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 direct physiologic effects of drugs or abuse or 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, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, or separation anxiety disorder.
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:
Palpitations, pounding heart, or accelerated heart rate
Sensations of shortness of breath or smothering
Feeling of choking
Feeling dizzy, unsteady, lightheaded, or faint
Derealization (feelings of unreality) or depersonalization (being detached from oneself) Fear of losing control or going crazy Paresthesias (numbness or tingling sensations) Chills or hot flashes including shakiness, trembling, and myalgias. Gastrointestinalsymptoms (nausea, vomiting, diarrhea) and autonomic symptoms (tachycardia, shortness of breath) commonly coexist. Inchildren and adolescents, the specific symptoms of autonomicarousal are less prominent, and symptoms are often related toschool performance or sports. Children with GAD are oftenexceedingly self-conscious, exhibit behavioral inhibition, havelow self-esteem, and have more sleep disturbance than patientswith other kinds of anxiety disorder. Care must be taken to elicit internalizing symptoms of negative cognitions aboutthe self (hopelessness, helplessness, worthlessness, suicidalideation), as well as those concerning relationships (embarrassment, self-consciousness) and associated with anxieties.Inquiry about eating, weight, energy, and interests should alsobe carried out to eliminate a mood disorder.
Posttraumatic stress disorder (PTSD) is characterized by re-experiencing a traumatic event in which actual or threatened death or serious injury was possible. The reexperiencing
Criteria for Diagnosis of Generalized Anxiety Disorder
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about numerous events or activities
B. The person 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 present for more days than not for the past 6 months). Note: Only one symptom is required in children.
1.
2.
3.
4.
5.
6.
Sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep)
D. The focus of the anxiety and worry is not confined to features of a disorder (e.g., panic disorder, social phobia, obsessive-compulsive disorder, separation anxiety disorder, anorexia nervosa, somatization disorder, hypochondriasis), and the anxiety and worry do not occur exclusively during posttraumatic stress disorder.
E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
F. The disturbance is not due to the direct physiologic effects of a drug or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder.