Anxiety ICD-10 (A Complete Guide )

Who wouldn’t know about palpitation, sweaty palms and feet and nauseous feelings before an exam or before a stage performance or before an interview?

These are symptoms of anxiety and most of us have faced at one point or another.

Anxiety ICD-10 and other psychological disorders are diagnosed and differentially diagnosed on the basis of criteria in Diagnostic and Statistical Manual of Disorder (DSM-V).

In this article we discuss Anxiety ICD-10

However, DSM-V Is mostly used by psychologists and other mental health practitioners while doctors and medical staff still prefer International Classification of Diseases ICD-10.

It does not matter because the criteria remain the same with exception of codes and reporting systems.

This article will throw light on all the anxiety disorders reported in ICD-10. You will have a deep understanding of different types of anxiety disorder and how these are different from one another.

However, just like the new version of DSM-V, the reporting system of disorders such as anxiety ICD-10  has also been changed by ICD-10.

Let’s take a look at the anxiety disorders presented in ICD-10.

Anxiety ICD-10

ICD-10 has brought all stress related disorders, somatoform disorders and neurotic disorders under one cluster.

Anxiety disorders come under the umbrella term of neurotic disorders. This has been done because three of these disorders have historical association because of their link with neurosis possible psychological causation.

However, the reason to bring these three disorders in one cluster is not neurosis but all the disorders are dealt with carefully while bringing under these clusters.

Moreover, a mixture of symptoms is very common especially co-existence of depression and anxiety in less severe stages of these disorders is seen most commonly.

It should be made clear before the criteria that what is predominant syndrome but a category is provided for those cases of mixed symptoms of anxiety and depression where it is difficult to make a decision.

F40 Phobic anxiety disorders according to Anxiety ICD-10

Phobic anxiety is only evoked when the person encounters certain situations or objects which are not currently harmful.

As a consequence, the person tries to avoid these objects or these situations with dread.

Phobic anxiety is not much distinguishable from other anxiety disorders in terms of behavioral, subjective and physiological symptoms, but it may vary in severity from slight uneasiness to extreme terror.

The person suffering from phobic anxiety may have feelings of palpitation, feeling faint or even have a secondary fear of dying, losing control or going crazy.

The person who is suffering from phobic anxiety would not feel relieved by the fact that other people do not consider the situation as threatening.

The thought of entering the anxious situation or encountering the anxiety ICD-10 evoking event can cause anticipatory anxiety. 

Phobic anxiety is often found co-existent with depression and it gets worse during intercurrent depressive episodes.

Depressive mood is often accompanied by some phobias especially agoraphobia and some depressive episodes are accompanied by a temporary episode of phobic anxiety.

Whichever occurs first should be given precedence, if a depressive episode occurred before the symptoms of phobic anxiety the depressive disorder would be given diagnostic precedence and vice versa.

Phobias are more common in women than in men with the exception of social phobia. 

One thing should be kept in mind that a panic attack or anxiety ICD-10 attack occurring in an established phobic situation will be taken into account as the severity of the phobia and would not be given a separate diagnosis.

A main diagnosis should be only given if there is no phobia present.

F40.0 Agoraphobia according to Anxiety ICD-10

Agoraphobia is a term which was introduced to use for the fear of public spaces but now its usage has increased to the aspects related to open spaces.

For instance, now the term agoraphobia can also be used for fear of crowds’ presence and the difficulty to find an escape particularly towards home.

Therefore, the term agoraphobia is generally referred to as an interrelated cluster which is often an overlapping cluster of phobias which refers to fears like fear of leaving home, fear of public places, fear of entering shops or crowds or traveling alone in planes, buses or train.

Severity can be varying but it is one of the most terrifying of all the effects of phobias because it leaves the sufferer homebound.

It is more prevalent in women, and the onset is commonly in early adulthood. 

Diagnosis 

Following diagnostic criteria should be met for a definitive diagnosis of agoraphobia. 

• Anxiety symptoms should be primarily manifested and not secondary to other symptoms like delusions or obsession thoughts.
•  The anxious state during phobic situation must be restricted to in at least two of the situations given below:

1. Crowds
2. Travelling from home
3. Travelling alone
4. Public Places

And  

• Avoidance of these situations which awake phobia must be a prominent feature.

Differential Diagnosis

• Some people with agoraphobia experience less anxiety because they are focused on avoiding phobic situations.
• It should be carefully observed if other symptoms like depression, obsessions, depersonalization and social phobias were present before the symptoms of anxiety. 
• The presence of symptoms of panic disorders should be also recorded as a fifth character

F40.1 Social phobias

These phobias included fear of scrutiny by other people in smaller groups (contrary to crowds in agoraphobia) which commonly leads to avoiding social situations.

These are equally prevalent in men and women.

This phobia can be discrete (i.e. it is restricted to public speaking, or to eating in public places, or to encounters with opposite sex) or it can be diffuse which mean the sufferer avoids all type of social situations outside of family circle.

Eye-to-eye confrontation is specifically difficult for some people in some cultures or a fear of public vomiting.

This phobia is particularly associated with low self-esteem and fear related to criticism.

A social phobic person may report nausea, blushing, the urgency of micturition or hand tremor.

It can sometimes lead to panic attacks and these symptoms become primary problems rather than being secondary symptoms of anxiety manifestations.

Avoidance is present and sometimes leads to complete social isolation in extreme cases.

Diagnosis

Following criteria should be met for a definitive diagnosis of Social phobia. 

1. The anxiety symptoms including behavioral, psychological and autonomic manifestations should be primary and not secondary to other symptoms as obsessions or delusions. 
2. Anxiety predominates or must be restricted to social situations
3. Avoidance of public situations whenever possible. 

Differential Diagnosis

Agoraphobia and depression often coexist with social phobia and sometimes the distinction is hard to make.

If symptoms of both agoraphobia and social phobia are met then precedence should be given to agoraphobia.

However, caution should be observed while making a diagnosis of depression. 

F40.2 Specific (isolated) phobias

As the name represents, these phobias are restricted to highly specific situations like heights, darkness, proximity to certain animals, thunder, closed spaces, eating certain foods, urinating or defecating in public toilets, sight of blood or injury, dentistry and the fear of exposure to certain diseases.

The onset is often childhood or early adulthood and these phobias can persist for a longer period of time even for decades if they are not treated.

Contrary to agoraphobia, these are not fluctuating.

Radiation sickness and venereal infections and AIDS are common subjects of disease phobias. 

Diagnosis

Following criteria should be met for a definitive diagnosis of social phobia.

1. The anxiety ICD-10 symptoms including which are manifested autonomically, psychologically and behaviorally should be primary and not secondary to other symptoms as obsessions or delusions. 
2. The anxiety ICD-10 is associated only with the presence of particular object or situation
3. Phobic situation is avoided on every possibility

Differential Diagnosis

Mostly there are no other psychiatric symptoms contrary to agora and social phobias (with exception of blood-injury phobias).

Fear of specific diseases is reported under hypochondria disorders unless they relate to specific situations until the intensity of thoughts do not match that of delusional disorder. 

Anxiety ICD-10 is the major symptom of these disorders and these are not restricted to any particular situation.

Other symptoms are maybe present but are not severe to notice or to put as primary diagnosis.  

F41.0 Panic disorder [episodic paroxysmal anxiety]

In panic disorder the essential feature is recurrent attacks of severe anxiety and these are not specific to any particular situation or circumstances and unpredictable in nature.

Dominant symptoms can vary from individual to individual but sudden palpitation, choking sensations, feelings of unreality (derealization or depersonalization), chest pain and dizziness are common.

It is mostly accompanied with an invariable fear of dying, or going crazy and losing control.

Panic attacks usually last for minutes but the course and time of the disorder are both rather variable.

Frequent and unpredictable panic attacks produce fear of being alone or going in public and one attack is followed by a persistent fear of another attack.

Diagnosis

Panic diagnosis will only be given in the absence of phobias.

A definitive diagnosis of panic disorder requires several severe attacks over the course of 1 month and

1. in a situation which is not objectively dangerous
2. without being confined to known or predictable situations, and
3. with comparative freedom from symptoms of anxiety during attacks

Differential Diagnosis

A careful differential diagnosis should be made from panic attacks as part of phobic disorders and depressive disorders (especially in men).

F41.1 Generalized anxiety disorder

Free-floating anxiety is the main feature of generalized anxiety disorder which means the anxiety is not specific to a situation or object.

Continuous feeling of trembling, epigastric discomfort, palpitations, nervousness, sweating, muscular tension and lightheadedness is common just like other anxiety disorders.

Fear for a relative to fall ill or the sufferer can feel the fear for him or have an accident accompanied with other worries or forebodings.

This is more common in women and it tends to be chronic and fluctuating.

Diagnosis

Primary symptoms of anxiety should be present for at least several weeks or several months.

Feelings of apprehension, motor tension, autonomic overactivity are present along with primary symptoms of anxiety ICD-10. 

Differential Diagnosis

Generalized anxiety disorder should be carefully differentiated from depression, phobic anxiety, panic disorder and obsessive compulsive disorders

F41.2 Mixed anxiety and depressive disorder

This disorder has both symptoms of anxiety ICD-10 and depression but symptoms are interconnected.. 

F41.3 Other mixed anxiety disorders

This disorder meets the criteria for both generalized anxiety disorder and also has prominent features of other disorders of the same cluster.

FAQ about Anxiety ICD-10 disorders 

References

icd10data.com/ICD10CM/Codes/F01-F99/F40-F48/F41-/F41.9

icd.who.int/browse10/2016/en#F40.0

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