Dsm 5 Anxiety Disorders (A Complete Guide)

In this guide, we will discuss the DSM-5 Anxiety Disorders criteria, subtypes of anxiety disorders, biological bases for the fear response and the most common treatment options.

What are Dsm 5 Anxiety Disorders?

DSM 5 Anxiety disorders are grouped to include disorders that share the same excessive fear and anxiety-related behaviors. 

The disorders included in this category are: separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, substance-induced anxiety and anxiety disorder due to another medical condition. 

In this version compared to the DSM 4, Obsessive-compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder were removed from the anxiety disorders category and moved into their own. 

Anxiety: Response mechanisms

When we feel threatened or we perceive a situation is potentially dangerous, then our body reacts by releasing adrenaline and other chemicals into our bloodstream which will eventually increase your heart rate, make you sweat, sharpen our senses and heighten our physical abilities.

Then your brain decides if we should fight or run to protect our physical integrity

Is it a matter of survival?

As mentioned, we need this type of physiological response to ensure our survival when we come in contact with something potentially dangerous.

For example, let’s say you are walking down the street and someone comes up to you and takes a very sharp machete and threatened to kill you if you don’t give him your wallet.

In this case, your body reacts and makes the response by attacking the person in front of you or it can make go the other way and run as fast as possible. 

Fear response and the Brain

When we have an intense physiological response to a situation or object that we qualify as harmful or dangerous, our brain starts activating certain regions.

One of them is the amygdala, which has been said to intervene in emotional responses such as fear and anxiety. 

Current imaging techniques such as functional magnetic resonance imaging or fMRI, used in research studies, have identified a heightened response from the amygdala when being exposed to things or situations that potentially generate anxiety symptoms.

The amygdala and other limbic structures are connected to our pre-frontal cortex regions which are said to be involved in planning, decision making and inhibiting socially unacceptable behaviors. 

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder is characterized by exaggerated or excessive worry about daily life activities or events with no apparent reason to worry.

People with GAD tend to expect disaster and can’t stop worrying about their medical condition, financial related problems, their family or their work. 

The worry does not match reality and it is considered way out of proportion for any given situation.

Symptoms of GAD

According to the Mayo Clinic, Generalized Anxiety Disorder Symptoms can Vary from one person to another, but there are some common physical symptoms that someone with GAD might experience:

• Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events
• Overthinking plans and solutions to all possible worst-case outcomes
• Perceiving situations and events as threatening, even when they aren’t
• Difficulty handling uncertainty
• Indecisiveness and fear of making the wrong decision
• Inability to set aside or let go of a worry
• Inability to relax, feeling restless, and feeling keyed up or on edge
• Difficulty concentrating, or the feeling that your mind “goes blank”

Physical signs and symptoms may include:

• Fatigue
• Trouble sleeping
• Muscle tension or muscle aches
• Trembling, feeling twitchy
• Nervousness or being easily startled
• Sweating. Check the best antiperspirants for anxiety sweat.
• Nausea, diarrhea or irritable bowel syndrome
• Irritability

Selective Mutism in Children 

Selective Mutism is related to Social Anxiety Disorder. Children experience difficulty or inability to speak in social contexts or situations (e.g. School, sporting events, personal safety and the safety of family members, disasters or future events).

This needs to be present most days during at least 6 months. 

Panic Disorder

People with Panic Disorder often experience Panic Attacks that tend to appear suddenly and without an evident related cause. People with this disorder are frequently thinking about future attacks due to the nature of the panic attacks being so intense causing a lot of anxiety.

A panic attack is described by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as “an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following symptoms occur”:

• Accelerated heart rate
• Sweating
• Trembling or shaking
• Sensation of choking
• Shortness of breath
• Chest pain or sensation of discomfort
• Nausea
• Feeling dizzy or about to faint
• Chills or heat sensations
• Tingling sensation or numbness
• Feeling of unreality or being detached from oneself
• Fear of losing control or “going mad”
• Fear of dying

Agoraphobia

This type of anxiety disorder is characterized by the fear of situations where escaping may be difficult or too embarrassing, or help might not be available if the person suffering from a panic attack. 

This fear is considered out of proportion when contrasted with reality and it usually lasts 6 months or more causing problems in daily life activities.

Someone with agoraphobia experiences fear in 2 or more of these situations:

• Being in open spaces
• Being outside their home alone
• Being in reduced or enclosed spaces
• Being in open spaces
• Using public transportation (crowded)

People suffering from agoraphobia tend to avoid those situations, ask someone else to be with them or go through those situations with intense symptoms of fear and anxiety.

If left untreated it can even be really disabling and the person may even be unable to leave home. 

Specific Phobias

The main characteristic of this type of anxiety disorder is the excessive and persistent fear of a situation, activity or object that is not harmful.

Some of them are aware that their phobia is excessive but are unable to control it. 

Separation Anxiety Disorder

People with separation anxiety disorder feel really anxious when separating from someone they are really attached to.

To meet diagnostic criteria, it needs to be present and persist for at least 4 weeks in children and 6 months in adults and cause significant disruption in daily life activities. 

They tend to be worried and think about losing that someone who is really close to them, may refuse to go to sleep away from that person or may experience nightmares about being separated from them. 

Social Anxiety Disorder (SAD)

A person with this anxiety disorder feels highly uncomfortable when being humiliated, embarrassed or rejected in social interactions.

They will behave avoiding being exposed to those situations or will go through them with intense anxiety symptoms.

Examples of situations they tend to avoid are meeting new people or speaking in public. 

The symptoms need to be present for at least 6 months and cause disruption in daily activities to meet the diagnosis of SAD. 

Anxiety disorder due to medical conditions

People with anxiety disorder due to medical conditions tend to worry excessively about getting sick or becoming severely ill.

They tend to seek medical assistance because they feel “physically ill” (somatization) and ultimately look for reassurance that they are not ill or sick, eventually reducing their anxiety levels. 

Substance-induced anxiety disorder

People with this type of anxiety feel restless or nervous due to consuming substances or stopping the intake.

This is not limited just to drugs, it can also be generated by consuming alcohol, caffeine, phencyclidine, inhalants, cocaine, amphetamines or other hallucinogens. 

Known medications that can cause substance-induced anxiety include:

• Analgesic
• Sympathomimetic or other bronchodilators
• Anticholinergics
• Anesthetic
• Insulin
• Oral contraceptives
• Antiparkinsonian
• Anticonvulsants
• Lithium
• Antipsychotic
• Antidepressants 
• Corticosteroids 

Treatment for DSM 5 anxiety disorders

Usually, the DSM 5 anxiety disorders are treated through psychotherapy and/or medication. 

Psychotherapy

The most used therapies  are:

• Talk therapy
• Cognitive Behavioral Therapy (CBT)

Medication therapy

The most commonly prescribed medications are antidepressants and they belong to the family of Selective Serotonin Reuptake Inhibitors or SSRIs and serotonin-norepinephrine reuptake Inhibitors or SNRIs.

Some of them are:

• Fluoxetine (Prozac)
• Citalopram (Celexa)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Escitalopram (Lexapro)
• Duloxetine (Cymbalta)
• Venlafaxine (Effexor ER)

Comorbidities with other disorders

Some of the other disorders that can simultaneously exist with an anxiety disorder and increasing the risk of misdiagnosing are:

• Depressive disorders
• Substance use disorders

Why is this blog post about DSM 5 Anxiety Disorders?

This post is important because it gives a comprehensive understanding of each of the anxiety disorders included in the DSM 5 Anxiety Disorders section.

It also provides a better approach to identifying the symptoms and the required criteria for someone to be diagnosed with one of these disorders. 

Additionally, we now understand why they are called anxiety disorders and we are aware of what is the main characteristic common to all the disorders: the excessive and unrealistic fear and worry across different contexts or situations. 

Please feel free to comment in the comments section below!

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Frequently Asked Questions (FAQ’s) about DSM 5 Anxiety Disorders

Recommended Reading:

1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
2. Anxiety and Related Disorders Interview Schedule for DSM-5® (ADIS-5) – Adult and Lifetime Version: Clinician Manual (Treatments That Work) 
3. CBT Toolbox for Children and Adolescents: Over 200 Worksheets & Exercises for Trauma, ADHD, Autism, Anxiety, Depression & Conduct Disorders 
4. Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5)® – Adult Version: Client Interview Schedule 5-Copy Set (Treatments That Work) 
5. The Complete Adult Psychotherapy Treatment Planner: Includes DSM-5 Updates

References:

Very Well Mind

NCBI

Medscape

IHS

Talk space

American Psychiatric Association