What are the diagnostic criteria for anxiety disorder?

From the Guidelines

The diagnosis of anxiety disorders should be guided by the DSM-5 criteria, which characterize anxiety disorders as developmentally inappropriate, excessive worry or distress associated with separation from a primary caregiver or major attachment figure, and must be distinguished from everyday worries and fears. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1, anxiety disorders are characterized by excessive worry or fear that is difficult to control and lasts for at least six months. The guideline outlines specific criteria for different anxiety disorders, including separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, substance/medication-induced anxiety disorder, and anxiety disorder due to another medical condition.

Some key characteristics of anxiety disorders include:

• Developmentally inappropriate, excessive worry or distress associated with separation from a primary caregiver or major attachment figure
• Excessive fear or worry about a specific object or situation (specific phobia)
• Excessive fear or worry about being negatively evaluated by others in social situations (social anxiety disorder)
• Recurrent unexpected panic attacks with physical and cognitive manifestations (panic disorder)
• Excessive fear or worry about being in situations in which the individual may be unable to escape or get help should panic-like or other overwhelming or embarrassing symptoms occur (agoraphobia)
• Excessive, uncontrollable worries regarding numerous everyday situations or activities (generalized anxiety disorder)

The assessment of anxiety disorders typically involves a comprehensive clinical interview, possibly supplemented by standardized questionnaires such as the Pediatric Symptom Checklist or the Difficulties Questionnaire 1. The American Psychiatric Association (APA) developed the freely available parent- and self-rated Level 1 Cross-Cutting Symptom Measures to screen for multiple psychiatric disorders, including anxiety 1. A more standardized approach to identification, such as the use of these screening instruments, may be useful in primary care, school, or other child-serving settings. The diagnosis of anxiety disorders requires that symptoms cause significant distress or impairment in daily functioning and cannot be better explained by another medical condition, substance use, or other mental disorder 1.

From the FDA Drug Label

Generalized anxiety disorder is characterized by unrealistic or excessive anxiety and worry (apprehensive expectation) about two or more life circumstances, for a period of 6 months or longer, during which the person has been bothered more days than not by these concerns At least 6 of the following 18 symptoms are often present in these patients: Motor Tension (trembling, twitching, or feeling shaky; muscle tension, aches, or soreness; restlessness; easy fatigability); Autonomic Hyperactivity (shortness of breath or smothering sensations; palpitations or accelerated heart rate; sweating, or cold clammy hands; dry mouth; dizziness or light-headedness; nausea, diarrhea, or other abdominal distress; flushes or chills; frequent urination; trouble swallowing or 'lump in throat'); Vigilance and Scanning (feeling keyed up or on edge; exaggerated startle response; difficulty concentrating or 'mind going blank' because of anxiety; trouble falling or staying asleep; irritability) These symptoms must not be secondary to another psychiatric disorder or caused by some organic factor.

The guidelines for diagnosing anxiety, specifically Generalized Anxiety Disorder, include:

• A period of 6 months or longer with unrealistic or excessive anxiety and worry about two or more life circumstances
• The person has been bothered more days than not by these concerns
• At least 6 of the 18 symptoms are present, including:
  • Motor Tension
  • Autonomic Hyperactivity
  • Vigilance and Scanning
• These symptoms must not be secondary to another psychiatric disorder or caused by some organic factor 2.

For Panic Disorder, the diagnosis is characterized by:

• Recurrent unexpected panic attacks, with at least 4 of the 13 symptoms developing abruptly and reaching a peak within 10 minutes, including:
  • Palpitations or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Derealization or depersonalization
  • Fear of losing control
  • Fear of dying
  • Paresthesias
  • Chills or hot flushes 2.

From the Research

Guidelines for Diagnosing Anxiety

The diagnosis of anxiety disorders, including generalized anxiety disorder (GAD), involves a comprehensive assessment of symptoms, medical history, and psychological evaluation. The following guidelines are based on the available evidence:

• Diagnostic Criteria: The diagnosis of GAD is based on the presence of excessive and persistent worry about everyday things, even when there is no apparent reason to worry 3, 4, 5.
• Screening Instruments: The Generalized Anxiety Disorder 2-item scale (GAD-2) and 7-item scale (GAD-7) are commonly used screening instruments for detecting GAD, with adequate accuracy for detecting the disorder 6.
• Clinical Evaluation: A thorough clinical evaluation, including a diagnostic interview and assessment of symptom severity, is essential for diagnosing anxiety disorders in adults 7.
• Psychological Assessment: Clinician-rated measures and self-report scales can be used to characterize anxiety symptom severity and identify clinical profiles contributing to symptom maintenance and severity 7.
• Differential Diagnosis: It is essential to rule out other medical and psychological conditions that may mimic anxiety symptoms, such as depression, substance abuse, or medical conditions like thyroid disorders 3, 4, 5.

Assessment Tools

The following assessment tools can be used to diagnose and monitor anxiety disorders:

• GAD-2 and GAD-7: These screening instruments can be used to detect GAD and monitor symptom severity 6.
• Diagnostic Interviews: Structured diagnostic interviews, such as the Diagnostic Interview Schedule (DIS), can be used to assess diagnostic criteria and symptom severity 7.
• Clinician-Rated Measures: Clinician-rated measures, such as the Hamilton Anxiety Rating Scale (HAM-A), can be used to assess symptom severity and monitor treatment response 7.
• Self-Report Scales: Self-report scales, such as the Beck Anxiety Inventory (BAI), can be used to assess symptom severity and monitor treatment response 7.

Treatment Considerations

The treatment of anxiety disorders, including GAD, involves a comprehensive approach that includes:

• Pharmacotherapy: Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines are commonly used medications for treating GAD 3, 4, 5.
• Psychotherapy: Cognitive-behavioral therapy (CBT) and other forms of psychotherapy can be effective in reducing symptom severity and improving quality of life 6, 7.
• Lifestyle Modifications: Lifestyle modifications, such as regular exercise, healthy eating, and stress management, can also be beneficial in reducing symptom severity and improving overall well-being 7.