Anxiety Disorders

Anxiety Disorders include disorders that share features of excessive fear

and anxiety and related behavioral disturbances. Fear is the emotional response to real
or perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously,
these two states overlap, but they also differ, with fear more often associated with surges
of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and
escape behaviors, and anxiety more often associated with muscle tension and vigilance
in preparation for future danger and cautious or avoidant behaviors. Sometimes the level
of fear or anxiety is reduced by pervasive avoidance behaviors. Panic attacks feature
prominently within the anxiety disorders as a particular type of fear response. Panic
attacks are not limited to anxiety disorders but rather can be seen in other mental
disorders as well. The anxiety disorders differ from one another in the types of objects or
situations that induce fear, anxiety, or avoidance behavior, and the associated cognitive
ideation. Thus, while the anxiety disorders tend to be highly comorbid with each other,
they can be differentiated by close examination of the types of situations that are feared
or avoided and the content of the associated thoughts or beliefs. Anxiety disorders differ
from developmentally normative fear or anxiety by being excessive or persisting beyond
developmentally appropriate periods. They differ from transient fear or anxiety, often
stress-induced, by being persistent (e.g., typically lasting 6 months or more), although the
criterion for duration is intended as a general guide with allowance for some degree of
flexibility and is sometimes of shorter duration in children (as in separation anxiety
disorder and selective mutism). Since individuals with anxiety disorders typically
overestimate the danger in situations they fear or avoid, the primary determination of
whether the fear or anxiety is excessive or out of proportion is made by the clinician,
taking cultural contextual factors into account. Many of the anxiety disorders develop in
childhood and tend to persist if not treated. Most occur more frequently in females than in
males (approximately 2:1 ratio). Each anxiety disorder is diagnosed only when the
symptoms are not attributable to the physiological effects of a substance/medication or to
another medical condition or are not better explained by another mental disorder.
Selective mutism is characterized by a consistent failure to speak in social
situations in which there is an expectation to speak (e.g., school) even though the
individual speaks in other situations. The failure to speak has significant consequences
on achievement in academic or occupational settings or otherwise interferes with normal
social communication. Individuals with specific phobia are fearful or anxious about or
avoidant of circumscribed objects or situations. A specific cognitive ideation is not
featured in this disorder, as it is in other anxiety disorders. The fear, anxiety, or
avoidance is almost always immediately induced by the phobic situation, to a degree that
is persistent and out of proportion to the actual risk posed. There are various types of
specific phobias: animal; natural environment; blood-injection-injury; situational; and
other situations.

1. Separation Anxiety Disorder

Definition: an in which an individual experiences excessive regarding separation from
home or from people to whom the individual has a strong (e.g. a parent, caregiver,
significant other or siblings). It is most common in infants and small children, typically
between the ages of 67 months to 3 years, although it may pathologically manifest itself
in older children, adolescents and adults. Separation anxiety is a natural part of the
developmental process. Unlike SAD (indicated by excessive ), normal separation anxiety
indicates healthy advancements in a childs cognitive maturation and should not be
considered a developing behavioral problem.

Symptoms
clinging to parents
extreme and severe crying
refusal to do things that require separation
physical illness, such as headaches or vomiting
violent, emotional temper tantrums
refusal to go to school
poor school performance
failure to interact in a healthy manner with other children
refusing to sleep alone
nightmares

Characteristics
Depending on their age, individuals may have fears of animals, monsters, the dark,
muggers, burglars, kidnappers, car accidents, plane travel, and other situations that are
perceived as presenting danger to the integrity of the family or themselves. Concerns
about death and dying are common. School refusal may lead to academic difficulties and
social avoidance. Children may complain that no one loves them or cares about them
and that they wish they were dead. When extremely upset at the prospect of separation,
they may show anger or occasionally hit or lash out at someone who is forcing
separation.

Diagnostic Criteria
A. Developmentally inappropriate and excessive fear or anxiety concerning separation
from those to whom the individual is attached, as evidenced by at least three of the
following:
1. Recurrent excessive distress when anticipating or experiencing separation from home
or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about
possible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting
lost, being kidnapped, having an accident, becoming ill) that causes separation from a
major attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to school, to work, or
elsewhere because of fear of separation.
5. Persistent and excessive fear of or reluctance about being alone or without major
attachment figures at home or in other settings.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without
being near a major attachment figure.
7. Repeated nightmares involving the theme of separation. 8. Repeated complaints of
physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when
separation from major attachment figures occurs or is anticipated.
B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and
adolescents and typically 6 months or more in adults.
C. The disturbance causes clinically significant distress or impairment in social,
academic, occupational, or other important areas of functioning.
D. The disturbance is not better explained by another mental disorder, such as refusing
to leave home because of excessive resistance to change in autism spectrum disorder;
delusions or hallucinations concerning separation in psychotic disorders; refusal to go
outside without a trusted companion in agoraphobia; worries about ill health or other
harm befalling significant others in generalized anxiety disorder; or concerns about
having an illness in illness anxiety disorder.
2. Specific Phobia
Definition: A specific phobia, formerly called a simple phobia, is a lasting and
unreasonable fear caused by the presence or thought of a specific object or situation that
usually poses little or no actual danger. Exposure to the object or situation brings about
an immediate reaction, causing the person to endure intense (nervousness) or to avoid
the object or situation entirely. The distress associated with the phobia and/or the need to
avoid the object or situation can significantly interfere with the person's ability to function.
Adults with a specific phobia recognize that the fear is excessive or unreasonable, yet
are unable to overcome it.

Symptoms
a feeling of imminent danger or doom
the need to escape
heart palpitations
sweating
trembling
shortness of breath or a smothering feeling
a feeling of choking
chest pain or discomfort
nausea or abdominal discomfort
feeling faint, dizzy or lightheaded
a sense of things being unreal, depersonalization
a fear of losing control or going crazy
a fear of dying
tingling sensation
chills or heat flush

Characteristics
Marked and persistent fear that is excessive or unreasonable, cued by the presence or
anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an
injection, seeing blood).
The fear is persistent, typically lasting at least 6 months.
Exposure to the phobic stimulus almost invariably provokes an immediate anxiety
response, which may take the form of a situationally bound or situationally predisposed .
(In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.)
The fear or anxiety is out of proportion to the actual danger posed by the specific object
or situation and is not a typical response in the persons social or cultural context. Most
adults will recognize that their fear is excessive or unreasonable and are bothered by the
fact that they have this fear.

Diagnostic Criteria
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights,
animals, receiving an injection, seeing blood). Note: In children, the fear or anxiety may
be expressed by crying, tantrums, freezing, or clinging.
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or
anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific
object or situation and to the sociocultural context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
G. The disturbance is not better explained by the symptoms of another mental disorder,
including fear, anxiety, and avoidance of situations associated with panic-like symptoms
or other incapacitating symptoms (as in agoraphobia): objects or situations related to
obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in
posttraumatic stress disorder); separation from home or attachment figures (as in
separation anxiety disorder); or social situations (as in social anxiety disorder).
Specify if: Code based on the phobic stimulus: 300.29 (F40.218) Animal (e.g., spiders,
insects, dogs). 300.29 (F40.228) Natural environment (e.g., heights, storms, water).
300.29 (F40.23X) Blood-injection-injury (e.g., needles, invasive medical procedures).

3. Social Anxiety Disorder (Social Phobia)

Definition: also known as social phobia, is an characterized by a significant amount of ,
causing considerable distress and impaired ability to function in at least some parts of
daily life. These fears can be triggered by perceived or actual scrutiny from others.

Symptoms
Fear of situations in which you may be judged
Worrying about embarrassing or humiliating yourself
Intense fear of interacting or talking with strangers
Fear that others will notice that you look anxious
Fear of physical symptoms that may cause you embarrassment, such as
 blushing, sweating, trembling or having a shaky voice
Avoiding doing things or speaking to people out of fear of embarrassment
Avoiding situations where you might be the center of attention
Having anxiety in anticipation of a feared activity or event
Enduring a social situation with intense fear or anxiety
Spending time after a social situation analyzing your performance and identifying
flaws in your interactions
Expecting the worst possible consequences from a negative experience during a
social situation

Characteristics
Social anxiety causes unreasonable, debilitating fear of being judged or publicly
humiliated. You may avoid or severely limit encounters with other people-which can keep
you from daily activities. You may develop physical symptoms such as a rapid heartbeat,
shortness of breath, or tightness in your chest when faced with a feared social situation.
When you have , common social situations-such as eating in public, writing in front of
other people, using a public restroom, or speaking in front of others-can cause
overwhelming fear and anxiety

Diagnostic Criteria
A. Marked fear or anxiety about one or more social situations in which the individual is
exposed to possible scrutiny by others. Examples include social interactions (e.g., having
a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and
performing in front of others (e.g., giving a speech). Note: In children, the anxiety must
occur in peer settings and not just during interactions with adults
B. The individual fears that he or she will act in a way or show anxiety symptoms that will
be negatively evaluated (i.e., will be humiliating or embarrassing: will lead to rejection or
offend others).
C. The social situations almost always provoke fear or anxiety. Note: In children, the fear
or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing
to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social
situation and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical condition.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another
mental disorder, such as panic disorder, body dysmohic disorder, or autism spectrum
disorder.
J. If another medical condition (e.g., Parkinsons disease, obesity, disfigurement from
bums or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is
excessive.
Specify if: Performance only: If the fear is restricted to speaking or performing in public.

4. Panic Disorder
Definition: An anxiety disorder that is characterized by sudden attacks of fear and
panic. Panic attacks may occur without a known reason, but more frequently they are
triggered by fear-producing events or thoughts, such as taking an elevator or driving.
Symptoms
Pounding or fast heartbeat
Sweating
Trembling or shaking
Shortness of breath or a feeling of being smothered
A choking feeling
Chest pain
Nausea or stomach pains
Feeling dizzy or faint
Chills or hot flashes
Numbness or tingling in the body
Feeling unreal or detached
A fear of losing control or going crazy
A fear of dying

Characteristics
Panic disorder is characterized by uncontrollable, recurrent episodes of panic and fear
that peak within minutes. Panic attacks are accompanied by physical manifestations,
such as heart palpitations, sweating, and dizziness as well as the fear of dying or
becoming insane. Worry about having an attack may lead to additional anxiety and
avoidance behaviors or to other problems in functioning.
Diagnostic Criteria
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.
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, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached from
oneself).
12. Fear of losing control or going crazy.
13. 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:
1. Persistent concern or worry about additional panic attacks or their consequences (e.g.,
losing control, having a heart attack, going crazy).
2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors
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 posttraumatic stress disorder: or in response to
separation from attachment figures, as in separation anxiety disorder).
Panick Attack Specifier
Note: Symptoms are presented for the purpose of identifying a panic attack; however,
panic attack is not a mental disorder and cannot be coded. Panick attack can occur in
the context of any anxiety disorder as well as other mental disorders (e.g., depressive
disorders, posttraumatic stress disorder, substance use disorders) and some medical
conditions (e.g., cardiac, respiratory, vestibular, gastrointestinal). When the presence of
a panic attack is identified, it should be noted as a specifier (e.g., posttraumatic stress
disorder with panic attacks). For panic disorder, the presence of panic attack is
contained within the criteria for the disorder and panic attack is not used as a specifier.
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.
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, light-headed, or faint.
9. Chilis or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached from
oneself).
12. Fear of losing control or going crazy.
13. 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.

5. Agoraphobia
Definition: Translated from Greek as "fear of the marketplace," agoraphobia involves
intense fear and anxiety to a real or anticipated place or situation where escape might be
difficult. People with agoraphobia may avoid situations such as being alone outside of
the home, traveling in a car, bus, or airplane, being in a crowded area, being in enclosed
spaces such as shops and cinemas, or being on a bridge or in an elevator.
Symptoms
Fear or anxiety about:

being outside of the home alone

using public transportation

being in enclosed places (stores, movie theaters)

standing in line or being in a crowd

being in open spaces (markets, parking lots)

being in places where escape might be difficult

Active avoidance of all situations that provoke fear and anxiety

Becoming housebound for prolonged periods

Feelings of detachment or estrangement from others

Feelings of helplessness

Dependence upon others

Anxiety or panic attack (acute severe anxiety)

Characteristics
Agoraphobic fears typically involve characteristic clusters of situations that include being
outside the home alone; being in a crowd or standing in a line; being on a bridge; and
traveling in a bus, train, or automobile.
A person who experiences agoraphobia avoids such situations (e.g., travel is restricted;
the person changes daily routines) or else they are endured with significant distress. For
example, people with agoraphobia often require the presence of a companion, such as a
family member, partner, or friend, to confront the situation.

Diagnostic Criteria
A. Marked fear or anxiety about two (or more) of the following five situations:
1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
3. Being in enclosed places (e.g., shops, theaters, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
B. The individual fears or avoids these situations because of thoughts that escape might
be difficult or help might not be available in the event of developing panic-like symptoms
or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear
of incontinence).
C. The agoraphobic situations almost always provoke fear or anxiety.
D. The agoraphobic situations are actively avoided, require the presence of a
companion, or are endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic
situations and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
H. If another medical condition (e.g., inflammatory bowel disease, Parkinsons disease)
is present, the fear, anxiety, or avoidance is clearly excessive.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another
mental disorderfor example, the symptoms are not confined to specific phobia,
situational type; do not involve only social situations (as in social anxiety disorder): and
are not related exclusively to obsessions (as in obsessive-compulsive disorder),
perceived defects or flaws in physical appearance (as in body dysmohic disorder),
reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation
(as in separation anxiety disorder).
Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an
individuals presentation meets criteria for panic disorder and agoraphobia, both
diagnoses should be assigned.

6. Generalized Anxiety Disorder

Definition: Generalized Anxiety Disorder (GAD) is characterized by persistent and
excessive worry about a number of different things. People with GAD may anticipate
disaster and may be overly concerned about money, health, family, work, or other
issues. Individuals with GAD find it difficult to control their worry. They may worry more
than seems warranted about actual events or may expect the worst even when there is
no apparent reason for concern.

Symptoms
Common body symptoms are:

Feeling tired for no reason

Headaches

Muscle tension and aches

Having a hard time swallowing

Trembling or twitching

Sweating

Nausea

Feeling lightheaded

Feeling out of breath

Having to go to the bathroom frequently

Hot flashes

In children and adolescents with generalized anxiety disorder, their anxieties and worries
are often associated with the quality of performance or competence at school or sporting
events. Additionally, worries may include punctuality, conformity, perfectionism, and they
may be so unsure of themselves that they will redo tasks to reach a level of perceived
perfection.

Characteristics
Generalized anxiety disorder (GAD) is characterized by six months or more of chronic,
exaggerated worry and tension that is unfounded or much more severe than the normal
anxiety most people experience. People with this disorder usually:
Can't control their excessive worrying
Have difficulty falling or staying asleep
Experience muscle tension
Expect the worst
Worry excessively about money, health, family or work, even when there are no signs of
trouble
Are unable to relax
Are irritable
Are easily startled
Are easily fatigued
Have difficulty concentrating or the mind goes blank

Diagnostic Criteria
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.
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 (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 posttraumatic 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).

7. Substance/Medication-Induced Anxiety Disorder

Definition: Prominent anxiety symptoms (i.e., generalized anxiety, panic attacks,
obsessive-compulsive symptoms, or symptoms) determined to be caused by the effects
of a is the primary feature of a . A substance may induce psychotic symptoms during
intoxication (i.e., while the individual is under the influence of the drug) or during
withdrawal (i.e., after an individual stops using the drug).
A substance-induced anxiety disorder is subtyped or categorized based on whether the
prominent feature is generalized anxiety, panic attacks, obsessive-compulsive
symptoms, or phobia symptoms. In addition, the disorder is subtyped based on whether
it began during intoxication on a substance or during withdrawal from a substance. A
substance-induced anxiety disorder that begins during substance use can last as long as
the drug is used. A substance-induced anxiety disorder that begins during withdrawal
may first manifest up to four weeks after an individual stops using the substance.

Symptoms
Thinking that bad things will happen or that you will never get better
Having trouble falling asleep or waking up often during the night
Having trouble concentrating or remembering things
Fearing that you are losing control of yourself and will go crazy or will die
Losing weight because you don't feel like eating, or because your stomach hurts
or you have vomiting or diarrhea
Having chills, hot flashes, sweating, shaking, numbness, or a pounding heartbeat
Having trouble breathing, trouble swallowing, or chest pain

Characteristics
The disorder is characterized by anxiety or fear, sometimes accompanied by such
physical symptoms as racing heart, breathless and shakiness, caused by the effects of a
medication or psychoactive substance. Although anxiety and fear are often used
interchangeably, the former term generally means an unpleasant emotional state for
which the cause is not apparent or which is perceived to be uncontrollable, while the
latter is usually the emotional and physical response to an identifiable threat. It has been
said that anxiety is the anticipation of future events, while fear is a reaction to current
events.

Diagnostic Criteria
A. Panic attacks or anxiety is predominant in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings of both
(1)and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or
withdrawal or atter exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion
A.
C. The disturbance is not better explained by an anxiety disorder that is not substance/
medication-induced. Such evidence of an independent anxiety disorder could include the
following: The symptoms precede the onset of the substance/medication use; the
symptoms persist for a substantial period of time (e.g., about 1 month) atter the cessation
of acute withdrawal or severe intoxication: or there is other evidence suggesting the
existence of an independent non-substance/medication-induced anxiety disorder (e.g., a
history of recurrent non-substance/medication-related episodes).
D. The 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 of functioning.
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or
substance withdrawal only when the symptoms in Criterion A predominate in the clinical
picture and they are sufficiently severe to warrant clinical attention.

8. Anxiety Disorder Due to Another Medical Condition

Definition: includes symptoms of intense anxiety or panic that are directly caused by a
physical health problem

Symptoms
Anxiety due to another medical condition may exhibit several symptom pictures. For
example, if the anxiety shows itself as panic disorder, symptoms may include sudden
onset of terror with no specific precipitating event (NIMH, n.d.). Along with the terror, a
pounding heart, sweating, feeling faint, or dizziness may be
experienced. The patient with panic may have physical symptoms that suggest a heart
attack, also. These include feeling chilled, numbness in hands, nausea, chest
pain, and feelings of smothering. A sense of loss of touch with reality, fear of some
impending doom, and fear of losing control add to the impact of panic. Many people who
experience panic attacks are convinced they are having a heart attack and seek medical
attention at emergency rooms.

Characteristics
When a person suffers from anxiety disorder due to another medical condition, the
presence of that medical condition leads directly to the anxiety experienced. The anxiety
is the predominant feature and may take the form of panic attacks, obsessive-compulsive
behavior, or generalized anxiety.

Diagnostic Criteria
A. Panic attacks or anxiety is predominant in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings that
the disturbance is the direct pathophysiological consequence of another medical
condition.
C. The disturbance is not better explained by another mental disorder.
D. The 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 of functioning.

9. Other Specified Anxiety Disorder

This category applies to presentations in which symptoms characteristic of an anxiety
disorder that cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning predominate but do not meet the full criteria for any
of the disorders in the anxiety disorders diagnostic class. The other specified anxiety
disorder category is used in situations in which the clinician chooses to communicate the
specific reason that the presentation does not meet the criteria for any specific anxiety
disorder. This is done by recording other specified anxiety disorder followed by the
specific reason (e.g., generalized anxiety not occurring more days than not).
Examples of presentations that can be specified using the other specified designation
include the following;
1. Limited-symptom attacks.
2. Generalized anxiety not occurring more days than not.
3. Khyl cap (wind attacks): See Glossary of Cultural Concepts of Distress in the
Appendix.
4. Ataque de nervios (attack of nerves): See Glossary of Cultural Concepts of Distress
in the Appendix.

10. Unspecified Anxiety Disorder

This category applies to presentations in which symptoms characteristic of an anxiety
disorder that cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning predominate but do not meet the full criteria for any
of the disorders in the anxiety disorders diagnostic class. The unspecified anxiety
disorder category is used in situations in which the clinician chooses not to specify the
reason that the criteria are not met for a specific anxiety disorder, and includes
presentations in which there is insufficient information to make a more specific diagnosis
(e.g., in emergency room settings).
Anxiety Disorders

Submitted to:
Prof. Serafina P. Maxino

Submitted by:
Marbella, Emmanuella Grace P.
BS Psychology 3-1
September 4, 2017
 Obsessive-Compulsive and Related Disorders
Obsessive-Compulsive and related disorders include
obsessive-compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder,
trichotillomania (hairpulling disorder), excoriation (skin-picking) disorder,
substance/medication-induced obsessive-compulsive and related disorder,
obsessive-compulsive and related disorder due to another medical condition, and other
specified obsessive-compulsive and related disorder and unspecified
obsessive-compulsive and related disorder (e.g., body-focused repetitive behavior
disorder, obsessional jealousy).
OCD is characterized by the presence of obsessions and/or compulsions.
Obsessions are recurrent and persistent thoughts, urges, or images that are experienced
as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts
that an individual feels driven to perform in response to an obsession or according to
rules that must be applied rigidly. Some other obsessive-compulsive and related
disorders are also characterized by preoccupations and by repetitive behaviors or mental
acts in response to the preoccupations. Other obsessive-compulsive and related
disorders are characterized primarily by recurrent body-focused repetitive behaviors
(e.g., hair pulling, skin picking) and repeated attempts to decrease or stop the behaviors.
The inclusion of a chapter on obsessive-compulsive and related disorders
in DSM-5 reflects the increasing evidence of these disorders' relatedness to one another
in terms of a range of diagnostic validators as well as the clinical utility of grouping these
disorders in the same chapter. Clinicians are encouraged to screen for these conditions
in individuals who present with one of them and be aware of overlaps between these
conditions. At the same time, there are important differences in diagnostic validators and
treatment approaches across these disorders. Moreover, there are close relationships
between the anxiety disorders and some of the obsessive-compulsive and related
disorders (e.g., OCD), which is reflected in the sequence of DSM-5 chapters, with
obsessive-compulsive and related disorders following anxiety disorders.
The obsessive-compulsive and related disorders differ from
developmentally normative preoccupations and rituals by being excessive or persisting
beyond developmentally appropriate periods. The distinction between the presence of
subclinical symptoms and a clinical disorder requires assessment of a number of factors,
including the individual's level of distress and impairment in functioning. The chapter
begins with OCD. It then covers body dysmorphic disorder and hoarding disorder, which
are characterized by cognitive symptoms such as perceived defects or flaws in physical
appearance or the perceived need to save possessions, respectively.
 The chapter then covers trichotillomania (hair-pulling disorder) and
excoriation (skin-picking) disorder, which are characterized by recurrent body-focused
repetitive behaviors. Finally, it covers substance/medication-induced
obsessive-compulsive and related disorder, obsessive-compulsive and related disorder
due to another medical condition, and other specified obsessive-compulsive and related
disorder and unspecified obsessive-compulsive and related disorder.
While the specific content of obsessions and compulsions varies among
individuals, certain symptom dimensions are common in OCD, including those of
cleaning (contamination obsessions and cleaning compulsions); symmetry (symmetry
obsessions and repeat- ing, ordering, and counting compulsions); forbidden or taboo
thoughts (e.g., aggressive, sexual, and religious obsessions and related compulsions);
and harm (e.g., fears of harm to oneself or others and related checking compulsions).
The tic-related specifier of OCD is used v^hen an individual has a current or past history
of a tic disorder.
1. Obsessive-Compulsive Disorder
Definition: an anxiety disorder in which people have unwanted and repeated thoughts,
feelings, images, and sensations (obsessions) and engage in behaviors or mental acts in
response to these thoughts or obsessions.Often the person carries out the behaviors to
reduce the impact or get rid of the obsessive thoughts, but this only brings temporary
relief. Not performing the obsessive rituals can cause great anxiety. A person's level of
OCD can be anywhere from mild to severe, but if left untreated, it can limit his or her
ability to function at work or school or even to lead a comfortable existence at home or
around others.

Symptoms
People with OCD may have symptoms of obsessions, compulsions, or both. These
symptoms can interfere with all aspects of life, such as work, school, and personal
relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety.
Common symptoms include:

Fear of germs or contamination

Unwanted forbidden or taboo thoughts involving sex, religion, and harm
Aggressive thoughts towards others or self
Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in
response to an obsessive thought. Common compulsions include:

Excessive cleaning and/or handwashing

Ordering and arranging things in a particular, precise way
Repeatedly checking on things, such as repeatedly checking to see if the door is
locked or that the oven is off
Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But
a person with OCD generally:

Can't control his or her thoughts or behaviors, even when those thoughts or
behaviors are recognized as excessive
Spends at least 1 hour a day on these thoughts or behaviors
 Doesnt get pleasure when performing the behaviors or rituals, but may feel brief
relief from the anxiety the thoughts cause
Experiences significant problems in their daily life due to these thoughts or
behaviors

Characteristics
Sufferers of OCD who have intrusive thoughts generally have reoccurring images in their
minds that are disturbing or horrific. These thoughts may occur based on an event that
happened in the persons life, or they may occur for no particular reason. Sufferers of
OCD who have the need to constantly check on people or items generally fear that
something bad will happen if they stop checking. For example, someone with OCD may
constantly walk throughout their home to make sure all the doors and windows are
locked due to their fear that someone might try to break in.Sufferers who have a fear of
contamination may take baths and wash their hands many times throughout the course
of one day, or they may be obsessed with cleaning every inch of their home to ensure it is
spotless and free of germs. OCD sufferers who hoard items are obsessed with making
sure they keep everything theyve ever owned, even if the item is worn out or useless. A
person who hoards becomes emotionally attached to items, and the very thought of
throwing things away can cause great distress.

Diagnostic Criteria
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images that are experienced, at some
time during the disturbance, as intrusive and unwanted, and that in most individuals
cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to
neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g.,
praying, counting, repeating words silently) that the individual feels driven to perform in
response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress,
or preventing some dreaded event or situation; however, these behaviors or mental acts
are not connected in a realistic way with what they are designed to neutralize or prevent,
or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental
acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per
day) or cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects
of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder
(e.g., excessive worries, as in generalized anxiety disorder; preoccupation with
appearance, as in body dysmorphic disorder; difficulty discarding or parting with
possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling
disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in
stereotypic movement disorder; ritualized eating behavior, as in eating disorders;
preoccupation with substances or gambling, as in substance-related and addictive
disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual
urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control,
and conduct disorders; guilty ruminations, as in major depressive disorder; thought
insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic
disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Specify if:
With good or fair insiglit: The individual recognizes that obsessive-compulsive disorder
beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are
probably true.
With absent insight/deiusionai beiiefs: The individual is completely convinced that
obsessive-compulsive disorder beliefs are true.
Specify if: Tic-reiated: The individual has a current or past history of a tic disorder.

2. Body Dysmorphic Disorder

Definition: an anxiety disorder that causes a person to have a distorted view of how they
look and to spend a lot of time worrying about their appearance.

Symptoms
Being extremely preoccupied with a perceived flaw in appearance that to others
can't be seen or appears minor
Strong belief that you have a defect in your appearance that makes you ugly or
deformed
Belief that others take special notice of your appearance in a negative way or
mock you
 Engaging in behaviors aimed at fixing or hiding the perceived flaw that are difficult
to resist or control, such as frequently checking the mirror, grooming or skin
picking
Attempting to hide perceived flaws with styling, makeup or clothes
Constantly comparing your appearance with others
Always seeking reassurance about your appearance from others
Having perfectionist tendencies
Seeking frequent cosmetic procedures with little satisfaction
Avoiding social situations
Being so preoccupied with appearance that it causes major distress or problems
in your social life, work, school or other areas of functioning

Characteristics
BDD is a body-image disorder characterized by persistent and intrusive preoccupations
with an imagined or slight defect in one's appearance.
People with BDD can dislike any part of their body, although they often find fault with
their hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a
slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and
prominent, often causing severe emotional distress and difficulties in daily functioning.
People with BDD suffer from obsessions about their appearance that can last for hours
or up to an entire day. BDD obsessions may be focused on musculature (i.e. fixation on
muscle mass or definition). Hard to resist or control, these obsessions make it difficult for
people with BDD to focus on anything but their imperfections. This can lead to low
self-esteem, avoidance of social situations, and problems at work or school.

Diagnostic Criteria
A. Preoccupation with one or more perceived defects or flaws in physical appearance
that are not observable or appear slight to others.
B. At some point during the course of the disorder, the individual has performed repetitive
behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking)
or mental acts (e.g., comparing his or her appearance with that of others) in response to
the appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The appearance preoccupation is not better explained by concerns with body fat or
weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
Specify if:
With muscle dysmorphia: The individual is preoccupied with the idea that his or her body
build is too small or insufficiently muscular. This specifier is used even if the individual is
preoccupied with other body areas, which is often the case.
Specify if:
Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., I look ugly
or I look deformed).
With good or fair insight: The individual recognizes that the body dysmorphic disorder
beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks that the body dysmorphic disorder beliefs are
probably true.
With absent insight/delusional beliefs: The individual is completely convinced that the
body dysmorphic disorder beliefs are true.

3. Hoarding Disorder
Definition: Hoarding is a disorder characterized by an ongoing resistance to discarding
unnecessary items like junk mail, old newspapers, and materials that most people would
consider to be garbage. People with hoarding disorder also hold on to personal
possessions that are no longer needed, either because they feel personally attached to
the items or because they believe they will need them in the future. The accumulation of
clutter and lack of order and cleanliness can cause health and safety risks within the
home and create social, professional, and functional problems for a person with hoarding
disorder. The disorder also affects the people around the hoarder.

Symptoms
Excessively acquiring items that are not needed or for which there's no space
Persistent difficulty throwing out or parting with your things, regardless of actual
value
Feeling a need to save these items, and being upset by the thought of discarding
them
Building up of clutter to the point where rooms become unusable
Having a tendency toward indecisiveness, perfectionism, avoidance,
procrastination, and problems with planning and organizing
Excessive acquiring and refusing to discard items results in:
Disorganized piles or stacks of items, such as newspapers, clothes, paperwork,
 books or sentimental items
Possessions that crowd and clutter your walking spaces and living areas and
make the space unusable for the intended purpose, such as not being able to
cook in the kitchen or use the bathroom to bathe
Buildup of food or trash to unusually excessive, unsanitary levels
Significant distress or problems functioning or keeping yourself and others safe in
your home
Conflict with others who try to reduce or remove clutter from your home
Difficulty organizing items, sometimes losing important items in the clutter

Characteristics
Unlike someone who is a collector of objects generally recognized as collectable with
some known value, a person with hoarding disorder collects random items and is overly
attached to personal possessions that may or may not have any value. Although they
may be convinced to give up or throw away some of the items, doing so causes the
person great distress. Ultimately, almost every surface in the home of a hoarder,
including floors, furniture, counters and other fixtures, is covered in growing piles of
clutter. The hoarder has only a narrow path left clear for walking through the living space
which, for the most part, is no longer usable. The more cluttered and blocked the home
becomes, the more stress the person feels, because of the chaos within the living space
and often because of complaints from family members and neighbors.

Diagnostic Criteria
A. Persistent difficulty discarding or parting with possessions, regardless of their actual
value.
B. This difficulty is due to a perceived need to save the items and to distress associated
with discarding them.
C. The difficulty discarding possessions results in the accumulation of possessions that
congest and clutter active living areas and substantially compromises their intended use.
If living areas are uncluttered, it is only because of the interventions of third parties (e.g.,
family members, cleaners, authorities).
D. The hoarding causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning (including maintaining a safe
environment for self and others).
E. The hoarding is not attributable to another medical condition (e.g., brain injury,
cerebrovascular disease, Prader-Willi syndrome).
F. The hoarding is not better explained by the symptoms of another mental disorder (e.g.,
obsessions in obsessive-compulsive disorder, decreased energy in major depressive
disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in
major neurocognitive disorder, restricted interests in autism spectrum disorder).
Specify if:
With excessive acquisition: If difficulty discarding possessions is accompanied by
excessive acquisition of items that are not needed or for which there is no available
space.
Specify if:
With good or fair insight: The individual recognizes that hoarding-related beliefs and
behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are
problematic.
With poor insight: The individual is mostly convinced that hoarding-related beliefs and
behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are
not problematic despite evidence to the contrary.
With absent insight/delusional beliefs: The individual is completely convinced that
hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or
excessive acquisition) are not problematic despite evidence to the contrary.

4. Trichotillomania (Hair-Pulling Disorder)

Definition: Trichotillomania is a body-focused repetitive behavior classified as an impulse
control disorder (along the lines of pyromania, kleptomania, and pathologic gambling)
which involves pulling out one's hair. Hair pulling may occur in any region of the body in
which hair grows but the most common sites are the scalp, eyebrows, and eyelids.

Symptoms
Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes,
but sometimes from other body areas, and sites may vary over time
An increasing sense of tension before pulling, or when you try to resist pulling
A sense of pleasure or relief after the hair is pulled
Noticeable hair loss, such as shortened hair or thinned or bald areas on the scalp
or other areas of your body, including sparse or missing eyelashes or eyebrows
Preference for specific types of hair, rituals that accompany hair pulling or
patterns of hair pulling
Biting, chewing or eating pulled-out hair
Playing with pulled-out hair or rubbing it across your lips or face
Repeatedly trying to stop pulling out your hair or trying to do it less often without
 success
Significant distress or problems at work, school or in social situations related to
pulling out your hair

Characteristics
They may pull out the hair on their head or in other places, such as their eyebrows or
eyelashes.
Trichotillomania is an impulse-control disorder, a psychological condition where the
person is unable to stop themselves carrying out a particular action.
They will experience an intense urge to pull their hair out and growing tension until they
do. After pulling out hair, they'll feel a sense of relief. Pulling out hair on the head leaves
bald patches.
Trichotillomania can cause negative feelings, such as guilt. The person may also feel
embarrassed or ashamed about pulling their hair out, and may try to deny it or cover it
up. Sometimes trichotillomania can make the person feel unattractive and can lead to
low self-esteem.
Impulse-control disorders are more common among teenagers and young adults.
Trichotillomania tends to affect girls more than boys.

Diagnostic Criteria
A. Recurrent pulling out of ones hair, resulting in hair loss.
B. Repeated attempts to decrease or stop hair pulling.
C. The hair pulling causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The hair pulling or hair loss is not attributable to another medical condition (e.g., a
dermatological condition).
E. The hair pulling is not better explained by the symptoms of another mental disorder
(e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic
disorder).

5. Excoriation (Skin-Picking) Disorder

Definition: exxcoriation disorder is characterized by recurrent picking of one's skin
resulting in skin lesions. Excoriation disorder (also referred to as chronic skin-picking or
dermatillomania) is a mental illness related to obsessive-compulsive disorder. It is
characterized by repeated picking at ones own skin which results in skin lesions and
causes significant disruption in ones life.

Symptoms
 Trying to remove imperfections: Some people repeatedly scratch skin or try to
rub out imperfections they think they see in their skin. This, too, can cause
additional lesions, cuts, and sores.
Spending large amounts of time picking: Some people with this condition will pick
at their skin several times a day. Others may pick for several hours at a time.
Either way, the behavior can be a significant disruption to their social and
professional lives.
Developing scars and infections from frequent picking: The disorder can lead to
infections, lesions, and scars that last for long periods of time. Infections may
require treatment with antibiotics.
Avoiding public events because of their skin: Frequent picking can leave skin
covered in lesions and scars. Some people with this condition may avoid the
beach, gym, or venues that require less clothing because of their skins
appearance.

Characteristics
Excoriation Disorder, also known as skin picking disorder or dermatillomania, is
characterized by the repetitive picking of ones own skin. Individuals who struggle with
this disorder touch, rub, scratch, pick at, or dig into their skin in an attempt to improve
perceived imperfections, often resulting in tissue damage, discoloration, or scarring. Skin
picking disorder is one of a group of behaviors known as body-focused repetitive
behaviors (BFRBs), self-grooming behaviors in which individuals pull, pick, scrape, or
bite their own hair, skin, or nails, resulting in damage to the body.
Although the severity of excoriation disorder varies greatly, many people who struggle
with skin picking exhibit noticeable skin damage, which they attempt to camouflage with
makeup, clothing, or other means of concealing affected areas. Due to shame and
embarrassment, individuals may also engage in avoidance behaviors, including the
avoidance of certain situations that may lead them to feel vulnerable to being
discovered (e.g., wearing shorts, being seen by others without makeup, or intimacy).

Diagnostic Criteria
A. Recurrent skin picking resulting in skin lesions.
B. Repeated attempts to decrease or stop skin picking.
C. The skin picking causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The skin picking is not attributable to the physiological effects of a substance (e.g.,
cocaine) or another medical condition (e.g., scabies).
E. The skin picking is not better explained by symptoms of another mental disorder (e.g.,
delusions or tactile hallucinations in a psychotic disorder, attempts to improve a
perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in
stereotypic movement disorder, or intention to harm oneself in nonsuicidal self-injury).

6. Substance/Medication-Induced Obsessive-Compulsive and

Related Disorder
Definition: Substance or medication induced OCD occurs as a direct result of using
drugs, such as prescribed medications, illicit substances, alcohol, or exposure to certain
toxins. Medications or substances may induce while under their influence or upon
withdrawal from their use.

Symptoms
Severe, intrusive obsessive thoughts and/or compulsive behaviors (i.e. obsessive
checking, hand washing, , , repetitive rituals)
Symptoms begin within one month of drug or medication use, or upon withdrawal
from a substance or medication known to cause OCD anxiety symptoms
Symptoms are not due to a pre-existing OCD or related disorder that occurred
prior to substance exposure
symptoms cause significant anxiety and distress, impairing functioning in
everyday life

Characteristics
People with this condition have symptoms that closely resemble the symptoms of ) or
any one of several other conditions closely linked to OCD. However, these symptoms
stem from the effects of a medication or a legal or illegal substance, not from the internal
brain dysfunctions that normally trigger OCD and similar mental health problems.

Diagnostic Criteria
A. Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive
behaviors, or other symptoms characteristic of the obsessive-compulsive and related
disorders predominate in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings of both
(1)and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or
withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion
A.
C. The disturbance is not better explained by an obsessive-compulsive and related
disorder that is not substance/medication-induced. Such evidence of an independent
obsessive-compulsive and related disorder could include the following:
The symptoms precede the onset of the substance/medication use; the symptoms
persist for a substantial period of time (e.g., about 1 month) after the cessation of acute
withdrawal or severe intoxication; or there is other evidence suggesting the existence of
an independent non-substance/medication-induced obsessive-compulsive and related
disorder (e.g., a history of recurrent non-substance/medication related episodes).
D. The disturbance does not occur exclusively during the course of a delirium.
The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Note: This diagnosis should be made in addition to a diagnosis of substance intoxication
or substance withdrawal only when the symptoms in Criterion A predominate in the
clinical picture and are sufficiently severe to warrant clinical attention.

7. Obsessive-Compulsive and Related Disorder Due to Another

Medical Condition

Certain medical conditions can cause symptoms of OCD and related disorders. The
Diagnostic and Statistical Manual for Mental Health, Fifth Edition (DSM-5) recognizes
this by creating a new category for Obsessive- Compulsive and Related Disorders Due
to Another Medical Condition. This category appears in the chapter on typical
obsessive-compulsive and related disorders.

Diagnostic Criteria
A. Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking,
hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic of
obsessive-compulsive and related disorder predominate in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings that
the disturbance is the direct pathophysiological consequence of another medical
condition.
C. The disturbance is not better explained by another mental disorder.
D. The 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 of functioning.
Specify if:
With obsessive-compulsive disorder-like symptoms: If obsessive-compulsive
disorder-like symptoms predominate in the clinical presentation.
With appearance preoccupations: If preoccupation with perceived appearance defects or
flaws predominates in the clinical presentation.
With hoarding symptoms: If hoarding predominates in the clinical presentation.
With hair-pulling symptoms: If hair pulling predominates in the clinical presentation.
With skin-picking symptoms: If skin picking predominates in the clinical presentation.

8. Other Specified Obsessive-Compulsive and Related Disorder

This category applies to presentations in which symptoms characteristic of an

obsessivecompulsive and related disorder that cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning predominate
but do not meet the full criteria for any of the disorders in the obsessive-compulsive and
related disorders diagnostic class. The other specified obsessive-compulsive and related
disorder category is used in situations in which the clinician chooses to communicate the
specific reason that the presentation does not meet the criteria for any specific
obsessive-compulsive and related disorder. This is done by recording other specified
obsessive-compulsive and related disorder followed by the specific reason (e.g.,
body-focused repetitive behavior disorder).
Examples of presentations that can be specified using the other specified designation
include the following:
1. Body dysmorphic-like disorder with actual flaws: This is similar to body dysmorphic
disorder except that the defects or flaws in physical appearance are clearly observable
by others (i.e., they are more noticeable than slight). In such cases, the preoccupation
with these flaws is clearly excessive and causes significant impairment or distress.
2. Body dysmorphic-like disorder without repetitive behaviors: Presentations that meet
body dysmorphic disorder except that the individual has not performed repetitive
behaviors or mental acts in response to the appearance concerns.
3. Body-focused repetitive behavior disorder: This is characterized by recurrent body
focused repetitive behaviors (e.g., nail biting, lip biting, cheek chewing) and repeated
attempts to decrease or stop the behaviors. These symptoms cause clinically significant
distress or impairment in social, occupational, or other important areas of functioning and
are not better explained by trichotillomania (hair-pulling disorder), excoriation
(skin-picking) disorder, stereotypic movement disorder, or non-suicidal self-injury.
4. Obsessional jealousy: This is characterized by nondelusional preoccupation with a
partners perceived infidelity. The preoccupations may lead to repetitive behaviors or
mental acts in response to the infidelity concerns; they cause clinically significant distress
or impairment in social, occupational, or other important areas of functioning; and they
are not better explained by another mental disorder such as delusional disorder, jealous
type, or paranoid personality disorder.
5. Shubo-kyofu: A variant of taijin kyofusho (see Glossary of Cultural Concepts of
Distress in the Appendix) that is similar to body dysmorphic disorder and is
characterized by excessive fear of having a bodily deformity.
6. Koro: Related to dhat syndrome (see Glossary of Cultural Concepts of Distress in the
Appendix), an episode of sudden and intense anxiety that the penis (or the vulva and
nipples in females) will recede into the body, possibly leading to death.
7. Jikoshu-kyofu: A variant of taijin kyofusho (see Glossary of Cultural Concepts of
Distress in the Appendix) characterized by fear of having an offensive body odor (also
termed olfactory reference syndrome).

9. Unspecified Obsessive-Compulsive and Related Disorder

This category applies to presentations in which symptoms characteristic of an
obsessivecompulsive and related disorder that cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning predominate
but do not meet the full criteria for any of the disorders in the obsessive-compulsive and
related disorders diagnostic class. The unspecified obsessive-compulsive and related
disorder category is used in situations in which the clinician chooses not to specify the
reason that the criteria are not met for a specific obsessive-compulsive and related
disorder, and includes presentations in which there is insufficient information to make a
more specific diagnosis (e.g., in emergency room settings).
Obsessive-Compulsive and Related
Disorders

Submitted to:

Prof. Serafina P. Maxino

Submitted by:
Marbella, Emmanuella Grace P.
BS Psychology 3-1
September 4, 2017