For many different reasons, psychologists, therapists, and psychiatrists need to have a single diagnostic manual in order to diagnose people correctly with mental health issues, such as anxiety. Known as the Diagnostic and Statistical Manual (DSM), It's updated once or twice every decade, and goes through iterations that can be seen in the numbers (DSM I, DSM II, etc.)
The DSM-IV is an outdated DSM for anxiety, as it was replaced by both the DSM-IV-TR, and now the DSM-V. But the manual itself still tends to hold true today. In this article, we'll discuss what the DSM IV says about anxiety.
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The DSM And Anxiety
The DSM is likely always to be the diagnostic manual psychologists use to diagnose anxiety. It should be noted, however, that even if you do not qualify for a diagnosable disorder, you may still be suffering from enough anxiety that it warrants treatment. Take my anxiety test, and remember that it's not always about what you're suffering from so much as it's about not suffering.
The DSM-IV had much of the same anxiety disorders as previous iterations. The only difference was the adding of "acute stress disorder," which is the disorder that leads to post-traumatic stress disorder. After a trauma, the person may experience flashbacks and severe anxiety, but for a PTSD diagnosis, 30 days must pass. ASD, on the other hand, can be diagnosed after just two days, and at 30 days could become PTSD.
Beyond that, the anxiety disorders are generally the same. Below are some brief examples of how anxiety disorders are diagnosed:
Generalized Anxiety Disorder
- Excessive anxiety in many different activities.
- Controlling that anxiety is difficult.
- Symptoms of restlessness, fatigue, irritability, muscle tension, trouble concentrating, and problems sleeping are present.
- Physical or mental symptoms cause significant distress or impairment.
- Regular panic attacks (rapid heartbeat, chest pain, trouble breathing, lightheadedness, feelings of doom.
- Fear/anxiety about experiencing another panic attack.
- Significant life impairment.
- Panic attacks change a person's behavior.
- May or may not involve agoraphobia.
- Fear of leaving home, or unfamiliar places, or places that may be difficult to escape.
- Often occurs as a result of panic attacks.
- Individual may purposefully reduce the likelihood of being in a situation they would be uncomfortable.
- Significant life impairment.
Post Traumatic Stress Disorder
- Severe anxiety after experiencing, witnessing, or being exposed to a traumatic event that may have or could have caused death or injury.
- May relive the event often, either in flashbacks, memories, or emotions.
- Difficulty confronting the trauma - may actively change behaviors to avoid reminders.
- Hyper-vigilance, possibly with a quick startle reflex.
Obsessive Compulsive Disorder
- Recurrent thoughts that may be fears themselves or cause fears after the thought occurs.
- Thoughts may be about day to day life, or violent, sexual, or taboo in manner.
- Behaviors are used to try to stop the anxiety-fueling thoughts.
- Persistent and/or unreasonable fear of social situations.
- Specific fears of embarrassment or judgment.
- Social situations may cause extreme anxiety and possibly panic attacks.
- Anticipation of social events causes severe anxiety.
- Avoidance of social situations greatly reduces one's quality of life.
- Irrational fear of specific issues, like spiders or heights.
- Sight or confrontation with fear causes extreme anxiety, possibly panic attacks.
- Anticipation of possibly coming across the specific feared subject causes intense anxiety.
- Individual is often preoccupied with the fear and may change behaviors to avoid the feared subject.
Reminder About These Conditions
The above list is more of a summary, as the copyright of each condition belongs to the DSM-IV. But you can get a basic idea of what the conditions are and how they're diagnosed. All of them have the following in common:
- Must cause significant distress.
- Must decrease a person's quality of life.
- Must be difficult to stop and not explained by other conditions.
If you have a strong fear of lions, for example, you may not be diagnosed with a specific phobia because it may never affect your life. Similarly, if you only fear extremely large social gatherings and your anxiety isn't that strong, or you're perfectly content not attending those social gatherings, then you may not have social phobia. Each one has to be significant enough that treatment is worthwhile.
It should also be noted that even if you don't qualify for a diagnosis, seeking help may still be valuable. If your life could improve by decreasing your anxiety or stress, you may still be someone that benefits from treatment.
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Changes in the DSM-IV-TR and DSM-V
Recall that the DSM-IV is a much older version of the DSM. Since then, they have released the DSM-IV-TR and the DSM-V. The following represent the changes to anxiety disorders in the DSM-IV-TR:
Panic Disorder The American Psychiatric Association added information for those that aren't always able to identify the trigger of their panic attacks, known as "unexpected" attacks.
Obsessive Compulsive Disorder The APA added information on ways that OCD can manifest itself in different age groups, as well as comorbidity with other disorders.
Changes in data and basic information on prevalence rates and familiar relationships was also added. Also, the following changes were made to the DSM-V:
Generalized Anxiety Disorder The number of physical symptoms associated with GAD was reduced to two.
Phobias All phobias received wording changes that indicate a person can be diagnosed with a phobia before six months. Before, all phobias required at least six months of living with the phobia before it could be diagnosed with a phobia.
Added Criteria The APA also added information for substance-induced anxiety disorders, medical condition anxiety disorders, and "not elsewhere specified" anxiety disorders.
The nature of most anxiety disorders remained the same, but the information on how the disorders are diagnosed went through changes.
Why Does the DSM Matter?
The DSM plays a very important role in psychology and psychiatry. While the DSM may seem like a strange tool (after all, a person who experiences multiple panic attacks may "obviously" qualify for panic disorder, so why is the DSM necessary?), but it's a very important one. The following are reasons the DSM-IV and DSM-V are considered such an important part of mental health:
Insurance Claims Many insurance companies cover mental health disorders. They need a set of diagnostic tools to ensure that you qualify for mental health care, and are not simply seeking it out because you can.
Formal Diagnosis The DSM makes sure that your diagnosis will stay the same across psychologists and psychiatrists. Meaning, if you quit your current therapist and see another, you want to know that you'd still be diagnosed with the same disorder.
Treatment Choices Every disorder is treated differently, even when some have similarities. A lot of research goes into mental health treatments. Without a formal way of diagnosing certain conditions, it's possible that you receive the wrong treatment because the individual treating you came to their own conclusion.
The DSM also drives research, and while it does change over time, it ensures that all changes must be verified and agreed upon. It is for these reasons that the DSM remains an important part of today's mental health culture and a very important tool for determining the existence of mental health conditions.
If you're someone that believes they're suffering from mental health issues, consider taking my free 7-minute anxiety test now. This test is a very valuable tool for figuring out the type of anxiety you may be dealing with and learning ways to control it.
Author: Micah Abraham, BSc Psychology, last updated Nov 27, 2017.