Irritability or outbursts of anger 3.
4.
5.
E. Duration of the disturbance (symptoms in criteria B, C, and D) is >1 month
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Specify the following:
Acute: if duration of symptoms is <3 months
Chronic: if duration of symptoms is ≥3 months
With delayed onset: if onset of symptoms is at least 6 mo after the stressor within 3 months of the trauma, although delay in symptom expression can occur. Rates of suicide attempts are threefold higher than unaffected controls.
Acute stress disorder is characterized by the same signs and symptoms as PTSD but occurs immediately after a traumatic event. If impaired function persists after 1 month, the diagnosis is PTSD.
Anxiety disorder not otherwise specified is a common condition in clinical practice. This diagnosis is used when there is impairing anxiety or phobic symptoms that do not meet full criteria for another anxiety disorder.
Separation anxiety disorder (SAD) is seen in childrenand adolescents who express vague somatic symptoms (e.g.,headaches, abdominal pain, fatigue) to avoid or refuse togo to school. Patients may have a valid or an irrational concern about a parent or have had an unpleasant experience inschool. They often have been seen by numerous specialistsand have undergone elaborate medical evaluations. Theirabsence from school often is mistakenly seen as a consequence of their symptoms. The prospect of returning toschool provokes extreme anxiety and escalating symptoms.True phobia related to schoolwork is rare. SAD is a strong(78%) risk factor for developing problems in adulthood, suchas panic disorder, agoraphobia, and depression. School phobia that first presents during adolescence may be an expression of a severe underlying psychopathologic condition.Psychiatric consultation is needed.
Specific phobias are marked persistent fears of things or situations, which often lead to avoidance behaviors (Table 17-6). The associated anxiety is almost always felt immediately when the person is confronted with the feared object or situation. The greater the proximity or the more difficult it is to escape, the higher the anxiety. Many patients have had actual fearful experiences with the object or situation (traumatic event). The response to the fear can range from limited symptoms of anxiety to full panic attacks. Children may not recognize that their fears are out of proportion to the circumstances, unlike adolescents and adults, and express their anxiety as crying, tantrums, freezing, or clinging.
School phobia is one of a range of reasons for school nonattendance. In severely worried children, defensive aggression may be used to prevent attendance. Otherwise these patients do not have antisocial tendencies. Boys and girls are equally affected and there is no association with social class, intelligence, or academic ability. The youngest in a family of several children is more likely to be affected as well as children of older parents. Truancy is generally associated with older adolescents with lower levels of fear. Unlike anxious school refusers, truants hide their school nonattendance from their parents.
Social phobia is a common (3% to 13% prevalence; girls predominate over boys) type of phobia characterized by a marked and persistent fear of social or performance situations in which embarrassment might occur (Table 17-7).
There is a wariness of strangers and social apprehension or anxiety when encountering new, strange, or socially threatening situations. Children appear to have a lower rate of negative cognitions (e.g., embarrassment, overconcern, self-consciousness) than adults. Children with simple avoidant disorders are younger than those with more socialized phobic conditions. Left untreated or poorly treated, phobias can become immobilizing and result in significant morbidity and restriction of their lives.
A. 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)