DSM-5-TR · anxiety · differential diagnosis

Could I have an anxiety disorder?

Anxiety is a normal emotion. It becomes a disorder when it is excessive, persistent, difficult to control, or leads to avoidance that significantly interferes with everyday life.

DSM-5-TR distinguishes anxiety disorders according to what triggers the fear, what the person expects might happen, and how they respond. Similar physical symptoms can therefore belong to very different diagnoses.

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Normal anxiety or anxiety disorder?

The presence of anxiety alone does not make a diagnosis

Normal anxiety

It appears in response to threat, an exam, an important decision or a stressful period, and tends to decrease when circumstances change.

Anxiety disorder

Fear or worry is disproportionate, persistent or pervasive, leads to avoidance, and causes significant distress or impairment.

The main pages in this section

Five anxiety disorders to distinguish

The same symptom — palpitations, tension, avoidance or a sense of danger — can mean something different depending on what triggers it and what the person fears.

Generalized anxiety disorderExcessive, difficult-to-control worry across several areas of life, present more days than not for at least six months.Panic disorderRecurrent unexpected panic attacks followed by persistent concern about further attacks or behavioural changes intended to avoid them.Specific phobiaIntense fear or anxiety triggered by a specific object or situation.Social anxiety disorderMarked fear or anxiety in one or more social situations in which the person may be observed or judged by others.AgoraphobiaMarked fear or anxiety about several situations in which escape might feel difficult or help might not be available.

DSM-5-TR

The chapter also includes other anxiety disorders

DSM-5-TR also includes separation anxiety disorder, selective mutism, substance/medication-induced anxiety disorder, anxiety disorder due to another medical condition, other specified anxiety disorder and unspecified anxiety disorder.

OCD and Posttraumatic Stress Disorder are not classified in the DSM-5-TR anxiety-disorders chapter, even though both may involve significant anxiety.

The key diagnostic question

What is the person actually afraid will happen?

“What if something goes wrong?”Multiple hard-to-control worries → generalized anxiety disorder.
“What if I have another attack?”Unexpected attacks + concern about their consequences → panic disorder.
“That object or situation is dangerous.”Fear focused on a specific stimulus → specific phobia.
“What if people judge me?”Fear of negative evaluation → social anxiety disorder.
“What if I cannot get out or get help?”Fear of several situations where escape seems difficult → agoraphobia.

Clinical assessment

How are anxiety disorders diagnosed?

Diagnosis is based on clinical interviewing, the history of symptoms, their duration and frequency, the situations that trigger them, and their functional impact. Differential diagnosis is essential, including depression, OCD, Autism Spectrum Disorder, some personality disorders, substance or medication effects, and medical causes.

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Not sure which type of anxiety fits your experience?

The purpose of assessment is precisely not to start with a predetermined answer: several disorders can produce similar symptoms while involving different underlying fears.

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