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DSM IV - TR Criteria
DSM IV - TR Criteria - Anxiety Disorders
12
Psychology
09/30/2007

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Term
Panic Attack
Definition

A discrete period of intense fear or discomfort, in which 4 or more of the following symptoms developed abruptly and reached a peak within 10 minutes.

    (1) palpitations, pounding heart, or accelerated heart rate.     (2) sweating    (3) trembling or shaking    (4) sensations of shortness of breath or smothering     (5) feelings of choking     (6) chest pain or discomfort     (7) nausea or abdominal distress     (8) feeling dizzy, unsteady, lightheaded or faint     (9) derealization or depersonalization     (10) fear of losing control or going crazy     (11) fear of dying     (12) paresthesias/numbness or tingling     (13) chills or hot flashes.    

Term
Agoraphobia
Definition

A) Anxiety about being in place 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-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone, being in a crowd or standing in line, being on a bridge, or traveling in a bus/train/automobile.

B) The situations are avoided or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the

C) The anxiety or phobic avoidance is not better accounted for by another mental disorder such as Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder or Separation Anxiety Disorder.

Term
Panic Disorder Without Agoraphobia
Definition

A) Both (1) and (2):
   (1) Recurrent unexpected Panic Attacks
   (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 bout the implications of the attack or its consequences
    c) a significant change in behavior related to the attacks.

B) Absence of Agoraphobia

C) The Panic Attacks are not due to the direct physiological effects of a substance or a general medical condition

D) The Panic Attacks are not better accounted for by another mental disorder; Social Phobia, Specific Phobia, OCD, PTSD, Separation Anxiety Disorder.

Term
Panic Disorder with Agoraphobia
Definition

A) Both (1) and (2):
&NBSP&NBSP&NBSP(1) recurrent unexpected Panic Attacks
&NBSP(2) at least one of the attacks has been followed by one month or more of one or more of the following:
&NBSP&NBSP&NBSP a) persistent concern about having additional attacks
&NBSP&NBSP&NBSPb) worry about the implication of the attack or it's consequences c) significant change in behavior due to the attack B) The presence of Agoraphobia C) The Panic Attacks are not due to the direct physiological effects of a substance or general medical conditions D) The Panic Attacks are not better accounted for by another mental disorder; Social Phobia, Specific Phobia, OCD, PTSD, Separation Anxiety Disorder."

Term
Agoraphobia without history of Panic Disorder
Definition
"A) The presence of Agoraphobia related to fear of developing panicky-like symptoms.
B) Criteria have never been met for Panic Disorder.
C) The disturbance is not due to the direct physiological effects of a substance or a general 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 condition. "
Term
Specific Phobias
Definition
"A) Marked and persistent fear that is ecessie or unreasonable, cued by the presence or anticipation fo a specific object or situation (flying, heights, animals, seeing blood, etc)
B) Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally perdisposed Panic Attack. (in children may be crying, tantrums, freezing or clinging)
C) The person recognizes the fear is excessive and unreasonable (may be absent in children)
D) The phobic situation is avoided or endured with intense anxiety or distress.
E) The avoidance, anxious anticipation, or distress in the feared situation interferes significantly with the person's normal routine, occupational functioning or social activities or there is marked distress about having the phobia.
F) If under 18, duration is at least 6 months.
G) The anxiety, attacks or phobic avoidance are not better accounted for by another mental disorder such as OCD, PTSD, Separation Anxiety Disorder, Social PHobia or any Panic Disorders. "
Term
Social Phobia
Definition
"A) A marked and persistenf fear of on or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he will act in a way that will be humilitating or embarrassing. (must occure in a peer setting with children)
B) Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or sitationally predisposed Panic Attack.
C) The person recognizes that the fear is excessive or unreasonable. (this may be absent in children)
D) Teh feared social or performance situations are avoided or endured with intese anxiety or distress.
E) The avoidance, anxious anticipation, or distress in the feared situation interferes significantly with the person's normal routine, occupational functioning or social activities or there is marked distress about having the phobia.
F) If under 18, duration must be at least 6 months.
G) Not due to direct physiological effect of substance or medical condition and not better accounted for by another mental disorder; Panic Disorders, Separation Anxiety Disorders, Body Sysmorphic Disorder, Developmental Disorder, Schizoid Personality Disorder. "
Term
Posttraumatic Stress Disorder
Definition
"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 that involved actutal or threatened death or serious injury or a threat to physical integrity of self or others (2) the person's response involved intese fear, helplessness or horror. (may be disorganized or agitated bx in children)
B) The traumatic event is persistently reexperienced in one or more of the following 1) recurrent and intrusive distressing recollection of the event including images, thoughts and perceptions (repetitive play in children) 2) recurrent distressing dreams of the event. (in children may be frightening with no recognizable content) 3) acting or feeling as if the traumatic event were recurring (hallucinations, flashbacks, etc.) (trauma specific reenacment in children) 4) intense physiological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. 5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the event.
C) Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness not present before the trauma, as indicated by three or more of the following 1) efforts to avoid thoughts, feelings or conversations associated with the trauma 2) efforst to avoid activities, places or people that arouse recollection of the trauma 3) inability to recall an important aspect of the trauma 4) markedly diminished interes or participation in significant activities 5) feelings of detachment or estrangement from others 6) restricted range of affect 7) sense of a foreshortened future (doesn't expect to get married, have childent, etc.)
D) Persistente symptoms of increased arousal as indicated by 2 or more of the following: 1) difficulty falling or staying asleep 2) irritability or outbursts of anger 3) difficulty concentrating 4) hypervigilance 5) exaggerated startle response.
E) Duration of the symptoms in criterion b, c and d is more then 1 month.
F) The disturbance causes clinically significant distress or impairment in social, occupational or other important areas.
specify if: acute if duration is less then 3 months chronic if duration is more then 3 months delayed onset if symptoms is at least 6 months after event. "
Term
Acute Stress Disorder
Definition
"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 that involved actutal or threatened death or serious injury or a threat to physical integrity of self or others (2) the person's response involved intese fear, helplessness or horror.
B) Either while or after experiencing the distressing event, the individual has three or more of the following dissociative symptoms. 1) subjective sence of numbing, detachment or absence of emotional responsiveness. 2) reduction in awareness of surroundings (in a daze) 3) derealization 4) depersonalization 5) dissociative amnesia (cant recall trauma)
C) event is persistently reexperienved in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashbacks, reliving experience, distress at reminders of event.
D) Marked avoidance of stimuli that arouse recollections of the trauma (thoughts, feelings, places, people)
E) Marked symptoms of anxiety or increased arousal (difficulty sleeping, irritibility, poor concentration, hypervigilance, startl response, motor restlessness)
G) Disturbance lasts 2 days min, 4 weeks max and occures within 4 weeks of event.
H) Not due to effects of a substance or a medical condition and not Brief Psychotic Disorder, not exacerbation of a preexisting Axis I or II. "
Term
Generalized Anxiety Disorder
Definition
"A) Excessive anxiety and worry occurring more days then not for at least 6 months about a number of events or activities.
B) Person finds it difficult to control worry.
C) Anxiety and worry are associated with 3 or more of the following with some of the symptoms present for more days then not in the past 6 months. 1) restlessness or feeling keyed up or on edge 2) being easily fatigued 3) difficulty concentrating or mind going blank 4) irritability 5) muscle tension 6) sleep disturbance
D) The focus of the anxiety and worry is not confined to features of an Axis I disorder (getting fat, being dirty, being embarrassed in public, etc) and do not occur exclusively during a PTSD episode.
E) The anxiety cause clinically significant distress in functioning.
F) Not due to substance, medical condition or during a Mood, Psychotic or Pervasive Developmental Disorder. "
Term
Anxiety Disorder Due to….
Definition
"A) Prominent anxiety, Panic Attacks, or obsessions or compulsions predominates the clinical picture.
B) Evidence from history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
C) Disturbance is not better accounted for by another mental disorder (Adjustment Disorder with Anxiety in which the stressor is a medical condition)
D) Disturbance does not occur exclusively during the course of a delirium.
E) The disturbance causes clinically significant distress or impairment in social, occupational or other important areas.
Specify if general anxiety if excessive worry about a number of events or activities predominates in the clinical presentation panic attack if panic attacks predominate the clinical presentation obsessive-compulsive disorder if obsessions or compulsions predominate the clinical presentation"
Term
Substance-Induced Anxiety Disorder
Definition
"A) Prominent anxiety, Panic Attacks, or obessions or compusions perdominates the clinical picture.
B) There is evidence from the history, physical examination or laboratory findings of either (1) or (2). 1) The symptoms in criterion a developed during or within 1 mont of Substance Intoxication or Withdrawl (2) medication use in etiologically related to the disturbance.
C) Not better accounted for by an Anxiety Disorder that is not substance induced (symptoms preceed substance, persist for a substantial time after use, other evidence suggesting independent non-sustance episode)
D) Disturbance does not occur exclusively during the course of a delirium
E) The disturbance causes clinically significant distress or impairment in social, occupational or other important areas.
Specify if general anxiety if excessive worry about a number of events or activities predominates in the clinical presentation panic attack if panic attacks predominate the clinical presentation obsessive-compulsive symptoms if obsessions or compulsions predominate the clinical presentation phobic symptoms if phobic symptoms predominate clinical presentation
Specify if With Onset during Intoxication if criteria are met for intoxication with the substance and the symptoms develope during intoxication syndrome With Onset During Withdrawl if criteria are met for withdrawl from the substance and the symptoms develop during, or shortly after withdrawl syndrome. "