

clinical samples are considerably higher. For example, Panic Disorder is

diagnosed i.n approximately 10% of individuals referred for mental health consu ltation . In

general medical settings, preva lence rates vary from 10% to 30% in vestibular,

respiratory, and neurology clinics to as high as 60% in cardiology clinics. Approximately one-

third to one-half of individuals diagnosed with Panic Disorder in community

samples also have Agoraphobia, although a much higher rate of Agoraphobia is

encountered in clinical samples.

ANXIETY DISORDERS

Disorder (e.g ., on exposure to dirt in someone

with an obsession about contamination), Posttraumatic

Stress Disorder (e.g., in response to stimuli associated with a severe

stressor), Or Separation Anxiety Disorder (e.g ., in response to being away from home or

Close relatives).

Agoraphobia Without Histo ry of Panic Disorder is characterized by the

presence Of Agoraphobia and panic-like symptoms without a history of

unexpected Panic Attacks.

A. The presence of Agoraphobia (see p. 433) related to fea r of developing

panic-like Symptoms (e.g., dizziness or diarrhea).

B. Crit eri a have never been met for Panic Disorder (see p. 440).

C. The disturbance is not due to t he direct physiological effects of a

substance (e.g., a drug of abuse. A medication) or

a genera l medical condition. D. If an associated general medical

condition is present. The fear described in Criterion A

Is clearly in excess of that usually associated with the cond ition.

Some cultural or ethnic groups restrict the participation of women in public life, and

This must be distinguished from Agoraphobia. This di sorder is diagnosed fa r more often

In females than in males. In clinica l settings, almost all individuals (over

95%) who present with Agoraphobia Also have a current diagnosis (or hislory) of Panic Disorder. In contrast, the prevalence Of agoraphobia Without Hislory of Panic

Disorder in epidemiological samples Has been reporled 10 be higher than that for Panic Disorder With Agoraphobia. However, Problems with assessment appear to have

inflated the rates reported in epidemiological Studies. Recently, indi vidu als who were given

a diagnosis of Agoraphobia Without History of Panic Disorder in an

epidemiological study were reevaluated by Clinicians using standard interview schedules.

The majority were found to have Specific Phobias, but not Agoraphobia.

Panic Disorder With Agoraphobia A. Both (1) and (2): (1) recurrent unexpected Panic Attacks

(see p. 432) (2) at least one of the attacks has been followed by 1 month (or more) of one

(or More) of the following:

(a) persistent concern about having additional attacks

(b) worry about the implications of the attack or its consequences (e.g., losing Control, having a heart attack, "going

crazy" ) (c) a significant change in behavior

related to the attacks B. The presence of Agoraphobia (see p.

433). C. The Panic Attacks are not due to the

direct physiological ehects of a

Some cultural or ethnic groups restrict the participation of women in public life, and

this must be distinguished from Agoraphobia. This di sorder is diagnosed fa r more often

in females than in males.in clinica l settings, almost all individuals (over 95%) who present

with Agoraphobia also have a current diagnosis (or hislory) of

Panic Disorder

ANXIETY DISORDERS

substance (e.g ., A drug of abuse, a medication) or a

general medical condition (e.g., hyperthyroid·

Ism) . D. The Panic Attacks are not better accounted for by another mental

disorder, such as Socia l Phobia (e.g., occurring on

exposure to feared social situations), Specific Phobia

(e.g ., on exposure to a specific phobic situation), Obsessive-Compulsive

Disorder (e.g ., on exposure to dirt in someone

with an obsession about contamination), Posttraumatic

Stress Disorder (e .g ., in response to stimuli associated with a severe

stressor), Or Separation Anxiety Disorder (e.g ., in response to being away from home or

Close relatives).

Specific Phobia is characterized by clinically significant anxiety provoked by

exposure To a specific feared object or situation, often leading to avoidance behavior.

Animal Type. This subtype should be

specified if the fea r is cued by animals Or insects. This subtype generally has a

childhood onset. Natural Environment Type. This subty pe

should be speci fied if the fear is Cued by objects in the namral

environment, such as storms, heights, or water.

This subtype generally has a childhood onset.

Blood-Inj ection-Inju ry Type. Nus subtype should be specified if the fear is Cued by seeing blood or an injury or by receiving an injection or other invasive

Medical procedure. This subtype is highly familial and is often characterized

By a strong vasovagal response. Situation al Type. This sub type should

be specified if the fear is cued by a Specific situation such as public transportation, hmnels, bridges,

A. Marked and persistent fear that is excessive or unreasonable, cued by the

presence Or anticipation of a specific object or

situation (e.g., flying, heights, animals, receiving

An injection, seeing blood). B. Exposure to the phobic stimulus

almost invariably provokes an immediate anxiety response,

Which may take the form of a situationa lly bound or situationally predisposed

Panic Attack. Note: In children, the anxiety may be expressed by crying,

Tantrums, freezing, or clinging. C. The person recognizes that the fear is

excessive or unreasonable. Note: In children,

This feature may be absent. D. The phobic situation(s) is avoided or else is endured with intense anxiety or

distress. E. The avoidance, anxious anticipation,

or distress in the feared situation(s) interferes

Significantly with the person's normal routine, occupational (or academic)

function -

The ratio of women to men with Specific Phobias is approximately 2:1,

Even among the elderly. However, the sex ratio varies across different types of Spe.-

Cific Phobias. Approximately 750/0-90% of individuals with the Animal and Natural

Environment Type are female (except for feilr of heights, where the percentage of

Females is 550/0-70%). Similarly, approximately 75°/0-90% of individuals with the Sit·

Ua tional Type are female. Approximately 55°/0-70% of individua ls with the Blood·

Lnjection·Injury Type are female. Although phobias are common in the general

population, they rarely result in sufficient Impairment or distress to warrant a diagnosis

of Specifi c Phobia. The reported Prevalence may vary depending on the

threshold used to determine impairment or Distress and the number of types of phobias

surveyed. In community samples, cufrent Prevalence rates range from 4% to 8.8%, and

lifetime prevalence rates range from 7.2% to 11.3%. Prevalence rates decline in the

elderly. Also, prevalence estimates vary For different types of Specific Phobias.

ANXIETY DISORDERS

elevators, fi ying, Driving, or enclosed places. This subtype has a bimoda l age-at-onset distribution, With one peak in childhood and another

peak in the mid-20s. Nus Subtype appears to be similar to Panic

Disorder With Agoraphobia in its characteristic

Sex ratios, familial aggregation pattern, and age at onset.

Other Type. This subtype should be specified if the (ear is cued by other

Stimu li. These stimuli might include the fear of choking, vomiting, or contracting

An iuness; "space" phobia (Le., the individual is afraid of falling down if Away from walls or other means of

physical support); and children's fears of Loud sounds or costumed characters.

Ing, or social activities or relationships, or there is marked distress about having

the Phobia.

F. In individuals under age 18 years, the duration is at least 6 months .

•

Social Phobia is characterized by cl inically significant anxiety provoked by

exposure To certain types of social or

performance situa tions, often leading to avoidance

Behavior.

A. A marked and persistent fear of one or more social or performance

situations in which the person is exposed to unfamil

iar people or to possible scrutiny by others.

The individual fears that he or she will act in a way (or show anxiety

symptoms) that will be humil iat ing or embarrassing.

Note: In children, there must be evidence of

the ca pacity for age-appropriate social relationships with familiar people and

the anxiety must occur in peer settings, not

just in interactions with adu lts. B. Exposure to the feared social

situation almost invariably provokes anxiety, which

may t ake the form of a situationally bound or situation ally predisposed

Panic Attack. Note: In children, the anx iety

may be expressed by crying, tantrums, freezing,

or shrinking from social situations wit h unfamiliar people.

C. The person recognizes that the fear is excessive or unreasonable. Note: In

children, this feature may be absent.

In children, crying, tantrums, freezing. Clinging or s taying d ose to a familiar person,

And inhibited interactions to the point of mutism may be present. Young children

May appear excessively timid in unfamiliar social settings, shrink from contact with

O thers, refu se to participate in group play, typically stay on the periphery of social ac·

Ti vil'ies, and attempt to remain dose to familiar adults. Unlike adults, children with

Social Phobia usually do not have the option of avoiding feared situations altogether and may

be unable to identify the nature of their anxiety. There may be a decline in

Classroom performance, school refu sal, or avoidance of age-appropriate socia l activities And dating. To make the diagnosis in children,

there must be evidence of capacity For social relationships with famili ar people

and the social anxiety must occur in Peer settings, not jus t in interactions with

adults. Because of the disorder's earl y onset And chronic course, impairment in child ren tends to take the form of failure to achieve

An expected level of functioning, rather than a decline from an optimal level of functioning.

In contras t, when the onset is in ado lescence, the disorder may lead to decrements In social and academic performance.

Epidemiological and community-based studies suggest tha t Socia l Phobia is more

Common in women than in men. In mos t

ANXIETY DISORDERS

D. The feared socia l or performance situations are avoided or else are

endured with intense anxiety or distress.

E. The avoidance, anxious ant iCipation, or distress in t he feared social or

performance situation(s) interferes significantly with

the person's normal routine, occupational

(academic) functioning, or soc ial activities or relatio nships, or there is

marked dist ress about having the phobia.

F. In ind iv iduals unde r age 1B years, the duration is at least 6 months.

G. The fea r or avoidance is not due to the direct physiolog ical effects of a

substance (e.g., a drug of abuse. a medication) or a

general medical condit ion and is not better

accounted fo r by another mental disorder (e.g ., Panic Disorder With or

Without Agoraphobia. Separation Anx iety

Disorder, Body Dysmorphic Disorder, a Pervasive

Developmental Disorder, or Schizoid Personal ity Disorder).

H. If a genera l medical condition or another mental disorder is present, the

fear in Crite rion A is unrelated to it, e .g., the fea r is

not of Stuttering, t rembling in Parkinson's

disease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia

Nervosa .

Specify if: Generalized: if the fears include most

social situations (also consider the additional

diagnosis of Avoidant Personality Disorder)

clinical samples, however, the sexes are either Equally represented or the majority a re male. Epidemiological and community-based studies

have reported a lifetime prevalence of Social Phobia ranging from 3% to 13%. The

reported prevalence may vary depending on the threshold used to determine distress or

impairment and the number of types of social situations specifically surveyed.

In one study. 20% reported excessive fear of public speaking and performance, but

only about 2% appeared to experience enough impairment or distress 10 warrant a d

iagnOSiS of Social Phobia. In the genera l population, most individuals with Socia l Phobia

fear public speaking, whereas somewhat less than half fear speaking to s trangers or meeting new people. Other performance

fears (e.g., eating, drinking. or writing in public, o r using a public restroom)

appear to be less common. In clinical settings, the vast majority of persons with Social

Phobia fear more than one type of social s itua tion. Social Phobia is rarely the reason for admission to inpatient settings. In

outpatient clinics. ra tes of Social Phobia have ranged between 10% and 20% of individua ls

with Anxiety Disorders, but rales vary widely by site.

Obsessive-Compulsive Diso rder is characterized by obsessions (which

cause Marked anxiety or distress) and / or by compulsions (which serve to neutralize

A. Either obsessions or compulsions: Obsessions as defined by (1), (2), (3),

and (4): (1) recurrent and persistent thoughts,

impulses, or images that are

Community studies have estimated a life time prevalence of 2.5% and a I -year prevalence

of 0.5%- 2.1% in adults. However, methodological problems with the assessment

tool used raise the possibility that the true p

ANXIETY DISORDERS

anxiety). experienced, at some time during the disturbance, as intrusive and inappropriate and that

cause marked anxiety or distress

(2) the thoughts, impulses, or images are not simply excessive worries about

reallife problems

(3) the person attempts to ignore or suppress such thoughts, impulses, or

images, or to neutralize them with some other

thought or action (4) the person recognizes that the obsessional thoughts, impulses, or

images are a product of his or her own mind (not imposed from without as in thought

insertion) Compulsions as defined by (1) and (2):

(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental

acts (e.g., praying, cou nting, repeating

words silently) that the person feels driven

to perform in response to an obsession, or according to rules that must be

applied rigidly

(2) the behaviors or mental acts are aimed at preventing or reduCing dist

ress or preventing some dreaded event or situation;

however, these behaviors or mental acts either are not connected in a realistic way with what they are

designed to neutralize or prevent or are clearly

excessive 8. At some point during the course of

the disorder, the person has recogn ized that the

obsessions or compulsions are excessive or unreasonable. Note : Th is does not

apply to children. C. The obsessions or

compulsions cause marked dist ress, are time consuming (t ake more

than 1 hour a day), or significantly

revalence rates are much lower. Conununity studies of children and adolescents

have estimated a lifetime preva lence of 10/0-2.3% and a I-year prevalence of 0.7%.

Research indicates that prevalence rates of Obsessive-Compulsive Disorder are similar in

many differen t cultures around the world. In ad ults, this disorder is equally

common in males and females. However, in childhood-onset Obsessive-Compulsive

Disorder, the disorder is more common in boys than in girls.

ANXIETY DISORDERS

interfere wit h the person's normal routine, occupational

(or academic) funct ioni ng, or usual socia l activit ies or relat ionships.

D. If another Axis I disorder is present, th e content of t he obsessions or

compulsions is not restricted to it (e.g .. preoccupation with food in the presence of an Eat ing

Disorder; hair pulling in t he presence of Trichoti ll omania; concern with appearance in the presence of Body Dysmorphic Disorder;

preoccupation with drugs in t he presence of

a Subst ance Use Disorder; preoccupation wit h having a serious ill

ness in the presence of Hypochondriasis; preoccupation with

sexual urges or fa ntasies in the presence of

a Paraph ilia; or guilty ruminations in the presence of Major De pressive

Disorder). E. The distu rba nce is not due t o the

direct physiological effects of a substance (e.g .. a

drug of abuse, a medicat ion) or a general medica l condition.

Specify if: With Poor Insight: if, for most of the time during the current e pisode, the

person does not recognize that t he obsessions

and compulsions a re excessive or unreasona

ble

Posttraumatic Stress Disorder is characterized by the reexperiencing of

an extremely Traumatic event accompanied by

symptoms of increased arousal and by Avoidance of stimuli associated with the

trauma.

A. The person has been exposed to a traumatic event in which both of the

following were present:

(1) the person experienced, witnessed, or was confronted with an event or

events that involved actual or threatened

death or serious injury, or a threat to the

physica l integrity of self or others (2) the person's response involved

intense fear, helplessness, or horror. Note: In

In younger children, distressing dreams of the event may, within several weeks,

change into generalized nightmares of monsters, of rescuing others, or of threats to seU or others. Young children usually do not

have the sense that they are reliving the past; rather, the reliving of the trauma may occur through repetitive play (e.g., a child who was involved in a serious automobile accident repeatedly reenacts car crashes

with toy cars).

ANXIETY DISORDERS

children, this may be expressed instead by disorganized or agitated behaviour A. The person has been exposed to a traumatic event in which both of the

following were present:

(1) the person experienced, witnessed, or was confronted with an event or

events that involved actual or threatened

death or serious injury, or a threat to the

physica l integrity of self or others (2) the person's response involved

intense fear, helplessness, or horror. Note: In

children, this may be expressed instead by disorganized or agitated behavior

• Anxiety Disorders

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder

(continued) B. The traumatic event is persirtently reexperienced in one (or more) of the

following ways:

(1) recurrent and intrusive distressing recollections of the event, including

images, thoughts, or perceptions. Note: In you ng children, repetitive play may occur

in which themes or aspects of the trauma are expressed.

(2) recurrent dirtressing dreams of the event. Note: In children, there may be

frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recu rring (i ncludes a sense

of reliving the experience, illusions,

hallucinations, and dissociative flashbac k episodes,

including those that occu r on awakening or when intoxicated). Note:

In young ch ildre n, trauma-specific reenactment may occur.

(4) intense psychological dirtress at exposure to interna l or externa l cues

that symbol

ANXIETY DISORDERS

ize or resemble a n aspect of the traumat ic event

(5) physiological reactivity on exposure to internal or external cues that symbol

ize or resemble an aspect of the traumatic

event C. Persistent avoidance of rtimuli associated with the trauma and

numbing of general responsiveness (not present before the trauma), as indicated by three (or more)

of the follow ing :

(1) efforts to avoid thoughts, fee lings, or conversations associated with the

trauma (2) efforts to avoid activities, places, or people that a rouse recollections of the

trauma (3) inability to recall an important

aspect of the trauma (4) markedly diminished interest or participation in significant activities

(5) fee ling of detachment or ertrangement from ot hers

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career,

mar· riage, chi ldren, or a normal life spa n) D. Persistent symptoms of increased a

rousa l (not present before the trauma), as indicated

by two (or more) of the following: (1) difficulty fall ing or staying asleep (2) irritability or outbursts of anger

(3) diffic ulty concentrating (4) hypervigilance

(5) exaggerated startle response E. Duration of the disturbance

(symptoms in Criteria B, C, and 0 ) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in

social, occupational, or other importa nt areas of fu nct

ioning. Specify if:

Acute: if durat ion of symptoms is less

ANXIETY DISORDERS

than 3 months Chronic: if duration of symptoms is 3

mont hs or more Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the

stressor

Acute Stress Disorder is characterized by symptoms similar to those of

Posttraumatic Stress Disorder that occur immediately

in the aftermath of an extremely traumatic

Event.

A. The person has been exposed to a t raumatic event in which both of the

following were present:

(1) the person experienced, witnessed, or was confronted with an event or

events that involved actual or threatened

death or serious injury, or a threat to the

physical integrity of self or others (2) the person's response involved in tense fea r, helplessness, or horror

B. Either whi le experiencing or after experi encing the distressing event, the

individual has three (or more) of the fol lowing

dissociative symptoms: (1) a subjective sense of numbing,

detachment, or absence of emotional responsiveness

(2) a reduction in awareness of his or her surround ings (e.g., "being in a daze

") (3) derealization

(4) depersona lization (S) dissociative amnesia (i .e., inability to

recall an important aspect of the trauma) C. The traumatic event is

persistently reexperienced in at least one of the following

ways: recurrent images, tho ughts, dreams, illusions, flashba ck episodes,

or a sense of reliving the experience; or d istress on

exposure to reminders of the traumatic event.

D. Marked avoidance of stimuli that arouse reco llections of the trauma (e.g

., thoughts, fee lings, conversations, activities,

places, people). E. Marked symptoms of anxiety o r increased arousa l (e.g., difficulty

The prevalence of Acute Stress Disorder in a population exposed to a seriolls traumatic

stress depends on the severity and persistence of the trauma and the degree of

exposure to it . The prevalence of Acute Stress Disorder in the general population is

not known. In the few available studies, rates ranging from 14% to 33% have been

reported in individuals exposed to severe tralUna (i.e., being in a motor vehicle accident,

being a bystander at a mass shooting).

ANXIETY DISORDERS

sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor

restlessness). F. The disturbance causes clinica ll y significant distress or im pairment in

social, occupationa L or other important areas of

functioning or impairs the individual's ability to

pu rsue some necessary task, such as obtaining nece ssary assistance or mobi

lizing personal resources by t el ling family members

about the t raumatic experience. G. The distu rbance lasts for a minimum

of 2 days and a maximum of 4 weeks and occurs

within 4 weeks of the traumatic event. H. The d ist urbance is not due to the di rect physiological effects of a su bstance

(e.g., a d rug of abuse, a medication) or a

genera l medical condition, is not better account ed

fo r by Brief Psychotic Disorder, and is not merely an exacerbation of a

preexisting Axis I or Axis II disorder.

Generalized Anxiety Disorder is characterized by at least 6 months of

persisten t And excessive anxiety and worry.

A. Excessive anxiety and worry (apprehensive expectation), occurring

more days than not for at least 6 months, about a

number of events or activities (such as work or

school performance). B. The person f inds it difficult to control

the worry. C. The anxiety and worry are associated

with three (or more) of the follow ing six symptoms

(with at least some symptoms present for more days than not for the past 6 months), Note: Only one item is

required in chi ldren. (1) restlessness or feeling keyed up or

on edge (2) being easily fatigued

(3) difficulty concentrating or mind going blank

(4) irritability

In clinical settings, the disorder is diagnosed somewha t mo re frequently in women than in men (about 550/0-60% of those

presenting with the disorder are female). In epidemiological studies, the sex ratio is approxima tely two-thirds female. In a

community sample, the l -year prevalence ra te for Generalized Anxiety Disorder

was approximately 3%, and the lifetime prevalence rate was 5%. In anxiety disorder

clinics, up to a quarter of the ind ividuals have Generalized Anxiety Disorder as a presenting

or comorbid diagnosis.

ANXIETY DISORDERS

iAmerican Psychiatric Association: Diagnostic and Statistical MaJlJlal of Mf'Jl ta/ Disorders, Fourth Edition, Text Re,rision .. Washington, DC, American Psychiatric Association, 2000

(5) muscle tension (6) sleep disturbance (difficulty fall ing

or staying asleep, or restless unsatisfying

sleep) O. The focus of the anxiety and worry is not confined to features of an Axis I d

isorder, e.g ., the anxiety or worry is not about

having a Panic Attack (as in Panic Disorder),

being embarrassed in public (as in Socia l Phobia), being contaminated (as in

Obsessive ·Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in

Anorexia Nervosa), having multiple physical

complaints (as in Somatization Disorder), or havin g a serious illness (as

in Hypochon· driasis), and the anxiety and worry do

not occur exclusively during Posttraumatic

Stress Disorder. E. The anxiety, worry, or physical

symptoms cause clinically significant distress or impa

irment in social, occu pational, or other important areas of fu nctioning.

F. The disturbance is not due to the direct physiological effects of a

substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g.,

hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or

a Pervasive Developmental Disorder.