When Worry Becomes an Anxiety Disorder

With the troubling emotional and physical symptoms that accompany chronic worry, it can be difficult to determine where worry ends and anxiety disorders begin. I often hear the words “I think I have an anxiety disorder” when prospective clients phone our center. I receive these words with caution however. While feeling nervous on a regular basis and experiencing the unpleasant physical sensations of anxiety, there are actually a number of specific criteria that constitute an anxiety disorder. In this post, we hope to demystify  these unclear boundaries by presenting the diagnostic criteria that classify certain anxiety disorders according to the latest Diagnostic and Statistical Manual for the classification of psychological disorders (the DSM-5).

For Generalized Anxiety Disorder:

A. Characterized by excessive anxiety and worry occurring more days than not for at least 6 months, about numerous areas of life such as work, school, finances, etc.

B. Difficulty controlling the worry

C. Anxiety and worry are associated with at least three of the following 6 symptoms:

  1. Restlessness and feeling “on edge”
  2. Easily fatigued
  3. Difficulty concentrating (blank mind)
  4. Irritability
  5. Muscle tension
  6. Sleep disturbances

D. The anxiety or physical symptoms must cause distress or impairment in social, occupational or other areas of functioning

E. The symptoms cannot be caused by a substance (ex. a drug) or an independent medical condition (ex. hyperthyroidism)

F. The symptoms are not better explained by another psychological disorder (including more specified anxiety disorders – ex. social phobia)

For Panic Disorder:

A. Characterized by recurrent unexpected panic attacks. A panic attack is defined by an abrupt surge of intense fear or discomfort that reaches a peak within minutes and during which four or more of the following symptoms occur:

  1. Palpitations, pounding heart, or accelerated heart rate.
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feelings of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, lightheaded, or faint
  9. Chills or heat sensations
  10. Numbness or tingling sensations in the body
  11. “Derealization:” feelings of unreality or being detached from the self
  12. Fear or losing control or “going crazy”
  13. Fear of dying

B. At least one panic attack is followed by at least one month of one or both of the following:

  1. Persistent concern or worry about additional panic attacks or their residual effects
  2. Significant negative change in behaviour related to the attacks (ex. behaviours intended to avoid future panic attacks)

C. The symptoms are not attributable to other physiological effects such as drug abuse or independent medical conditions

D. The symptoms are not better explained by another psychological disorder

Keep in mind that it is possible to have a legitimate panic attack that fits the aforementioned criteria, without necessarily developing panic disorder. The same can be said of the symptoms for Generalized Anxiety Disorder: one can have many or all of the symptoms, but not fit the criteria with regard to duration of symptoms, for example. That said, not meeting the diagnostic criteria for an anxiety disorder does not mean that what you are experiencing is not real anxiety and that you should not consider getting help for it. In fact, seeking help at this stage is actually ideal as it could stop symptoms from further developing into a full-blown diagnosis. Lastly, it is important to comment on the word “diagnosis” as we know not everyone agrees with what it represents; clients and therapists alike. If considering your symptoms under the umbrella of a formal diagnosis helps you better understand them and organize your treatment plan, then that is how you should conceive of your condition in order to reach the best possible outcome for recovery. If the opposite is true for you, then continuing to work on your symptoms either via your own relaxation techniques or with a professional is equally beneficial.

Bear in mind that we have only covered two of the most common anxiety disorders in this post, and that there exist several others such as specific phobias, social anxiety disorder, and separation anxiety disorder. If your symptoms are more specific, we encourage you to research some of these other potential diagnoses, or schedule an appointment with a professional that will be able to help you identify what you are struggling with. If you or someone you care about is experiencing any of these symptoms, whether they fit the diagnostic criteria for an anxiety disorder or not, reaching out for help is the best way to overcome the difficulty.