Revise Diagnostic criteria for anxiety disorders and fear-related disorders for Cambridge 9990 (1.4.1)

To diagnose a mental health condition, clinicians require a standardised framework. The two primary systems are the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the International Classification of Diseases, Eleventh Revision (ICD-11). The DSM-5, published by the American Psychiatric Association, is widely used in research and is the primary reference for many studies you will encounter. The ICD-11 is a global health information standard from the World Health Organization. Both manuals provide operationalised diagnostic criteria, listing specific symptoms, duration, and severity thresholds for each disorder. This approach aims to increase diagnostic reliability (consistency between clinicians) and validity (accuracy of the diagnosis). It is important to note that these manuals are regularly updated to reflect new scientific understanding.

According to the DSM-5, the defining feature of Generalised Anxiety Disorder (GAD) is excessive anxiety and worry about a number of different events or activities (such as work or school performance). This worry must occur more days than not for a period of at least six months. A key criterion is that the individual finds it difficult to control the worry. Furthermore, the anxiety and worry are associated with three (or more) of the following six symptoms: restlessness or feeling on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance. Crucially, these symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

A Specific Phobia is characterised by 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, seeing blood). According to DSM-5, exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound Panic Attack. The phobic situation is actively avoided or else is endured with intense anxiety or distress. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation. For a diagnosis, this fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more, and causes clinically significant distress or impairment.

Panic Disorder is distinct from simply having a panic attack. The core diagnostic feature in the DSM-5 is the occurrence of recurrent and unexpected panic attacks. A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, during which four or more of 13 specific physical and cognitive symptoms occur (e.g., palpitations, sweating, trembling, fear of dying). For a diagnosis of Panic Disorder, the attacks must be followed by 1 month (or more) of one or both of the following: persistent concern or worry about additional panic attacks or their consequences (e.g., losing control), and/or a significant maladaptive change in behaviour related to the attacks (e.g., avoidance of exercise or unfamiliar situations).