REFERENCE

https://www.slideshare.net/Lucia_Merino/anx
iety-disorders-dsm5-41189388
DIAGNOSTIC AND STATISTICAL MANUAL DSM
V FIFTH EDITION
INTEGRATIVE APPROACH 7 EDITION BY
BARLOW AND DURAND
ANXIETY DIS ORDERS
DSM V
 Anxiety
Is a response that prepares us either to run or
approach danger by producing stress
hormones.
include disorders that share features of
excessive fear and anxiety and related
behavioral disturbances.
ANXIETY VS. FEAR
ANXIETY DIS ORDERS
SPECIFIC PHOBIA
SEPARATION ANXIETY DIS ORDER
SELECTIVE MUTISM
SPECIFIC PHOBIA
 VARIOUS TYPES OF SPECIFIC PHOBIA
ANIMAL

NATURAL ENVIRONMENT

BLOOD INJECTION- INJURY

SITUATIONAL AND OTHER SITUATIONS

 SOCIAL ANXIETY DIS ORDER

Persistent, unrealistically intense fear of social

situations
That involves being scrutinized by or even just
exposed to, unfamiliar people
Symptoms persist for at least 6 months
 PANIC DIS ORDER
Recurrent uncued panic attacks
At least 1 month of concern about the
possibility of more attacks, worry about the
possibility of more attacks, worry about the
consequences of an attack, or mal adaptive
behavioural changes because of the attacks.
Panic attacks
Uncued( Panic attack)
Occurred unexpectedly without warning
PANIC DIS ORDER
 PANIC DIS ORDER
Recurrent uncued panic attacks
At least 1 month of concern about the
possibility of more attacks, worry about the
possibility of more attacks, worry about the
consequences of an attack, or mal adaptive
behavioural changes because of the attacks.
Panic attacks
Uncued( Panic attack)
Occurred unexpectedly without warning
PANIC ATTACK - is a sudden attack of intense
apprehension, terror, and feelings of impending
doom, accompanied by at least four other
symptoms.

Labored breathing, heart palpitations, nausea,

upset stomach, chest pain, feelings of choking and
smothering, dizziness, lightheadedness, sweating,
chills, heat sensations, and trembling
OTHER SYMPTOMS INCLUDE;
DEPERSONALIZATION- a state in which one no longer
perceives the reality of ones self or ones
environment.
 Derealization is an altered mental state in which
the surrounding environment seems foggy, unreal,
or disconnected. It is similar to depersonalization
in that it alters a persons perception of reality.
However, while depersonalization results in a
feeling that one is robotic or detached from ones
environment, derealization causes the
environment itself to seem unreal.
AGORAPHOBIA
AGORAPHOBIA
GENERALIZED ANXIETY DIS ORDER
(GAD)
SUBSTANCE/ MEDICATION- INDUCED
ANXIETY DIS ORDER
ANXIETY DISORDER DUE TO ANOTHER
MEDICAL CONDITION
Hyperthyroidism is a condition in which the thyroid
overproduces hormones.
Common symptoms include weight loss, weakness, irregular
heartbeat, and difficulty sleeping.
Graves disease, the most common cause of hyperthyroidism, is
more prevalent in women than in men.
HYPOGLYCEMIA- also known as blood sugar, is when blood
sugar decreases to below normal levels this may result in a
variety of symptoms including clumsiness, trouble talking,
confusion, loss of consciousness, seizures or death.
PULMONARY EMBOLISM- is the sudden blockage of a major
blood vessel ( artery in the lung, ususally by a blood vessel (
artery in the lung, usually by a blood clot. (symptoms: sudden
shortness of breath or you may feel anxious or on edge . Sweat a
lot, feel lightheaded or faint or have a fast heart rate or
palpitations.
 PORYPHYRIA- a genetic abnormality of
metabolism causing abdominal pains &
mental confusion.
NEOPLASM-is an abnormal growth of tissue
which if it forms a mass is commonly referred
to as a tumor .
ANXIETY DUE TO MEDICAL
CONDITIONS
OTHER SPECIFIED ANXIETY DIS ORDER
UNSPECIFIED ANXIETY DIS ORDER
The other specified anxiety
disorder category is used in
situations in which the clinician
chooses to communicate the
specific reason that the
presentation does not meet the
criteria for any specific anxiety
disorder.
This is done by recording other
specified anxiety disorder
followed by the specific reason
(e.g., generalized anxiety not
occurring more days than not).
 The unspecified anxiety disorder category
is used in situations in which the clinician
chooses not to specify the reason that the
criteria are not met for a specific anxiety
disorder, and includes presentations in which
there is insufficient information to make a
more specific diagnosis (e.g., in emergency
room settings).
 Are syndromes whose predominant feature is
a disturbance in mood .
Involve disabling disturbances in emotion
from the extreme sadness and disengagement
of depression to the extreme elation and
irritability of mania.
TWO BROAD TYPES:
I. Involves only depressive symptoms
II. Involves manic symptoms (BIPOLAR DIS
ORDER)
 DEPRESSION CHARACTERIZED BY
(EXTREME SADNESS)
I. SADNESS
II. FEELINGS OF WORTHLESSNESS
AND GUILT
III. WITHDRAWAL FROM OTHERS
IV CHANGES IN SLEEP AND APPPETITE
MANIA CHARACTERIZED BY (
EXTREME HAPPINESS)
EPISODIC
SYMPTOMSTEND TO DESSIPATE OVER TIME.
SUBCLINICAL DEPRESSION
SADNESS PLUS 3 OTHER SYMPTOMS FOR 10
DAYS
SIGNIFICANT IMPAIRMENTS IN FUNCTIONING
EVEN THOUGH FULL DIAGNOSTIC CRITERIA ARE
NOT MET.
SPECIFIERS OF MAJOR DEPRESSIVE
DIS ORDER
 MELANCHOLIC FEATURE
SPECIFIER This specifier applies
only if the full criteria for a major
depressive episode have been met,
whether in the context of a
persistent depressive dis order or
not.
CATATONIC FEATURES SPECIFIER- This
serious condition involves an absence of
movement ( a stuporous state ) or
catalepsy, in which the muscles are
waxy and semirigid, so a patient s arms
or legs remain in any position in which
they are placed.
A TYPICAL FEATURES SPECIFIER-
Individuals with this specifier
consistently oversleep and over eat
during their depression and therefore
they gain weight.
 DISRUPTIVE MOOD DYSREGULATION
DIS ORDER
Severe recurrent temper outburst and persistent negative
mood for atleast 1 year beginning before age 10 ( only
children can diagnose and difficulty in handling their
emotion.)
Chronic depressive dis order (dysthymia)- characterized by
either major depressive dis order but milder form of
depression.
In the DSM-5, dysthymia is replaced by persistent
depressive disorder.[4] This new condition includes both
chronic major depressive disorder and the previous
dysthymic disorder. The reason for this change is that there
was no evidence for meaningful differences between these
two conditions.[9] The term is from Ancient
Greek meaning bad state of mind.
 Depressed mood for most of the day more
than half of a time for 2 years or 1 year for
children and adolescent.
DOUBLE DEPRESSION- Applies to those who
have a major depressive episode super
imposed on a longer standing dysthymia.
Have more severe depressive episodes than
do people with major depression alone.
 Gender differences in Depression
MDD Twice as common in women than men .
Similar discrepancy occurs in Many countries
Differences emerge in adolescents
*Some biological and psychological factors may factors*:
Hormones
Girls twice as likely to experience sexual abuse
Women may react more intensely to interpersonal loss
Women spend more time ruminating men to distract.
Ruminating-may intensify and prolong sad moods.
 BIPOLAR DIS ORDER
The proposed of DSM V Recognizes three forms
of bipolar disorders: bipolar I disorder , bipolar II
disorder and cyclothymic dis order.
Manic symptoms are the defining feature of each
of these dis orders.
Differentiated by how severe and long lasting the
manic symptoms are.
These disorders are labeled bipolar because
most people who experience mania will also
experience depression during their life time
 An episode of depression is not required for a
diagnosis of bipolar II disorder.
 BIPOLAR DIS ORDERS : THREE FORMS
1. BIPOLAR I Atleast one episode or mania or
mixed episode.( walang depression have
psychotic)
2. BIPOLAR II- (No psychotic) atleast one major
depressive episode with atleast one episode of
hypomania
3. Cyclothymic dis order- milder, chronic, form of
bipolar dis order lasts atleast 2 years. Numerous
periods with hypomanic and depressive
symptoms.
 MANIC AND HYPOMANIC EPISODES
Mania- mentall illness in which a person becomes
very emotional or excited .(example: that form of
mania often manifests itself in excessive and
often incoherent talkativeness.
Typically begins abruptly
The hallmark feature of a manic episode is
increased activity or energy. (talkativeness)
During a manic episode , the person experiences
a sudden elevation or expansion of mood and
feels unusually cheerful, euphoric , or optimistic
 Symptoms last for 1 week or require
hospitalization ( becomes bipolar 1 may
psychotic bipolar 1)
Symptoms cause significant distress or
functional impairment.
 Hypomania
A condition similar to mania but less severe. The
symptoms are similar with elevated mood,
increased activity, decreased need for sleep,
grandiosity, racing thoughts, and the like.
Hypomania - is a pleasurable state. It may confer a
heightened sense of creativity and power
Characterized by less severe symptoms of mania
Symptoms last at least 4 days (bipolar II)
Clear changes in functioning that are observable
to others , but impairment is not marked.
No psychotic symptoms are present.
 CYCLOTHYMIC DISORDER
Usually begins in late adolescence or early adulthood and
persist for years
During a period of atleast 2 years the adult with
cyclothymia has numerous periods of hypomanic symptoms
that are not severe enough to meet the criteria for a
hypomanic episode and numerous periods of mild
depressive symptoms that do not measure up to a major
depressive episode.
RAPID CYCLING SPECIFIER- presence of atleast four manic
or depressive episodes within a year .
When this direct transition from one mood state to another
happens it is referred to as rapid switching or rapid mood
switching.
 Epidemiology and Consequences
Prevalence rates lower than MDD
1% in U. S.; 0.6% worldwide for Bipolar I
0.4% 2% for Bipolar II
4% for Cyclothymia
Average age of onset in 20s
No gender differences
Women experience more depressive episodes
Severe mental illness
A third unemployed a year after hospitalization (Harrow et
al., 1990)
Suicide rates high (Angst et al., 2002)
 Epidemiology and Consequences
1. Symptom variation across cultures
Latino cultures
Complaints of nerves and headaches
Asian cultures
Complaints of weakness, fatigue, and poor concentration
Smaller distance from equator (longer day length) and higher
fish consumption associated with lower rates of MDD
Symptom variation across life span
Children
Stomach and headaches
Older adults
Distractibility and forgetfulness
Co-morbidity
2/3 of those with MDD will also meet criteria for anxiety
disorder at some point
 Psychological Treatment of Mood Disorders
1. Symptom variation across cultures
Latino cultures
Complaints of nerves and headaches
Asian cultures
Complaints of weakness, fatigue, and poor concentration
Smaller distance from equator (longer day length) and higher
fish consumption associated with lower rates of MDD
Symptom variation across life span
Children
Stomach and headaches
Older adults
Distractibility and forgetfulness
Co-morbidity
2/3 of those with MDD will also meet criteria for anxiety
disorder at some point
 Lithium
Up to 80% receive at least some relief with this mood
stabilizer
Potentially serious side effect
Lithium toxicity
Newer mood stabilizers
Anticonvulsants
Depakote
Antipsychotics
Zyprexa
Both also have serious side effects