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DSM-IV

In DSM-IV, this disorder is called Anxiety Disorder Due to a General Medical Condition

For more information, see Mental Disorders Due to a General Medical Condition

Diagnostic Criteria

A. Prominent anxiety, Panic Attacks, or obsessions or compulsions predominate in the clinical picture.

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.

C. The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder With Anxiety in which the stressor is a serious general medical condition).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

  • With Generalized Anxiety: if excessive anxiety or worry about a number of events or activities predominates in the clinical presentation
  • With Panic Attacks: if Panic Attacks predominate in the clinical presentation
  • With Obsessive-Compulsive Symptoms: if obsessions or compulsions predominate in the clinical presentation

Note: Include the name of the general medical condition, e.g., Anxiety Disorder Due to Pheochromocytoma, With Generalized Anxiety; also record the general medical condition.

Specifiers

The following specifiers can be used to indicate which symptom presentation predominates in Anxiety Disorder Due to a General Medical Condition:

With Generalized Anxiety

This specifier may be used if excessive anxiety or worry about a number of events or activities predominates in the clinical presentation.

With Panic Attacks

This specifier may be used if Panic Attacks predominate in the clinical presentation.

With Obsessive-Compulsive Symptoms

This specifier may be used if obsessives or compulsions predominate in the clinical presentation.

Recording Procedures

In recording the diagnosis of Anxiety Disorder Due to a General Medical Condition, the clinician should first note the presence of the Anxiety Disorder, then the identified general medical condition judged to be causing the disturbance, and finally the appropriate specifier indicating the predominant symptom presentation (e.g., Anxiety Disorder Due to Thyrotoxicosis, With Generalized Anxiety). The general medical condition should also be noted (e.g., thyrotoxicosis).

Associated General Medical Conditions

A variety of general medical conditions may cause anxiety symptoms, including endocrine conditions (e.g., hyper- and hypothyroidism, pheochromocytoma, hypoglycemia, hyperadrenocorticism), cardiovascular conditions (e.g., congestive heart failure, pulmonary embolism, arrhythmia), respiratory conditions (e.g., chronic obstructive pulmonary disease, pneumonia, hyperventilation), metabolic conditions (e.g., vitamin B12 deficiency, porphyria), and neurological conditions (e.g., neoplasms, vestibular dysfunction, encephalitis). The associated physical examination findings, laboratory findings, and patterns of prevalence or onset reflect the etiological general medical condition.

Differential Diagnosis

Delirium

A separate diagnosis of Anxiety Disorder Due to a General Medical Condition is not given if the anxiety disturbance occurs exclusively during the course of a delirium. If the presentation includes a mix of different types of symptoms (e.g., mood and anxiety), the specific Mental Disorder Due to a General Medical Condition depends on which symptoms predominate in the clinical picture.

Substance-Induced Anxiety Disorder

If there is evidence of recent or prolonged substance use (including medications with psychoactive effects), withdrawal from a substance, or exposure to a toxin, a Substance-Induced Anxiety Disorder should be considered. It may be useful to obtain a urine or blood drug screen or other appropriate laboratory evaluation. Symptoms that occur during or shortly after (i.e., within 4 weeks of) Substance Intoxication or Withdrawal or after medication use may be especially indicative of a Substance-Induced Anxiety Disorder, depending on the type, duration, or amount of the substance used. If the clinician has ascertained that the disturbance is due to both a general medical condition and substance use, both diagnoses (i.e., Anxiety Disorder Due to a General Medical Condition and Substance-Induced Anxiety Disorder) can be given.

Other Anxiety Disorders, Adjustment Disorders, and other mental disorders

Anxiety Disorder Due to a General Medical Condition should be distinguished from a primary Anxiety Disorder (especially Panic Disorder, Generalized Anxiety Disorder, and Obsessive-Compulsive Disorder) and from Adjustment Disorder With Anxiety or With Mixed Anxiety and Depressed Mood (e.g., a maladaptive response to the stress of having a general medical condition). In primary mental disorders, no specific and direct causative physiological mechanisms associated with a general medical condition can be demonstrated. Late age at onset and the absence of a personal or family history of Anxiety Disorders suggest the need for a thorough assessment to rule out the diagnosis of Anxiety Disorder Due to a General Medical Condition. In addition, anxiety symptoms may be an associated feature of another mental disorder (e.g., Schizophrenia, Anorexia Nervosa).

Anxiety Disorder Not Otherwise Specified

Anxiety Disorder Not Otherwise Specified is diagnosed if the clinician cannot determine whether the anxiety disturbance is primary, substance induced, or due to a general medical condition.

DSM-5

Diagnostic Criteria

A. Panic attacks or anxiety is predominant in the clinical picture.

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

C. The disturbance is not better explained by another mental disorder.

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note: Include the name of the other medical condition within the name of the mental disorder (e.g., anxiety disorder due to pheochromocytoma). The other medical condition should be listed separately immediately before the anxiety disorder due to the medical condition (e.g., pheochromocytoma; anxiety disorder due to pheochromocytoma.

Differential Diagnosis

Delirium

A separate diagnosis of anxiety disorder due to another medical condition is not given if the anxiety disturbance occurs exclusively during the course of a delirium. However, a diagnosis of anxiety disorder due to another medical condition may be given in addition to a diagnosis of major neurocognitive disorder (dementia) if the etiology of anxiety is judged to be a physiological consequence of the pathological process causing the neurocognitive disorder and if anxiety is a prominent part of the clinical presentation.

Mixed presentation of symptoms (e.g., mood and anxiety)

If the presentation includes a mix of different types of symptoms, the specific mental disorder due to another medical condition depends on which symptoms predominate in the clinical picture.

Substance/medication-induced anxiety disorder

If there is evidence of recent or prolonged substance use (including medications with psychoactive effects), withdrawal from a substance, or exposure to a toxin, a substance/medication-induced anxiety disorder should be considered. Certain medications are known to increase anxiety (e.g., corticosteroids, estrogens, metoclopramide), and when this is the case, the medication may be the most likely etiology, although it may be difficult to distinguish whether the anxiety is attributable to the medications or to the medical illness itself. When a diagnosis of substance-induced anxiety is being made in relation to recreational or nonprescribed drugs, it may be useful to obtain a urine or blood drug screen or other appropriate laboratory evaluation. Symptoms that occur during or shortly after (i.e., within 4 weeks of) substance intoxication or withdrawal or after medication use may be especially indicative of a substance/medication-induced anxiety disorder, depending on the type, duration, or amount of the substance used. If the disturbance is associated with both another medical condition and substance use, both diagnoses (i.e., anxiety disorder due to another medical condition and substance/medication-induced anxiety disorder) can be given. Features such as onset after age 45 years or the presence of atypical symptoms during a panic attack (e.g., vertigo, loss of consciousness, loss of bladder or bowel control, slurred speech, amnesia) suggest the possibility that another medical condition or a substance may be causing the panic attack symptoms.

Anxiety disorder (not due to a known medical condition)

Anxiety disorder due to another medical condition should be distinguished from other anxiety disorders (especially panic disorder and generalized anxiety disorder). In other anxiety disorders, no specific and direct causative physiological mechanisms associated with another medical condition can be demonstrated. Late age at onset, atypical symptoms, and the absence of a personal or family history of anxiety disorders suggest the need for a thorough assessment to rule out the diagnosis of anxiety disorder due to another medical condition. Anxiety disorders can exacerbate or pose increased risk for medical conditions such as cardiovascular events and myocardial infarction and should not be diagnosed as anxiety disorder due to another medical condition in these cases.

Illness anxiety disorder

Anxiety disorder due to another medical condition should be distinguished from illness anxiety disorder. Illness anxiety disorder is characterized by worry about illness, concern about pain, and bodily preoccupations. In the case of illness anxiety disorder, individuals may or may not have diagnosed medical conditions. Although an individual with illness anxiety disorder and a diagnosed medical condition is likely to experience anxiety about the medical condition, the medical condition is not physiologically related to the anxiety symptoms.

Adjustment disorders

Anxiety disorder due to another medical condition should be distinguished from adjustment disorders, with anxiety, or with anxiety and depressed mood. Adjustment disorder is warranted when individuals experience a maladaptive response to the stress of having another medical condition. The reaction to stress usually concerns the meaning or consequences off the stress, as compared with the experience of anxiety or mood symptoms that occur as a physiological consequence of the other medical condition. In adjustment disorder, the anxiety symptoms are typically related to coping with the stress of having a general medical condition, whereas in anxiety disorder due to another medical condition, individuals are more likely to have prominent physical symptoms and to be focused on issues other than the stress of the illness itself.

Associated feature of another mental disorder

Anxiety symptoms may be an associated feature of another mental disorder (e.g., schizophrenia, anorexia nervosa).

Other specified or unspecified anxiety disorder

This diagnosis is given if it cannot be determined whether the anxiety symptoms are primary, substance-induced, or associated with another medical condition.