The Classification and Diagnosis of Anxiety Disorders
Now that we have distinguished normal anxiety from pathological anxiety, and have learned how anxiety disorders are developed and maintained, it's time to review the specific anxiety disorders and the defining symptoms that lead to the diagnosis of a particular disorder.
If you have done any research on anxiety disorders, or any other mental disorders, you most likely have come across references to the DSM, which is the abbreviation for the Diagnostic and Statistical Manual of Mental Disorders. The DSM is often referred to as the "bible" of mental disorders. First introduced in 1952 by the American Psychiatric Association, the DSM was published to describe and categorize mental disorders for use by mental health researchers and clinicians. The DSM has undergone several revisions since then. At the time of this writing, the most current version is the DSM-IV-Text Revision (DSM-IV-TR, 2000), which includes the latest research and statistical information regarding psychiatric disorders.
The DSM is divided into different sections which represent separate, broad categories of psychiatric disorders. One of these categories is anxiety disorders. The disorders found in this category are: Panic Disorder without Agoraphobia; Panic Disorder with Agoraphobia; Agoraphobia without a History of Panic Disorder; Specific Phobia; Social Phobia; Obsessive-Compulsive Disorder (OCD); Post-traumatic Stress Disorder (PTSD); Acute Stress Disorder; Generalized Anxiety Disorder (GAD); Anxiety Disorder Due to a General Medical Condition; Substance-Induced Anxiety Disorder; and Anxiety Disorder Not Otherwise Specified.
As mentioned previously, anxiety disorders are fairly common. According to the National Institute of Mental Health (NIMH, 2008), approximately 40 million American adults (i.e., 18.1 %) have an anxiety disorder in a given year, with their first episode occurring before the age of 21.5. This prevalence rate is really quite astonishing: roughly one in five persons will have experienced an anxiety disorder during that year. The most commonly occurring anxiety disorders are Social and Specific Phobias, followed by PTSD, GAD, Panic Disorder, and OCD (in descending order of prevalence).
There are other categories of mental disorders that include features of anxiety but are not classified as anxiety disorders. For instance, eating disorders could certainly be considered obsessive and compulsive, as are many addictions. Several personality disorders (another DSM category) also contain an anxious component. Some of these other disorders and their features and symptoms will be reviewed here as well.
To be diagnosed with a mental disorder, such as an anxiety disorder, the DSM states the symptoms must cause a person significant distress or impairment. Therefore, just because someone is experiencing some symptoms of anxiety, it does not mean they meet the requirements for a mental disorder unless their symptoms are highly distressing to them, and/or cause significant problems in their social or occupational functioning. We begin to consider the possibility of a disorder when someone's symptoms start to interfere with their ability to have meaningful social relationships, and/or when their symptoms cause problems or difficulties at work or at school.
The DSM establishes a symptom criteria set for each disorder and establishes certain number of symptoms, from that set, that must be met in order to be diagnosed with an anxiety disorder. Because it is not necessary to have every symptom in the criteria set, people with the same disorder may not necessarily have the exact same set of symptoms. For instance, someone might experience chest pain as their primary symptom of a panic attack, while another person may feel lightheaded. Both of these symptoms are part of the set of symptoms for panic attack.
While both adults and children may experience anxiety, children may display different symptoms, or their symptoms may be described differently than adults. Also, in order to meet the diagnostic criteria, children's symptoms do not require the same duration of time that is required for adults. The dissimilarities between adults and children will be described in the explanation of each disorder when applicable.