4.2 Diagnostic criteria for generalised anxiety disorder and panic disorder
In Section 3 we began to explore some of the complexities associated with the diagnosis of mood disorders, noting in particular the lack of definitive biological, genetic or brain imaging markers (biomarkers) that could be used to support diagnosis at the present time. Anxiety can co-exist with other psychiatric conditions, most notably depression. It can also manifest as a consequence of a somatic complaint (physical illness such as cancer, diabetes, cardiovascular disease or chronic pain), and may present differently in children and adolescents compared with adults, adding further complication to diagnosis. Generalised anxiety disorder (GAD) and panic disorder (PD) are amongst the most prevalent of anxiety disorders in the world today. You can read further about the diagnosis and management of GAD and PD in the article by Locke et al. (2015). Written from a US perspective aimed at family physicians (i.e. GPs) and those in continuing medical education, Locke and colleagues consider important aspects of diagnosis and management of GAD and PD in adults using the DSM-5 diagnostic criteria (discussed in Section 3.3) which are of wider, global relevance. The link to the article is provided in the References section should you wish to read further on this topic, beyond this course. The DSM-5 criteria for GAD and PD are presented in Boxes 7 and 8 (APA, 2013), for information.
Box 7 DSM-5 diagnostic criteria for generalised anxiety disorder
adapted from Locke et al. (2015) based on APA (2013, p.222)
A.Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B.The individual finds it difficult to control the worry.
C.The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item is required in children.
Restlessness or feeling keyed up or on edge.
Being easily fatigued.
Difficulty concentrating or mind going blank.
Irritability.
Muscle tension.
Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
D.The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E.The disturbance is not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another medical condition (e.g. hyperthyroidism).
F.The disturbance is not better explained by another mental disorder (e.g. anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in post-traumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).
Box 8 DSM-5 diagnostic criteria for panic disorder
adapted from Locke et al. (2015) based on APA (2013, p.208-9)
A.Recurrent unexpected panic attacks. A panic attack is 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:
Note: The abrupt surge can occur from a calm state or an anxious state.
Palpitations, pounding heart, or accelerated heart rate.
Sweating.
Trembling or shaking.
Sensations of shortness of breath or smothering.
Feelings of choking.
Chest pain or discomfort.
Nausea or abdominal distress.
Feeling dizzy, unsteady, light-headed, or faint.
Chills or heat sensations.
Paresthesias (numbness or tingling sensations).
Derealization (feelings of unreality) or depersonalization (being detached from oneself).
Fear of losing control or 'going crazy'.
Fear of dying.
Note: Culture-specific symptoms (e.g. tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
B.At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
Persistent concern or worry about additional panic attacks or their consequences (e.g. losing control, having a heart attack, 'going crazy').
A significant maladaptive change in behaviour related to the attacks (e.g. behaviours designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
C.The disturbance is not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another medical condition (e.g. hyperthyroidism, cardiopulmonary disorders).
D.The disturbance is not better explained by another mental disorder (e.g. the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in post-traumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).