The Classification and Diagnosis of Anxiety Disorders
So far, we've distinguished normal anxiety from anxiety disorders. Next, we learned how anxiety disorders are developed and maintained. Now it's time to review the specific anxiety disorders and to define the symptoms that lead to each diagnosis.
If you have done any research on anxiety disorders, or any other mental disorders, you most likely have come across references to the DSM. DSM 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 published in 1952 by the American Psychiatric Association, the DSM describes and categorizes 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 recent version is the DSM-5 (APA 2013). DSM-5 includes the latest research and statistical information regarding psychiatric disorders.
The DSM lists different categories of disorders. One of these categories is anxiety disorders. Each disorder is applicable to both children and adults. However, some disorders are more common in children and adolescents (e.g. Separation Anxiety Disorder). Many of these disorders develop during childhood, and persist into adulthood untreated. While both adults and children may experience anxiety, children may display different symptoms. Children may also describe their symptoms differently. In order to meet the diagnostic criteria, the duration of children's symptoms may differ from adults. The dissimilarities between adults and children will be described in the explanation of each disorder when applicable.
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. On average, the first episode occurs 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 Anxiety Disorders and Specific Phobias.
As we have discussed, anxiety and fear are normal human emotions. Anxiety disorders differ from normal these normal emotions in terms of degree and duration. The fear is excessive and continues beyond developmentally appropriate periods. For instance, it is developmentally normal for infants to become highly distressed upon separation from their caregiver. It is not developmentally normal for a 7 year old to behave in the same manner.
In order to be diagnosed with an anxiety disorder, the DSM criteria require that 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 functioning.
Culture plays a predominant role in all anxiety disorders. For instance, there is a great deal of cultural variation in terms of what is considered an acceptable and normative attachment between adults and their offspring. Likewise, there are cultural variations in normative reactions to separation of children from their caregivers. Similarly, panic attacks are a prominent symptom of many anxiety disorders. However, panic attacks may be presented and described differently across cultures. Therefore, cultural interpretation needs to be included in the diagnostic process.
The DSM establishes a symptom criteria set for each disorder. From this symptom set a certain number of symptoms must be met for diagnosis. Because it is not necessary to have every symptom in the criteria set, people with the same disorder may not have the exact same set of symptoms. For instance, someone might experience chest pain as the primary symptom of a panic attack. Another person may feel lightheaded. Both of these symptoms are part of the set of symptoms for panic attack (see next section).