*Anxiety Disorders Proposed for Possible Removal from DSM (No DSM-5 Criteria Proposed)
Agoraphobia Without History of Panic Disorder
A. The presence of Agoraphobia related to fear of developing panic-like symptoms (e.g., dizziness or diarrhea).
B. Criteria have never been met for Panic Disorder.
C. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
D. If an associated general medical condition is present, the fear described in Criterion A is clearly in excess of that usually associated with the condition.
*Anxiety Disorders Proposed to be Subsumed Under Other Diagnoses (No DSM-5 Criteria Proposed
Panic Disorder Without Agoraphobia
A. Both (1) and (2):
1. Recurrent unexpected Panic Attacks
2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
a. Persistent concern about having additional attacks
b. Worry about the implications of the attack or its consequences(e.g., losing control, having a heart attack, “going crazy”)
c. A significant change in behavior related to the attacks
B. Absence of Agoraphobia
C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
D. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
Panic Disorder With Agoraphobia
A. Both (1) and (2):
1. Recurrent unexpected Panic Attacks
2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
a. Persistent concern about having additional attacks
b. Worry about the implications of the attack or its consequences(e.g., losing control, having a heart attack, “going crazy”)
c. A significant change in behavior related to the attacks
B. The presence of Agoraphobia.
C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
D. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
Updated May-18-2010
Definition of a Mental Disorder
A proposed revision for the definition of a mental disorder is being addressed by select members of the Anxiety, Obsessive-Compulsive, Posttraumatic, and Dissociative Disorders Work Group, a member of the Mood Disorders Work Group, and additional individuals (see Stein DJ et al: What is a Mental/Psychiatric Disorders? From DSM-IV to DSM-V; Psychological Medicine, 2010; in press)
Features
A. A behavioral or psychological syndrome or pattern that occurs in an individual
B. That reflects an underlying psychobiological dysfunction
C. The consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning)
D. Must not be merely an expectable response to common stressors and losses (for example, the loss of a loved one) or a culturally sanctioned response to a particular event (for example, trance states in religious rituals)
E. That is not primarily a result of social deviance or conflicts with society
Other Considerations
F. That has diagnostic validity on the basis of various diagnostic validators (e.g., prognostic significance, psychobiological disruption, response to treatment)
G. That has clinical utility (for example, contributes to better conceptualization of diagnoses, or to better assessment and treatment)
H. No definition perfectly specifies precise boundaries for the concept of either “medical disorder” or "mental/psychiatric disorder”
I. Diagnostic validators and clinical utility should help differentiate a disorder from diagnostic “nearest neighbors”
J. When considering whether to add a mental/psychiatric condition to the nomenclature, or delete a mental/psychiatric condition from the nomenclature, potential benefits (for example, provide better patient care, stimulate new research) should outweigh potential harms (for example, hurt particular individuals, be subject to misuse)
Anxiety Disorders
300.29 Specific Phobia
300.23 Social Phobia
309.81 Posttraumatic Stress Disorder
308.3 Acute Stress Disorder
300.02 Generalized Anxiety Disorder
293.84 Anxiety Disorder Due to a General Medical Condition
300.00 Anxiety Disorder Not Otherwise Specified
Panic Attack
Agoraphobia
Panic Disorder
Substance-Induced Anxiety Disorder
Panic Attack
Note: A Panic Attack is not a codable disorder. List Panic Attack as a specifier (categorical or dimensional) for all DSM disorders to which it may apply.
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. 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. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, 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, and uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
Agoraphobia [pending field trial]
Note: Agoraphobia is a codable disorder
A. Marked fear or anxiety about more than one situation from a characteristic cluster of agoraphobic situations. Agoraphobic situations typically include: being outside the home alone; public transportation (e.g., traveling in a bus, train, ship, plane); open spaces (e.g., parking lots, market place); being in shops, the theater, or cinemas; standing in line or being in a crowd.
B. The individual fears and/or avoids these situations because escape might be difficult or help might not be available in the event of incapacitation or panic-like symptoms
C. The agoraphobic situations consistently provoke fear or anxiety
D. The agoraphobic situations are 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. NOTE: Out of proportion refers to the sociocultural context; see text.
F. The duration is at least xxx months *
G. The fear, anxiety, and avoidance cause clinically significant distress or impairment in social, occupational, or other important areas of functioning **
H. The fear, anxiety, and avoidance are not restricted to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., cardiopulmonary disorders).
I. The fear, anxiety, and avoidance are not restricted to the symptoms of another mental disorder, such as Specific Phobia (e.g., if limited to one or a few circumscribed phobic objects or situations), Social Phobia (e.g., in response to feared social situations), Obsessive-Compulsive Disorder (e.g., in response to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a traumatic event), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
* Need to examine a potential duration requirement in secondary data analyses and field trials
** An option that will be tested in the field trial is the possibility of deleting criterion G.
Agoraphobia: Alternative Option that is under discussion
Note: Agoraphobia is a codable disorder
A. Anxiety about being, or anticipating being, in 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, being suddenly incapacitated, or having sudden physical symptoms (including panic-like symptoms or other somatic events such as dizziness, vomiting, or diarrhea).
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 in the center of a theater row or on a bridge; traveling in a bus, train, automobile, or plane; or being in open spaces (e.g., parking lots, market place)
B. Situations from which escape might be difficult are avoided (e.g., travel is restricted); endured with marked distress or with anxiety about having a Panic Attack, panic-like or other symptoms; or require the presence of a companion.
C. The fear, anxiety, or avoidance cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
D. The anxiety or phobic avoidance is not restricted to the symptoms of another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to one or only a few specific situations like dogs or elevators), Social Phobia (e.g., avoidance limited to social situations), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance in response to stimuli associated with a traumatic event), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives.
Panic Disorder (includes previous diagnoses of Panic Disorder with Agoraphobia and Panic Disorder without Agoraphobia)
A. Recurrent unexpected panic attacks
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. 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 Panic Attacks are not restricted to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The Panic Attacks are not restricted to the symptoms of another mental disorder, such as Social Phobia (e.g., in response to feared social situations), Specific Phobia (e.g., in response to a circumscribed phobic object or situation), Obsessive-Compulsive Disorder (e.g., in response to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a traumatic event), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
Substance-Induced Anxiety Disorder
No revisions are being recommended for this disorder at the current time
Panic Attack
Proposed Revision
Rationale
1. NOTE: Panic attacks predict onset and severity of psychopathology beyond anxiety disorders
Reference: Craske MG et al: Panic Disorder: A Review of DSM-IV Panic Disorder and Proposals for DSM-V; Depression & Anxiety (2010; epub ahead of print) (section 3A-H)
2. Changes to the definition of Panic Attack are designed to facilitate separation of panic attacks from surrounding anxiety; increase reliability/validity
Reference: Craske MG et al: Panic Disorder: A Review of DSM-IV Panic Disorder and Proposals for DSM-V; Depression & Anxiety (2010; epub ahead of print) (section 2F)
3. List of symptoms is reordered; increase ease of use and clinical utility
Reference: Craske MG et al: Panic Disorder: A Review of DSM-IV Panic Disorder and Proposals for DSM-V; Depression & Anxiety (2010; epub ahead of print) (section 2D); Lewis-Fernández R et al: Culture and the Anxiety Disorders: Recommendations for DSM-5; Depression & Anxiety (2009; epub ahead of print)
4. Term “hot flushes” is replaced with “heat sensations” and reference to other culture based symptoms is made in the Note attached to the diagnostic criteria in order to increase cultural sensitivity. The note is to reference symptoms that may be seen in different cultures, but four or more symptoms are required from the original list of 13 symptoms to define a full panic attack
Reference: Craske MG et al: Panic Disorder: A Review of DSM-IV Panic Disorder and Proposals for DSM-V; Depression & Anxiety (2010; epub ahead of print) (section 2D); Lewis-Fernández R et al: Culture and the Anxiety Disorders: Recommendations for DSM-5; Depression & Anxiety (2009; epub ahead of print)
Severity
Recommendations for severity assessment are forthcoming. We encourage you to check our Web site regularly for updates.
DSM-IV
Panic Attack (DSM-IV)
Note: A Panic Attack is not a codable disorder. Code the specific diagnosis in which the Panic Attack occurs (e.g., 300.21 Panic Disorder With Agoraphobia).
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. Fear of losing control or going crazy
11. Fear of dying
12. Paresthesias (numbness or tingling sensations)
13. Chills or hot flushes
Panic Disorder (includes previous diagnoses of Panic Disorder with Agoraphobia and Panic Disorder without Agoraphobia)
A. Recurrent unexpected panic attacks
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. 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 Panic Attacks are not restricted to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The Panic Attacks are not restricted to the symptoms of another mental disorder, such as Social Phobia (e.g., in response to feared social situations), Specific Phobia (e.g., in response to a circumscribed phobic object or situation), Obsessive-Compulsive Disorder (e.g., in response to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a traumatic event), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
. Title change; since Agoraphobia is proposed to be a codable disorder in DSM-5
Reference: Wittchen U-H et al: Agoraphobia: A Review of the Diagnostic Classificatory Position and Criteria; Depression & Anxiety (2010; in press)
2. Criteria A/B. Restructure DSM-IV Criterion A into Criteria A and B; within new Criterion B, collapse three options into two options, given high rates of joint endorsement and conceptual overlap; to increase ease of use and clinical utility
Reference: Craske MG et al: Panic Disorder: A Review of DSM-IV Panic Disorder and Proposals for DSM-V; Depression & Anxiety (2010; epub ahead of print) (section 4F)
3. Operationalize ‘change in behavior’; to increase ease of use and clinical utility and validity [text will refer to agoraphobia as an example of behavior change, and conditions under which a comorbid diagnosis of Agoraphobia would be assigned]
4. DSM-IV Criterion B deleted as Agoraphobia is proposed to be a codable disorder in DSM-5
Reference: Craske MG et al: Panic Disorder: A Review of DSM-IV Panic Disorder and Proposals for DSM-V; Depression & Anxiety (2010; epub ahead of print) (Section 4G)
5. Criterion C. Addition of common medical conditions with important differential diagnostic consequences
Reference: Wittchen U-H et al: Agoraphobia: A Review of the Diagnostic Classificatory Position and Criteria; Depression & Anxiety (2010; in press)
6. Criterion D. Change in phrasing to improve clinical utility (i.e., “not restricted to the symptoms of”)
Reference: Craske MG et al: Panic Disorder: A Review of DSM-IV Panic Disorder and Proposals for DSM-V; Depression & Anxiety (2010; epub ahead of print) (Section 4G)
Rationale for Severity Measure
Panic Disorder Severity Scale-Self Report (Houck et al., 2002).
Seven items rated on 0-4 severity scales: panic attack frequency, panic attack distress, anticipatory anxiety, agoraphobic avoidance, interoceptive avoidance, work/home impairment, and social impairment
This scale does not specifically assess diagnostic criteria. It includes a definition of panic attacks.
Criteria
Brief, self-report, diagnostic criteria linked if possible, adequate psychometric properties
About DSM-5
Meet Us
Research Background
Progress Reports
Proposed Revisions
Newsroom
DSM-5 Overview: The Future Manual
Timeline
Board of Trustee Principles
Frequently Asked Questions
Task Force Members
Study Group Members
Work Group Members
Board of Trustee Principles
DSM-5 Research Planning Conference Summaries and Monographs
Presentations on DSM-5 and Related Topics
Publications from DSM-5 Development
DSM-5 Field Trials
Structural, Cross-Cutting, and General Classification Issues for DSM-5
Adjustment Disorders
Anxiety Disorders
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Dissociative Disorders
Eating Disorders
Factitious Disorders
Impulse-Control Disorders Not Elsewhere Classified
Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
Mood Disorders
Other Clinical Conditions That May Be a Focus of Clinical Attention
Personality and Personality Disorders
Schizophrenia and Other Psychotic Disorders
Sexual and Gender Identity Disorders
Sleep Disorders
Somatoform Disorders
Substance-Related Disorders
Conditions Proposed by Outside Sources
Press Releases
Media Contact
Frequently Asked Questions
Home / Proposed Revisions / Proposed Revision
Panic Disorder
• Proposed Revision
• Rationale
• Severity
• DSM-IV
Panic Disorder Severity Scale-Self Report (Houck et al., 2002).
Below is an alternative scale that has been developed and is being tested. This scale assesses fear, anxiety and avoidance, as well as distress.
Anxiety Disorder Specific Severity Measure: Panic Disorder
A panic attack is an episode of intense fear, with several symptoms such as a racing heart, shortness of breath, dizziness, sweating, and fears of losing control or dying. Please rate your panic attacks, your anxiety about panic attacks, and behaviors intended to avoid panic attacks. Rate the items in relation to the last month.
INTENSITY (i.e., Severity and/or frequency over the last month):
0----------------------1------------------------2-------------------------3-------------------------4
None Mild/ Moderate/ Strong/ Extreme/
Fewer than Once per Several times Daily
Once per week week per week
Rate items 1-4 using the Intensity Scale shown above:
1. Acute panic, involving an abrupt surge of arousal (e.g., racing heart, sweating, shortness of breath) and urges to escape or actual escape………………………….................................._____
2. Anxiety, worry, or nervousness about having more panic attacks……………………………............................_____
3. Thoughts or images about losing control, dying, going crazy, or other catastrophes as a result of panic attacks…………………………………………………..……………..._____
4. Muscle tension, feeling keyed up or on edge, restlessness, and difficulty relaxing or sleeping in the build up to or following panic attacks……….…………_____
AVOIDANCE (i.e., Usual behaviors when/if faced with panic attacks over the last month):
0-----------------------1------------------------2-------------------------3--------------------------4
Never Occasionally Half of the Most of the All of the
time time time
Rate items 5-8 using the Avoidance Scale shown above:
5. Refuse to enter situations in which panic attacks may occur……………......................................... _____
6. Leave situations early or participate only minimally because of panic attacks……………….._____
7. Actively distract yourself to cope with panic attacks…………………………………………………..……_____
8. Rely on other people or things (e.g., alcohol, illicit drugs, superstitious objects) to cope with panic attacks........................................................._____
9. OVERALL DISTRESS (i.e., How upset or bothered you were by panic attacks over the last month) (circle a number below):
0--------------1----------------2-----------------3----------------4
Not at all A little bit Moderately Quite a bit Extremely
This disorder is not listed in DSM-IV; therefore, DSM-IV criteria for this disorder do not exist. The proposed draft criteria for Panic Disorder includes previous diagnoses of Panic Disorder with Agoraphobia and Panic Disorder without Agoraphobia.
Panic Disorder With/Without Agoraphobia (these are two separate disorders in DSM-IV)
A. Both (1) and (2):
1. Recurrent unexpected Panic Attacks
2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
a. Persistent concern about having additional attacks
b. Worry about the implications of the attack or its consequences(e.g., losing control, having a heart attack, “going crazy”)
c. A significant change in behavior related to the attacks
B. The presence (or absence) of Agoraphobia
C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
D. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
No comments:
Post a Comment