Anxiety Disorders, Dissociative Disorders, and Adjustment Disorders for professionals
Anxiety and fear are ubiquitous emotions. The terms anxiety and fear have specific scientific meanings, but common usage has made them interchangeable. For example, a phobia is a kind of anxiety that is also defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) as a "persistent or irrational fear."
Fear is defined as an emotional and physiological response to a recognized external threat (eg, a runaway car or an impending crash in an airplane). Anxiety is an unpleasant emotional state, the sources of which are less readily identified. It is frequently accompanied by physiological symptoms that may lead to fatigue or even exhaustion. Because fear of recognized threats causes similar unpleasant mental and physical changes, patients use the terms fear and anxiety interchangeably. Thus, there is little need to strive to differentiate anxiety from fear. However, distinguishing among different anxiety disorders is important, since accurate diagnosis is more likely to result in effective treatment and a better prognosis.
- Anxiety Disorders: Introduction
- Panic Attack
- Panic Disorder
- Agoraphobia Without History of Panic Disorder
- Specific Phobia (formerly Simple Phobia)
- Social Phobia (Social Anxiety Disorder)
- Obsessive- Compulsive Disorder
- Posttraumatic Stress Disorder
- Acute Stress Disorder
- Generalized Anxiety Disorder (Includes Overanxious Disorder of Childhood)
- Anxiety Disorder Due to a General Medical Condition
- Substance-Induced Anxiety Disorder
- Anxiety Disorder Not Otherwise Specified
The intensity of anxiety has many gradations ranging from minor qualms to noticeable trembling and even complete panic, the most extreme form of anxiety.
The course of anxiety also varies, with peak severity being reached within a few seconds or more gradually over minutes, hours, or days. Duration also varies from a few seconds to hours or even days or months, although episodes of panic usually abate within 10 minutes and seldom last more than 30 minutes.
The following disorders are contained in this section: Panic Disorder Without Agoraphobia, Panic Disorder With Agoraphobia, Agoraphobia Without History of Panic Disorder, Specific Phobia, Social Phobia, Obsessive -Compulsive Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder, Generalized Anxiety Disorder, Anxiety Disorder Due to a General Medical Condition, Substance-Induced Anxiety Disorder, and Anxiety Disorder Not Otherwise Specified. Because Panic Attacks and Agoraphobia occur in the context of several of these disorders, criteria sets for a Panic Attack and for Agoraphobia are listed separately at the beginning of this section.
A Panic Attack is a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of "going crazy" or losing control are present.
A common and serious mental disorder characterized by loss of contact with reality (psychosis), hallucinations (false perceptions), delusions (false beliefs), abnormal thinking
Agoraphobia is anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms.
Panic Disorder Without Agoraphobia is characterized by recurrent unexpected Panic Attacks about which there is persistent concern. Panic Disorder With Agoraphobia is characterized by both recurrent unexpected Panic Attacks and Agoraphobia.
Agoraphobia Without History of Panic Disorder is characterized by the presence of Agoraphobia and panic-like symptoms without a history of unexpected Panic Attacks.
Specific Phobia is characterized by clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behavior.
Social Phobia is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behavior.
Obsessive-Compulsive Disorder is characterized by obsessions (which cause marked anxiety or distress) and/or by compulsions (which serve to neutralize anxiety).
Posttraumatic Stress Disorder is characterized by the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma.
Acute Stress Disorder is characterized by symptoms similar to those of Posttraumatic Stress Disorder that occur immediately in the aftermath of an extremely traumatic event.
Generalized Anxiety Disorder is characterized by at least 6 months of persistent and excessive anxiety and worry.
Anxiety Disorder Due to a General Medical Condition is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a general medical condition.
Substance-Induced Anxiety Disorder is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a drug of abuse, a medication, or toxin exposure.
Anxiety Disorder Not Otherwise Specified is included for coding disorders with prominent anxiety or phobic avoidance that do not meet criteria for any of the specific Anxiety Disorders defined in this section (or anxiety symptoms about which there is inadequate or contradictory information).
Because Separation Anxiety Disorder (characterized by anxiety related to separation from parental figures) usually develops in childhood, it is included in the "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" section. Phobic avoidance that is limited to genital sexual contact with a sexual partner is classified as Sexual Aversion Disorder and is included in the "Sexual and Gender Identity Disorders" section.
Work problems, going away to school, an illness - any number of life changes can cause stress. Most of the time, people adjust to such changes within a few months. But if you continue to feel down or self-destructive, you may have an adjustment disorder.
An adjustment disorder is a type of stress-related mental illness. You may feel anxious or depressed, or even have thoughts of suicide. Your normal daily routines may feel overwhelming. Or you may make reckless decisions. In essence, you have a hard time adjusting to change in your life, and it has serious consequences.
You don't have to tough it out on your own, though. Adjustment disorder treatment - usually brief - is likely to help you regain your emotional footing.
What Is Adjustment Disorder?
Adjustment disorder is an unexpectedly strong emotional or behavioral reaction that occurs in response to an identifiable stressful life event or life change that occurred within the previous three months.
Types of Adjustment Disorder
Adjustment disorder can be acute (lasting less than six months) or chronic (lasting longer than six months). Keep in mind that the definition of adjustment disorder does not allow the symptoms to last longer than six months after the stressor has terminated. A chronic diagnosis is only allowed if the stressful event or life change is persistent. In addition to an acute and chronic diagnosis, there are six subtypes of adjustment disorder that are classified by the predominant symptoms you are experiencing. The six subtypes are:
- adjustment disorder with depressed mood
- adjustment disorder with anxiety
- adjustment disorder with mixed anxiety and depressed mood
- adjustment disorder with disturbance of conduct
- adjustment disorder with mixed disturbance of emotions and conduct
- unspecified adjustment disorder (problematic thinking and behavior that is not classifiable by the other adjustment disorder subtypes
Signs and symptoms
As the term adjustment disorder implies, symptoms develop when the person is responding to a particular event or situation, for example a loss, a problem in a close relationship, an unwanted move, a disappointment, or a failure. Typical symptoms include the following:
- Low mood
- Poor concentration
- Other typical manifestations - Loss of self esteem, hopelessness, feeling trapped, having no good options, and feeling isolated or cut off from others
Children and adolescents with adjustment disorder commonly exhibit the following:
- Depressed/irritable mood
- Sleep disturbances
- Poor performance in school q ul>
- Antisocial Personality Disorder
- Paranoid Personality Disorder
- Avoidant Personality Disorder
- Borderline Personality Disorder
- Dependent Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
- Obsessive-Compulsive Personality Disorder
- Schizoid and Schizotypal Personality Disorders
- Emotional or behavioral symptoms develop in response to an identifiable stressor or stressors within 3 months of the onset of the stressor(s) plus either or both of (1) marked distress that is out of proportion to the severity or intensity of the stressor, even when external context and cultural factors that might influence symptom severity and presentation are taken into account and/or (2) significant impairment in social, occupational, or other areas of functioningThe stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
- The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
- The symptoms do not represent normal bereavement
- After the termination of the stressor (or its consequences), the symptoms persist for no longer than an additional 6 months
- With depressed mood
- With anxious mood
- With mixed anxiety and depressed mood
- With disturbance of conduct
- With mixed disturbance of emotions and conduct
No specific physical findings correlate with adjustment disorder, but people may consult a healthcare provider for poor sleep, aches and pains, indigestion, fatigue, and other typical symptoms.
Use of the Impact Thermometer in combination with the Distress Thermometer can help identify patients with adjustment disorder; however, the inability of these measures to distinguish between adjustment disorder and other depressive disorders limits their diagnostic utility.
The specific DSM-5 diagnostic criteria for adjustment disorder are as follows :
The following 6 specifiers are used to identify subtypes of adjustment disorder:
As in all psychiatric diagnoses, a complete evaluation and mental status examination must be conducted.