Anxiety and OCD — Determine Diagnosis — Clinical Pathway: Outpatient Behavioral Health and Primary Care

Anxiety Disorder and OCD Clinical Pathway — Outpatient Behavioral Health and Primary Care

Determine Diagnosis

The table below provides a brief summary of the diagnostic criteria for anxiety disorders and OCD.

Reference

  • Adapted from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • Adapted from American Psychiatric Association, 2013
Types of Disorders
Generalized Anxiety Disorder (GAD)
  • A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities
  • B. Difficult to control the worry
  • C. ≥ 3* of the following:
    • 1. Restlessness or feeling keyed up or on edge
    • 2. Being easily fatigued
    • 3. Difficulty concentrating or mind going blank
    • 4. Irritability
    • 5. Muscle tension
    • 6. Sleep disturbance
      • Difficulty falling or staying asleep, restless, or unsatisfying sleep
Social Anxiety
  • Marked fear or anxiety about > 1 social situations in which individual is exposed to possible scrutiny by others
    • e.g. social interactions, being observed, performing in front of others
  • Individual fears he/she will act in a way or show anxiety symptoms that will be negatively evaluated
  • Social situations almost always provoke fear or anxiety
  • Social situations are avoided or endured with intense fear or anxiety
  • Fear or anxiety is out of proportion to the actual threat posed by social situation and to the sociocultural context
  • Persistent and lasts at least 6 months or more
Separation Anxiety
  • Excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by three of the following:
    • 1. Worry when anticipating / experiencing separation from home or attachment figure
    • 2. Worry about losing or harm to attachment figure
    • 3. Worry about experiencing an untoward event that causes separation
      • e.g. getting lost, having an accident
    • 4. Reluctance or refusal to go out, away from home or to school
    • 5. Fear or reluctance about being alone or without attachment figure at home / other settings
    • 6. Reluctance or refusal to sleep away from home / go to sleep alone
    • 7. Nightmares involving separation
    • 8. Complaints of physical symptoms when separation occurs or is anticipated
  • Lasting at least 4 weeks in children and adolescents or 6 months in adults
Specific Phobia
  • Fear or anxiety about a specific object / situation
  • Object/situation almost always provokes immediate fear / anxiety
  • Object/situation is avoided or endured with intense fear / anxiety
  • Fear / anxiety out of proportion with actual danger posed
  • Lasting 6 months or more
Panic Disorder
  • Abrupt surge of intense fear or discomfort with the following symptoms:
    • Accelerated/pounding heart, sweating, trembling, shortness of breath, fear of choking, chest pain, nausea or abdominal distress, dizzy or faint, chills / hot flash, paresthesias, derealization, fear of going crazy, fear of dying
  • At least one attack has been followed by 1 month (or more) of:
    • Worry about additional attacks
    • Significant change in behavior (e.g. avoiding places attacks occurred)
Selective Mutism
  • Failure to speak in a specific social situation in which there is an expectation for speaking (e.g. school) despite speaking in other situations
  • Interferes with educational or occupational achievement or with social communication
  • Duration of at least 1 month (not limited to first month of school)
  •  
  • Not attributed to lack of knowledge or comfort with spoke language)
Other Specified Anxiety Disorder and Unspecified Anxiety Disorder
  • Presentations in which symptoms cause clinically significant distress or impairment, but do not meet full criteria for any of the disorders in the anxiety disorders diagnostic class. Other Specified is used in situations in which the clinician communicates the reason criteria for a specific anxiety disorder is not met whereas Unspecified is used in situations in which the clinicians does not indicate the reason.
Obsessive Compulsive Disorder
  • Presence of obsessions, compulsions, or both:
  •  
  • Obsessions are defined by (1) and (2):
    • Recurrent and persistent thoughts, urges, or images, experienced as intrusive and unwanted, and that in most individuals cause anxiety or distress
    • The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)
    •  
  • Compulsions are defined by (1) and (2):
    • Repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts that the individual feels driven to perform in response to an obsession
      e.g. praying, counting, repeating words silently
    • The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
  •  
  • The obsessions or compulsions are time-consuming:
    • e.g. take more than 1 hour per day or cause clinically significant distress

*Note: Only one item is required in children