{"id":152197,"date":"2024-03-03T14:48:42","date_gmt":"2024-03-03T19:48:42","guid":{"rendered":"https:\/\/effectsofanxiety.net\/archives\/152197"},"modified":"2024-03-03T14:48:42","modified_gmt":"2024-03-03T19:48:42","slug":"anxiety-disorders-in-the-dsm-5-tr-symptoms-and-diagnosis-2","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/152197","title":{"rendered":"Anxiety Disorders in the DSM 5 TR | Symptoms and Diagnosis"},"content":{"rendered":"
https:\/\/www.youtube.com\/watch?v=D7qZ66inJQY<\/div>00:00:01<\/a>Hey there everybody and welcome to this\u00a0 presentation on diagnosing anxiety and panic\u00a0\u00a0 in the dsm-5tr i’m your host dr donnelly snipes\u00a0 in this presentation very briefly we’re going\u00a0\u00a0 to review the diagnostic criteria for anxiety\u00a0 disorders or at least most of them in the dsm 5 tr00:00:24<\/a>so let’s talk a little bit about anxiety\u00a0 disorders in general when we’re talking about\u00a0\u00a0 anxiety disorders we need to remember that fear\u00a0 and anxiety may be expressed as fighting agitation\u00a0\u00a0 tantrums fleeing freezing fawning clinging or\u00a0 withdrawal or what i call the final f which is um\u00a0\u00a000:00:46<\/a>politely forget about it because people just don’t\u00a0 have any more energy left so they kind of withdraw\u00a0\u00a0 anxiety disorders differ from each other\u00a0 regarding the types of objects or situations\u00a0\u00a0 that cause fear anxiety or avoidance\u00a0 behaviors and the associated beliefs\u00a0\u00a000:01:07<\/a>anxiety disorders represent a response that is\u00a0 not developmentally culturally or i also add\u00a0\u00a0 contextually normative in terms of intensity or\u00a0 duration so when we’re looking at what somebody is\u00a0\u00a0 anxious about we want to examine obviously culture\u00a0 and development something that a five-year-old is\u00a0\u00a000:01:29<\/a>afraid of is not necessarily going to be the\u00a0 same thing that a 25 year old is afraid of\u00a0\u00a0 we also want to look at context though\u00a0 something that uh you’re afraid of in one\u00a0\u00a0 context you may not be afraid of in another\u00a0 like for children being around strangers\u00a0\u00a000:01:50<\/a>may not be stressful for them when they are at\u00a0 home or when they’re at school and somebody comes\u00a0\u00a0 in to do a presentation versus when they are\u00a0 alone and they don’t have a caregiver around interestingly from august 2020 through december\u00a0 2020 the percentage of adults reporting symptoms\u00a0\u00a000:02:15<\/a>of an anxiety disorder rose from 31.4 to\u00a0 36.9 now when you go through the dsm and\u00a0\u00a0 you start adding up the prevalence of these\u00a0 anxiety disorders it is really hard to get to\u00a0\u00a0 a number anywhere close to 36.9 so the\u00a0 numbers in the dsm and the numbers in the\u00a0\u00a000:02:40<\/a>uh national health survey don’t seem to jive very\u00a0 well we also have to remember that during 2020 we\u00a0\u00a0 were at the beginning of the pandemic so there\u00a0 was obviously more anxiety you would expect that\u00a0\u00a0 but even the 31 percent that it was prior to 2020\u00a0 seems to be higher than what is identified in the\u00a0\u00a000:03:05<\/a>dsm so i think that’s interesting the anxiety\u00a0 chapter in the dsm-5tr just like in the dsm-5\u00a0\u00a0 is arranged in order of diagnosis which appear\u00a0 in children first so separation anxiety disorder\u00a0\u00a0 appears first and generalized anxiety disorder\u00a0 is down a little ways whereas you might expect\u00a0\u00a000:03:29<\/a>some of the quote more common disorders to be\u00a0 first but that’s not how the dsm is arranged however in this presentation i did put\u00a0 generalized anxiety first when we talk about\u00a0\u00a0 generalized anxiety we’re talking about excessive\u00a0 anxiety most days for six or more months and the\u00a0\u00a000:03:51<\/a>anxiety is about a variety of things it’s not\u00a0 just about one particular thing like health or\u00a0\u00a0 an individual or a phobia it is about a variety\u00a0 of things the worry in addition to being excessive\u00a0\u00a0 for the person’s developmental age culture\u00a0 and context the worry is difficult to control\u00a0\u00a000:04:18<\/a>the anxiety or the feeling of anxiety is\u00a0 associated with three or more symptoms in adults\u00a0\u00a0 or one or more symptoms in children feeling\u00a0 restless or feeling keyed up or on edge\u00a0\u00a0 easily fatigued difficulty concentrating or mind\u00a0 going blank irritability muscle tension or sleep\u00a0\u00a000:04:40<\/a>disturbance i want you to think about it anxiety\u00a0 is part of the fight or flight response so we\u00a0\u00a0 would expect somebody experiencing anxiety would\u00a0 it be experiencing symptoms of hpa axis activation\u00a0\u00a0 or activation of the threat threat response or\u00a0 stress response whatever you want to call it\u00a0\u00a000:05:00<\/a>so we would expect all of these symptoms\u00a0 or any of these symptoms because when the\u00a0\u00a0 fight or flight system is engaged the body\u00a0 is not focused on higher order processing or\u00a0\u00a0 memory or the concentration it’s focused on\u00a0 self-preservation and protection the person\u00a0\u00a000:05:22<\/a>becomes more vigilant because they are trying to\u00a0 protect themselves from threats they’re not able\u00a0\u00a0 to relax enough to get good quality sleep because\u00a0 guess what they are keyed up they’re scanning for\u00a0\u00a0 those threats muscle tension and i’ve mentioned\u00a0 in other videos when i used to play tennis my\u00a0\u00a000:05:41<\/a>coach always used to say don’t stand flat-footed\u00a0 on the baseline because it takes more time and\u00a0\u00a0 it’s harder for you to run and spring into\u00a0 action to where that ball is going to be\u00a0\u00a0 now that is not a threat per se but the same thing\u00a0 is true for people with anxiety disorders when\u00a0\u00a000:06:00<\/a>you are when you’ve got that muscle tension it’s\u00a0 kind of like standing on your toes on the baseline\u00a0\u00a0 in tennis you are primed and ready to go and it\u00a0 makes it easier to theoretically fight or flee\u00a0\u00a0 these symptoms have to cause clinically\u00a0 significant distress people can have subclinical\u00a0\u00a000:06:22<\/a>anxiety disorder where they have a lot of worry\u00a0 about a variety of things but it is either not\u00a0\u00a0 excessive for what they’re worried about or it\u00a0 doesn’t cause them clinically significant distress\u00a0\u00a0 overall they report a decent quality of life it\u00a0 doesn’t interfere with functioning in major areas\u00a0\u00a000:06:44<\/a>of their life and generalized anxiety disorder\u00a0 as well as all of the disorders are not better\u00a0\u00a0 explained by a medical mental or substance use\u00a0 disorder and we’re going to talk in the end about\u00a0\u00a0 differential diagnosis of the anxiety disorders\u00a0 in general because there’s a lot of overlap\u00a0\u00a000:07:09<\/a>between the symptoms as well as the\u00a0 differential diagnosis and comorbidities for\u00a0\u00a0 anxiety disorders remember the difference is often\u00a0 what the person experiences anxiety about and\u00a0\u00a0 the cognitions associated with that diagnostic\u00a0 features of generalized anxiety disorder well\u00a0\u00a000:07:34<\/a>this section as with most of the sections in the\u00a0 anxiety chapter pretty much just recapitulated\u00a0\u00a0 the diagnostic criteria and it elaborated a\u00a0 little bit one interesting feature is that\u00a0\u00a0 for generalized anxiety disorder they noted that\u00a0 adults tend to worry about general life things\u00a0\u00a000:07:57<\/a>like paying bills and getting a promotion or\u00a0 what’s going to happen with this or that or what’s\u00a0\u00a0 going on in the world kids tend to worry about\u00a0 their competence like performing at school or\u00a0\u00a0 their ability to be competent in relationships\u00a0 sometimes they worry about disaster now with\u00a0\u00a000:08:19<\/a>coming off of the pandemic\u00a0 we can probably add that too\u00a0\u00a0 but other disasters like hurricanes and\u00a0 fires and floods and those sorts of things\u00a0\u00a0 can prompt a lot of worry in\u00a0 children and and punctuality\u00a0\u00a000:08:34<\/a>interestingly enough some children become very\u00a0 concerned about being punctual and so it’s\u00a0\u00a0 interesting to note that there is a difference\u00a0 in what they worry about which makes sense\u00a0\u00a0 because adults have different responsibilities\u00a0 than kids do and you notice that with the\u00a0\u00a000:08:53<\/a>exception of disaster a lot of these worries\u00a0 revolve around the primary life areas or functions\u00a0\u00a0 of the person you know kids aren’t worried\u00a0 about paying bills or or maintaining\u00a0\u00a0 or parenting or some of the things that that\u00a0 adults worry about associated symptoms well let\u00a0\u00a000:09:18<\/a>me talk about disaster really quick i’m trying not\u00a0 to go too far off the rails today because we’ve\u00a0\u00a0 got a lot to cover but it’s important to recognize\u00a0 that children have a difficult time understanding\u00a0\u00a0 prevalence and likelihood of things so when there\u00a0 is a disaster such as you know we’ve had several\u00a0\u00a000:09:38<\/a>in middle tennessee over the past two years and a\u00a0 child watching the news or hearing about the news\u00a0\u00a0 may not understand how close or far away that\u00a0 disaster was or the likelihood of it recurring\u00a0\u00a0 adults are better able to understand you know\u00a0 it’s a 100 year flood or there’s the chances\u00a0\u00a000:10:03<\/a>of it happening again are you know whatever\u00a0 the probability is depending on what you’re\u00a0\u00a0 talking about children don’t understand that\u00a0 they see it on the news it feels like since\u00a0\u00a0 it’s on the news it’s kind of in their house\u00a0 so it feels like it’s right in their space\u00a0\u00a000:10:20<\/a>and it’s hard to know when it’s going to end\u00a0 or when it’s going to happen again which can\u00a0\u00a0 prompt them to have a lot more worries about\u00a0 disasters parents can help by explaining some\u00a0\u00a0 of the things to them and explaining to children\u00a0 the probability of another disaster occurring and\u00a0\u00a000:10:42<\/a>you know how that they’re safe right now and the\u00a0 steps that they can take it won’t do everything\u00a0\u00a0 but it is important again to recognize children’s\u00a0 different cognitive abilities compared to adults\u00a0\u00a0 associated symptoms with generalized anxiety\u00a0 disorder other somatic symptoms that are not\u00a0\u00a000:11:02<\/a>as intense as those seen in panic disorder so we\u00a0 will also see potentially heart racing clammy skin\u00a0\u00a0 rapid breathing other things and an upset\u00a0 stomach that aren’t specifically indicated\u00a0\u00a0 in diagnostic criteria but we know happen when\u00a0 that fight or flight response is kicked off\u00a0\u00a000:11:27<\/a>the prevalence remember i said if you start add\u00a0 up the prevalence of all these anxiety disorders\u00a0\u00a0 you’re going to be hard-pressed to get anywhere\u00a0 close to 31 percent and according to the dsm-5 tr\u00a0\u00a0 between one percent of adolescents and three\u00a0 percent of adults in the u.s experience\u00a0\u00a000:11:46<\/a>generalized anxiety disorder according to\u00a0 the national center on health statistics\u00a0\u00a0 in 2019 now that was before the pandemic\u00a0 15.6 of adults experienced symptoms of\u00a0\u00a0 generalized anxiety disorder in the prior\u00a0 two weeks the development and course\u00a0\u00a000:12:11<\/a>the mean onset is rarely before adolescence\u00a0 and is i’m sorry the mean onset is 35\u00a0\u00a0 and rarely before adolescence so this is one\u00a0 of the disorders that actually has a much\u00a0\u00a0 later onset than other disorders which i\u00a0 did find that to be somewhat interesting00:12:34<\/a>now we’ll move on to separation anxiety separation\u00a0 anxiety is the first disorder in the chapter\u00a0\u00a0 because it tends to be the one that presents\u00a0 earliest and it can be diagnosed as early as\u00a0\u00a0 preschool separation anxiety is characterized by\u00a0 developmentally inappropriate excessive recurrent\u00a0\u00a000:12:53<\/a>anxiety about separation from major attachment\u00a0 figures in order to be diagnosed the person has to\u00a0\u00a0 have three or more symptoms it can be diagnosed\u00a0 in childhood it can be diagnosed in adulthood\u00a0\u00a0 if it’s diagnosed in adulthood you do\u00a0 not have to have a childhood onset of\u00a0\u00a000:13:15<\/a>separation anxiety it actually can have an\u00a0 adult onset so that is something to remember symptoms three or more distress due to or in in\u00a0 anticipation of separation from home or from major\u00a0\u00a0 attachment figures anxiety about losing a major\u00a0 attachment figure or about possible harm to them\u00a0\u00a000:13:41<\/a>anxiety about something bad happening to the\u00a0 person the patient which would cause them to be\u00a0\u00a0 separated from an anxiety from an attachment\u00a0 figure so they have fears about something\u00a0\u00a0 happening to the attachment figure causing\u00a0 separation and fears about them something\u00a0\u00a000:13:59<\/a>bad happening to themselves causing separation a\u00a0 reluctance a refusal to go out or away from home\u00a0\u00a0 because of fear of separation now generally\u00a0 this is leaving home and separating from that\u00a0\u00a0 attachment figure but in some cases it can include\u00a0 even being reluctant to leave the house be cut\u00a0\u00a000:14:24<\/a>with the attachment figure because they’re afraid\u00a0 that when they’re out there they may get separated\u00a0\u00a0 now think how this might occur if there was a\u00a0 child who happened to be at a carnival and got\u00a0\u00a0 separated from their caregiver that might prompt\u00a0 future fears of separation when in public places\u00a0\u00a000:14:45<\/a>fear of or reluctance to being alone\u00a0 or without major attachment figures\u00a0\u00a0 refusal to go to sleep without being near a major\u00a0 attachment figure nightmares about separation\u00a0\u00a0 or physical complaints in reaction to or\u00a0 in anticipation of separation so they have\u00a0\u00a000:15:06<\/a>those physiological symptoms of anxiety\u00a0 now note here they keep talking about\u00a0\u00a0 major attachment figures because remember this can\u00a0 be diagnosed in adulthood we’re not talking about\u00a0\u00a0 the primary attachment from infancy we’re talking\u00a0 about the person’s current major attachment figure\u00a0\u00a000:15:26<\/a>whether that be their a significant other\u00a0 their parent whomever that happens to be the fear anxiety or avoidance is persistent\u00a0 lasting at least four weeks in children and\u00a0\u00a0 adolescents and typically six months or more\u00a0 in adults and you’ll find that’s a common theme\u00a0\u00a000:15:48<\/a>where a lot of these situations or conditions\u00a0 have to last six months or more and be causing\u00a0\u00a0 clinically significant distress for six\u00a0 months or more in order to rank a diagnosis\u00a0\u00a0 although the symptoms often develop in childhood\u00a0 they can be expressed throughout adulthood it can\u00a0\u00a000:16:12<\/a>be diagnosed in adults in the absence of a history\u00a0 of childhood separation anxiety disorder and as\u00a0\u00a0 i said it causes clinically significant distress\u00a0 or impairment in one or more areas of functioning the diagnostic features section repeats the\u00a0 diagnostic criteria with some elaboration\u00a0\u00a000:16:34<\/a>and examples it’s a pretty straightforward\u00a0 diagnosis in terms of development and course\u00a0\u00a0 the onset of separation anxiety can be any time\u00a0 from preschool through adulthood but generally\u00a0\u00a0 before the age of 30. so you can have diagnoses\u00a0 of separation anxiety up in through the 20s\u00a0\u00a000:16:58<\/a>there may be periods of exacerbation and remission\u00a0 although most child onset cases do not experience\u00a0\u00a0 ongoing clinically significant impairment\u00a0 i thought that was kind of interesting associated features now these are not diagnostic\u00a0 criteria these are features that are associated\u00a0\u00a000:17:19<\/a>with separation anxiety but didn’t rank in the\u00a0 diagnostic criteria sadness or apathy well if\u00a0\u00a0 somebody is perpetually anxious that hpa axis is\u00a0 going to down regulate some which may contribute\u00a0\u00a0 to apathy if they are perpetually anxious they\u00a0 may also start feeling hopeless and hopeless\u00a0\u00a000:17:43<\/a>which is associated with feelings of sadness and\u00a0 depression they may have difficulty concentrating\u00a0\u00a0 well the mind is not focused on concentration\u00a0 if it’s in a perpetual state of fight or flee\u00a0\u00a0 there may be social withdrawal just stepping\u00a0 away from everything because they don’t have\u00a0\u00a000:18:04<\/a>the energy to engage with others because the\u00a0 anxiety is so pervasive in older children you\u00a0\u00a0 may see homesickness or pining when they are away\u00a0 at camp or or something like that now obviously a\u00a0\u00a0 lot of children who don’t have separation\u00a0 anxiety disorder experience homesickness\u00a0\u00a000:18:25<\/a>when they’re away at camp for the first\u00a0 time however this is also associated with\u00a0\u00a0 separation anxiety the child migs or the person\u00a0 may exhibit anger or aggression towards separators\u00a0\u00a0 so anybody who’s causing a separation between the\u00a0 patient and their major attachment figures may00:18:48<\/a>provoke anxiety provoke anger perceptual\u00a0 disturbances now these are not hallucinations\u00a0\u00a0 these are when a person is alone for example at\u00a0 night and they feel like somebody’s watching them\u00a0\u00a0 or they think they see something moving in the\u00a0 shadows it’s not really there and by turning\u00a0\u00a000:19:11<\/a>on the light so there’s no more shadows you\u00a0 know that goes away it’s not a persistent\u00a0\u00a0 uh hallucination that the person is experiencing\u00a0 but perceptual disturbances are more common\u00a0\u00a0 in children than than they are in adults and\u00a0 we want to make sure we don’t mislabel that as\u00a0\u00a000:19:33<\/a>something related to a psychotic disorder children\u00a0 with separation anxiety tend to be described as\u00a0\u00a0 demanding intrusive and in need of constant\u00a0 attention according to the dsm now i would\u00a0\u00a0 argue when we get down a little further that this\u00a0 may be true of all people with separation anxiety\u00a0\u00a000:19:56<\/a>adults may appear dependent and are likely\u00a0 to contact their major attachment figures\u00a0\u00a0 throughout the day and track their whereabouts\u00a0 they are also often overprotective as parents\u00a0\u00a0 and pet owners interestingly enough the\u00a0 dsm did mention pets where the person with\u00a0\u00a000:20:16<\/a>separation anxiety may be excessively concerned\u00a0 about knowing where their pet is at all times the prevalence of separation anxiety in\u00a0 children is approximately four percent\u00a0\u00a0 and in adolescence and adults it ranges\u00a0 from one to two percent in the culture\u00a0\u00a000:20:38<\/a>section the dsm talked about the importance of\u00a0 differentiating separation anxiety disorder from\u00a0\u00a0 the high value some cultural communities place\u00a0 on strong interdependence among family members specific phobias is the next in the line of\u00a0 disorders we’re going to talk about and a specific\u00a0\u00a000:20:59<\/a>phobia is pretty straightforward there’s a marked\u00a0 fear or anxiety about an object or a situation\u00a0\u00a0 about 75 percent of people that have one phobia\u00a0 have more than one phobia and i think if you think\u00a0\u00a0 about it even if it doesn’t rise to the level\u00a0 of being a diagnosable phobia you can think\u00a0\u00a000:21:21<\/a>about if you have one what we’ll call irrational\u00a0 fear you probably have a couple of others when i\u00a0\u00a0 started to think about it i’m like yeah i have\u00a0 i have a couple in there the stimulus almost\u00a0\u00a0 always produces an immediate fear response and is\u00a0 actively avoided the fear is disproportionate to\u00a0\u00a000:21:41<\/a>the threat persist for guess what six months or\u00a0 more and causes clinically significant distress\u00a0\u00a0 and i have this bold and and italicized because\u00a0 it’s important to remember that having a fear\u00a0\u00a0 and i’ve talked in other videos about my fear of\u00a0 bridges i also have a fear of enclosed spaces i\u00a0\u00a000:22:02<\/a>hate you know those little water tubes and tunnels\u00a0 and things that make me feel closed in does it\u00a0\u00a0 cause me clinically significant distress or caused\u00a0 me to have to alter my life to get around it no so\u00a0\u00a0 it doesn’t rise to the level of specific phobia\u00a0 a lot of people have fears that may not have a um\u00a0\u00a000:22:28<\/a>basis or or the fear may be disproportionate\u00a0 to the threat in reality we recognize it but\u00a0\u00a0 it doesn’t cause us clinically significant\u00a0 distress so it would not be diagnosable as\u00a0\u00a0 a specific phobia and the specific phobia is\u00a0 not better explained by another mental disorder\u00a0\u00a000:22:49<\/a>and i’m thinking here more obsessive compulsive\u00a0 disorder but in the differential diagnosis list\u00a0\u00a0 on the anxiety disorders there were a lot so we’re\u00a0 just going to go through all of those at the end the diagnostic features again in for specific\u00a0 phobias was pretty much a restatement of the\u00a0\u00a000:23:11<\/a>diagnostic criteria associated features\u00a0 interestingly enough for some people\u00a0\u00a0 are arousal well that makes sense when the hpa\u00a0 axis kicks off a lot of people have a um increased\u00a0\u00a0 heart rate sort of a panic sort of feeling\u00a0 about them not to the level of a panic attack\u00a0\u00a000:23:36<\/a>necessarily but they have that aroused state in\u00a0 preparation for fight or flee other people may\u00a0\u00a0 have what they call a vasovagal response in which\u00a0 their heart rate decelerates their blood pressure\u00a0\u00a0 drops and they may faint my grandmother used\u00a0 to do this oh my gosh and it wasn’t necessarily\u00a0\u00a000:23:57<\/a>hers wasn’t phobia related but when she would get\u00a0 startled or surprised she would fall out and for\u00a0\u00a0 the longest time the doctors couldn’t figure\u00a0 out exactly what was going on but ultimately\u00a0\u00a0 my guess would be it re had something to do with\u00a0 with anxiety or generalized anxiety the prevalence\u00a0\u00a000:24:20<\/a>of phobias is between eight and twelve percent it\u00a0 peaks in adolescence at sixteen percent so sixty\u00a0\u00a0 percent of adolescents have specific phobias the\u00a0 development in course it usually develops prior\u00a0\u00a0 to age 10 or after a trauma and the presence\u00a0 of phobias is a risk factor for neurocognitive\u00a0\u00a000:24:46<\/a>disorders in older adults why is this we’ve\u00a0 again we’ve talked in other videos about how hyperactivation of that stress response system\u00a0 keeps levels of glutamate and norepinephrine and\u00a0\u00a0 stuff high in the brain which causes\u00a0 neurodegeneration which can lead to\u00a0\u00a000:25:08<\/a>neurocognitive disorders additionally because of\u00a0 social withdrawal and avoidance and restructuring\u00a0\u00a0 of their daily lives to avoid the phobic stimulus\u00a0 there tends to be less stimulation for the person\u00a0\u00a0 with specific phobias which may also lead to\u00a0 a decline in what they call cognitive reserve00:25:36<\/a>and social anxiety disorder in social\u00a0 anxiety disorder there’s a marked fear\u00a0\u00a0 of social situations in when in which one might be\u00a0 judged so you’ve got generalized anxiety which is\u00a0\u00a0 anxiety about a lot of things over the course of\u00a0 at least six months we have specific phobia which\u00a0\u00a000:25:57<\/a>is obviously something specific like enclosed\u00a0 spaces or spiders or snakes um separation anxiety\u00a0\u00a0 which is anxiety or fear of being separated from\u00a0 an attachment figure and then social anxiety which\u00a0\u00a0 is fear from being in situations in which one\u00a0 might be judged with children the symptoms have\u00a0\u00a000:26:22<\/a>to be present not only in relationships with\u00a0 adults but in relationships with their peers\u00a0\u00a0 it’s natural for children to be somewhat\u00a0 anxious if they’re interacting with adults\u00a0\u00a0 if they’re having the same anxiety when they’re\u00a0 interacting with their peers then that’s really\u00a0\u00a000:26:42<\/a>what we’re going to look for for a trigger the\u00a0 person has an excessive fear of being embarrassed\u00a0\u00a0 rejected or offensive and the offensive\u00a0 seems to be increasing in popularity\u00a0\u00a0 or not popularity in commonality um very\u00a0 quickly with twitter and facebook and tick\u00a0\u00a000:27:06<\/a>tock and all these other things and trying to be\u00a0 politically correct a lot of people have developed\u00a0\u00a0 a level of social anxiety maybe not to the level\u00a0 of being a disorder but definitely a level of\u00a0\u00a0 social anxiety because they fear not saying the\u00a0 right thing because they fear being cancelled\u00a0\u00a000:27:27<\/a>social situations almost always trigger\u00a0 the anxiety and social anxiety disorder\u00a0\u00a0 social situations are actively\u00a0 avoided or endured with intense fear\u00a0\u00a0 and the level of fear is disproportionate\u00a0 to the potential consequences\u00a0\u00a000:27:46<\/a>people may have a high level of fear and\u00a0 anxiety uh before going out and giving a\u00a0\u00a0 performance in front of 10 000\u00a0 people the level of anxiety for that\u00a0\u00a0 would probably be different than giving\u00a0 a speech in front of six classmates\u00a0\u00a000:28:12<\/a>you know you see the difference here but a person\u00a0 with social anxiety disorder they would have that\u00a0\u00a0 same level of fear in front of six people they\u00a0 knew as opposed to ten thousand that they didn’t\u00a0\u00a0 persistence again for six months or more\u00a0 causes clinically significant distress\u00a0\u00a000:28:29<\/a>and is not due to another medical mental\u00a0 health or substance related condition\u00a0\u00a0 there is a note that social anxiety disorder can\u00a0 be performance only and you do want to specify\u00a0\u00a0 that if it only has to do with giving speeches\u00a0 performing sports music anything like that00:28:55<\/a>the diagnostic criteria\u00a0\u00a0 features section gave further examples of the\u00a0 symptoms that were identified in the diagnostic\u00a0\u00a0 criteria associated features with social anxiety\u00a0 the person may be passive or shy they may want\u00a0\u00a000:29:14<\/a>to kind of blend into the wall they may be\u00a0 somewhat withdrawn because they don’t want to be\u00a0\u00a0 out there in the limelight they don’t want to\u00a0 be in this position where they fear being judged\u00a0\u00a0 on the other end of the spectrum though there’s a\u00a0 proportion of people with social anxiety disorder\u00a0\u00a000:29:32<\/a>who are highly controlling of situations and\u00a0 they may try to control the conversation and\u00a0\u00a0 control other people in the situation\u00a0 in order to avoid feeling out of control use of substances substance use misuse or abuse is\u00a0 often associated with people with social anxiety\u00a0\u00a000:29:56<\/a>disorder and i have parenthetically hear liquid\u00a0 courage that’s what we used to call it back in\u00a0\u00a0 the day i don’t know if it’s what they still call\u00a0 it but using substances to help temporarily allay\u00a0\u00a0 anxiety interestingly as alcohol leaves the body\u00a0 people tend to have an enhanced anxiety response\u00a0\u00a000:30:19<\/a>so using alcohol prior to a social situation\u00a0 may actually end up causing more problems\u00a0\u00a0 for some people but that’s that’s up to them\u00a0 additionally you may see a worsening of physical\u00a0\u00a0 illness symptoms such as tachycardia or increased\u00a0 tremor in people with social anxiety disorder so\u00a0\u00a000:30:41<\/a>if they already have something that causes a\u00a0 tremor or a tick that may get worse if they\u00a0\u00a0 already have something that causes tachycardia\u00a0 that may get worse in situations in which\u00a0\u00a0 they fear being judged now i have here increased\u00a0 pain question mark that’s not identified in the\u00a0\u00a000:31:02<\/a>dsm-5t however we know that hyperactivation of the\u00a0 hpa axis contributes to ultimately development of\u00a0\u00a0 systemic inflammation and worsening of autoimmune\u00a0 disorders so i would be interested to see\u00a0\u00a0 what the actual numbers are for that and no i\u00a0 could not find any research that actually compared\u00a0\u00a000:31:30<\/a>the rates of increased pain with social anxiety\u00a0 specifically prevalence seven percent of people\u00a0\u00a0 in the united states experience social anxiety\u00a0 disorder now brace yourself this is not a typo 2.3\u00a0\u00a0 percent of people in europe can be diagnosed with\u00a0 social anxiety disorder so what is that a third\u00a0\u00a000:31:59<\/a>what’s different in the united states that is\u00a0 contributing to significantly higher rates of\u00a0\u00a0 social anxiety and fear of being judged\u00a0 and fear of offending people just saying\u00a0\u00a0 additionally social anxiety disorder does\u00a0 tend to be highest in non-hispanic whites\u00a0\u00a000:32:22<\/a>so what is unique about non-hispanic whites\u00a0 in the us i’ll leave you to talk about that and panic disorder people with panic\u00a0 disorder experience recurrent unexpected\u00a0\u00a0 surges of intense fear or discomfort that peaks\u00a0 within minutes and has a and the accompanying\u00a0\u00a000:32:46<\/a>four plus symptoms now i have bolded\u00a0 and italicized unexpected here\u00a0\u00a0 there are expected panic attacks when you’re\u00a0 in a situation in which you’ve had a panic\u00a0\u00a0 attack before when there is a known trigger for\u00a0 the panic attack that’s a expected panic attack\u00a0\u00a000:33:06<\/a>that doesn’t count towards our diagnosis here\u00a0 which i don’t know seems a little strange but\u00a0\u00a0 okay the panic attacks have to be unexpected\u00a0 that is they come from out of the clear blue and the panic attacks need to be characterized\u00a0 by four or more of the following symptoms\u00a0\u00a000:33:27<\/a>palpitations which is when it feels\u00a0 like your heart is like fluttering\u00a0\u00a0 pounding heart or tachycardia which is\u00a0 racing heart sweating trembling or shaking\u00a0\u00a0 a feeling of shortness of breath or smothering\u00a0 you just can’t don’t feel like you can breathe\u00a0\u00a000:33:45<\/a>feeling like you’re choking chest pain or\u00a0 discomfort nausea or abdominal distress\u00a0\u00a0 feeling dizzy unsteady lightheaded or\u00a0 faint chills or heat sensations numbness\u00a0\u00a0 or tingling derealization which things just don’t\u00a0 feel real you feel like you’re kind of in a in a\u00a0\u00a000:34:08<\/a>dream or depersonalization you don’t feel\u00a0 like you’re part of your own body anymore\u00a0\u00a0 fear of losing control or going crazy and fear\u00a0 of dying now i’ll mention even though it’s\u00a0\u00a0 pretty obvious these many of these symptoms are\u00a0 also symptoms of a heart attack it is important\u00a0\u00a000:34:29<\/a>if you are a clinician not to assume that\u00a0 somebody who is experiencing a panic attack\u00a0\u00a0 it’s it’s just a panic attack and to dismiss\u00a0 it it’s important to take every panic attack\u00a0\u00a0 seriously when somebody’s experiencing it and\u00a0 work with their medical provider to help them\u00a0\u00a000:34:52<\/a>differentiate between what’s a panic attack how\u00a0 do i know when i’m having another panic attack\u00a0\u00a0 versus how do i know when i need to go to the\u00a0 er and their doctor will work with them on that culture specific symptoms for panic may\u00a0 include tinnitus or ringing in the ear\u00a0\u00a000:35:13<\/a>neck soreness headache uncontrollable screaming\u00a0 or crying interestingly even though these are\u00a0\u00a0 culture specific symptoms the dsm said those don’t\u00a0 count toward the required four plus symptoms so additionally at least one of the attacks\u00a0 unexpected attacks has been followed by one\u00a0\u00a000:35:35<\/a>month or more of both of the following persistent\u00a0 concern or worry about additional panic attacks or\u00a0\u00a0 their consequences and a significant maladaptive\u00a0 change in behavior related to the attacks\u00a0\u00a0 avoidance of situations where you think\u00a0 they might happen again or ritualized or\u00a0\u00a000:35:56<\/a>superstitious behavior or extreme behavior like\u00a0 changing your diet completely or doing something\u00a0\u00a0 extreme in order to try to prevent the attack\u00a0 so the unexpected attack happens and then for\u00a0\u00a0 the next month or more both of those persistent\u00a0 concern about it happening again and significant\u00a0\u00a000:36:21<\/a>maladaptive changes in behavior are occurring\u00a0 it has to cause clinically significant distress\u00a0\u00a0 and it’s not due to another mental\u00a0 medical or substance use disorder interestingly for panic attack there were no\u00a0 specifiers but in the diagnostic features it\u00a0\u00a000:36:43<\/a>did note that panic attacks can be full means\u00a0 four or more symptoms or limited symptom\u00a0\u00a0 so it doesn’t meet all of it doesn’t meet four\u00a0 symptoms or more but the person’s clearly having\u00a0\u00a0 a panic response if the person has never had a\u00a0 full-blown panic attack uh four or more symptoms\u00a0\u00a000:37:04<\/a>then you would not diagnose panic disorder\u00a0 frequency can be relatively regular like one\u00a0\u00a0 per week or it can come in bursts where they where\u00a0 they have multiple really close together then they\u00a0\u00a0 go weeks months or even years without having them\u00a0 and then they have another burst of panic attacks\u00a0\u00a000:37:28<\/a>and there could also be instances where they just\u00a0 have a panic attack and then they may go for a\u00a0\u00a0 couple of years or more before they have another\u00a0 one it still qualifies as panic disorder there is\u00a0\u00a0 no code for remission of panic disorder and the\u00a0 expectation is unfortunately that if somebody has\u00a0\u00a000:37:51<\/a>had a panic disorder at some point they probably\u00a0 will have another panic attack at another point\u00a0\u00a0 remember that expected to panic attacks occur with\u00a0 known triggers and there are many culture related\u00a0\u00a0 diagnostic issues due to expected triggers\u00a0 so if you read through the culture related\u00a0\u00a000:38:13<\/a>diagnostic issues section of the dsm-5tr\u00a0 you will find they talk about a lot of\u00a0\u00a0 culture bound triggers that can\u00a0 cause a panic attack in people associated features people who\u00a0 have panic attacks panic disorder\u00a0\u00a000:38:36<\/a>may also have intermittent anxiety\u00a0 about health or mental health\u00a0\u00a0 they tend to be more somatically sensitive that\u00a0 means they’re more aware of what’s going on in\u00a0\u00a0 their body well that makes sense if you’ve\u00a0 already had your body kind of go haywire on\u00a0\u00a000:38:52<\/a>you once makes sense that you would be a little\u00a0 bit more hypersensitive to it happening again\u00a0\u00a0 they may have increased anxiety about ability\u00a0 to tolerate daily stress there a lot of times\u00a0\u00a0 this may stem from the fear of if they experience\u00a0 too much stress it’ll trigger another panic attack\u00a0\u00a000:39:12<\/a>and they may have more extreme\u00a0 behaviors to control panic\u00a0\u00a0 the prevalence of panic disorder is about\u00a0 the same two and two percent to three percent\u00a0\u00a0 in both the u.s in europe and europe the\u00a0 only disorder that had a marked difference\u00a0\u00a000:39:30<\/a>between the u.s and other countries\u00a0 interestingly enough was social anxiety disorder\u00a0\u00a0 the development of panic disorder\u00a0 the median age is 20 to 24 in the us\u00a0\u00a0 and 32 worldwide so that is a little bit\u00a0 divergent you know the prevalence the the\u00a0\u00a000:39:53<\/a>number of people that experience it worldwide\u00a0 is pretty comparable but the median age for\u00a0\u00a0 panic disorder is much younger in the us than\u00a0 other countries additionally they speculate that\u00a0\u00a0 older adults may attribute symptoms to medical\u00a0 conditions so they may be under represented in the00:40:19<\/a>prevalence rates because when they’re having\u00a0 these panic symptoms they’re attributing\u00a0\u00a0 them to medication side effects or other\u00a0 health conditions that they already have so let’s talk about some of the risk and\u00a0 prognostic factors for anxiety disorders\u00a0\u00a000:40:37<\/a>in general anxiety disorders often develop\u00a0 after a life stress this could be a death a\u00a0\u00a0 severe illness a disaster a big move becoming a\u00a0 parent or adverse childhood experiences or aces\u00a0\u00a0 that’s just to name a few obviously\u00a0 that those aren’t all of the causes\u00a0\u00a000:41:00<\/a>but i think it’s interesting that\u00a0 becoming a parent was in there as a life stress that often triggers the development of\u00a0 anxiety disorders i mean i’m a parent myself i can\u00a0\u00a0 see how that could happen but it’s not something\u00a0 that i had really considered in the past as a00:41:23<\/a>risk factor for the development\u00a0 of anxiety disorders\u00a0\u00a0 people who’ve been bullied have an increased risk\u00a0 of developing anxiety disorders heritability of\u00a0\u00a0 anxiety disorders ranges between 30 and 75 percent\u00a0 i found that interesting but they didn’t explain\u00a0\u00a000:41:44<\/a>in any of the diagnoses whether they were looking\u00a0 at twins that were raised in the same household\u00a0\u00a0 or twins that were raised in different households\u00a0 if they’re raised in different households\u00a0\u00a0 it gives more credence to a genetic component if\u00a0 they’re raised in the same household then they’re\u00a0\u00a000:42:05<\/a>experienced to the same psychosocial environmental\u00a0 stressors both of them are so i i don’t know what\u00a0\u00a0 the actual data is on that people with negative\u00a0 affectivity they tend to be more brooding more\u00a0\u00a0 depressed more irritable people who are more\u00a0 self-conscious people who ruminate more also\u00a0\u00a000:42:31<\/a>all of these kind of are combined often referred\u00a0 to as neuroticism they are at higher risk for\u00a0\u00a0 the development of anxiety disorders attentional\u00a0 bias to threat was noted in generalized anxiety\u00a0\u00a0 disorder as being an associated feature but\u00a0 research actually shows that people with\u00a0\u00a000:42:57<\/a>any anxiety disorder tend to have a stronger\u00a0 attentional bias to threat which means they tend\u00a0\u00a0 to be more hyper vigilant they tend to be more\u00a0 aware when there’s threats in the environment\u00a0\u00a0 anxiety disorders by and large tend to be\u00a0 much more frequent in women than in men\u00a0\u00a000:43:18<\/a>interesting not sure why again my assumption\u00a0 is this is people who are biologically female\u00a0\u00a0 and it seems to be consistent across cultures\u00a0 therefore i am wondering what the genetic\u00a0\u00a0 predisposition might be that may cause this\u00a0 it seems like it’s less about environment and\u00a0\u00a000:43:46<\/a>shaping and behavioral training and\u00a0 more about a physiological response but\u00a0\u00a0 additionally and these last two were not in\u00a0 the dsm but i did a pubmed search for risk\u00a0\u00a0 factors for anxiety disorders and those\u00a0 who have a more external locus of control\u00a0\u00a000:44:08<\/a>that means they believe that things happen in\u00a0 the world by fate by chance there’s not a they\u00a0\u00a0 don’t have a whole lot of control or ability to\u00a0 change what’s going on destiny is preordained etc\u00a0\u00a0 people with that outlook who have a more external\u00a0 locus of control tend to have much higher rates\u00a0\u00a000:44:29<\/a>of anxiety and depressive disorders and again not\u00a0 in the dsm but in the in pubmed in the literature\u00a0\u00a0 people who have a lack of emotional\u00a0 support also tend to be at greater risk\u00a0\u00a0 for developing anxiety disorders seems pretty\u00a0 self-explanatory in terms of suicidal thoughts\u00a0\u00a000:44:54<\/a>anxiety itself increases risk of suicidal\u00a0 thoughts all of your anxiety disorders carry\u00a0\u00a0 with them an increased risk of suicidal\u00a0 thoughts people with separation anxiety have that generalized anxiety-related\u00a0 increased risk but people with specific\u00a0\u00a000:45:15<\/a>phobias interestingly enough have an\u00a0 increased transition from ideation to attempt\u00a0\u00a0 in a study that was cited in the ds well mentioned\u00a0 in the dsm but they didn’t say what the study was\u00a0\u00a0 they looked at adults and they found\u00a0 that up to 30 percent of people00:45:38<\/a>who had their first suicide attempt it was\u00a0 related they also had a specific phobia or it\u00a0\u00a0 was related to that specific phobia so that’s 30\u00a0 percent is a big number uh when we’re especially\u00a0\u00a0 when we’re talking about suicide suicide attempts\u00a0 and suicidal ideation if you have somebody with a\u00a0\u00a000:45:58<\/a>specific phobia we often downplay that because we\u00a0 think it’s just a fear of this or a fear of that\u00a0\u00a0 but that fear can feel very limiting and\u00a0 oppressive to a lot of people and again\u00a0\u00a0 30 percent of them uh 30 percent of people who\u00a0 have attempted suicide also had specific phobia00:46:23<\/a>functional consequences now i could go on a\u00a0 diatribe about the functional consequences\u00a0\u00a0 of anxiety disorders the dsm didn’t have much to\u00a0 say about it so let’s talk about some of these\u00a0\u00a0 limited independent activities this is especially\u00a0 true in agoraphobia and separation anxiety\u00a0\u00a000:46:47<\/a>people who are afraid of leaving the house\u00a0 for fear of being separated from their\u00a0\u00a0 significant other or for fear of being separated\u00a0 from their safe place and people who have social\u00a0\u00a0 anxiety who fear being in social situations\u00a0 may have a lot of restrictions on their life\u00a0\u00a000:47:08<\/a>activities and limited activities that they\u00a0 feel safe or comfortable doing by themselves\u00a0\u00a0 not in the dsm 5 tr but in the literature also the\u00a0 functional consequences of impaired relationships\u00a0\u00a0 people with anxiety disorders may be because of\u00a0 their restrictions on life activities and their\u00a0\u00a000:47:34<\/a>um potential need to know where people\u00a0 are and their separation anxiety etc\u00a0\u00a0 a lot of times people with anxiety disorders\u00a0\u00a0 struggle in their relationships because\u00a0 it can feel overwhelming to the partners\u00a0\u00a000:47:53<\/a>as i mentioned earlier people with anger anxiety\u00a0 disorders have higher rates of autoimmune issues\u00a0\u00a0 continuous or excessive levels of stress hormones\u00a0\u00a0 contributes to systemic inflammation\u00a0 which will trigger depression\u00a0\u00a000:48:12<\/a>or is associated with triggering depression and\u00a0 associated with worsening of autoimmune conditions\u00a0\u00a0 and obesity i thought this one was interesting\u00a0 but it makes sense when you look at it people\u00a0\u00a0 with anxiety disorders who often are restricted\u00a0 in their life activities may feel worn down and\u00a0\u00a000:48:35<\/a>exhausted from being stressed out all the time\u00a0 may not have a lot of energy to do other stuff\u00a0\u00a0 tend to be more prone to develop obesity so\u00a0 that’s an interesting functional consequence now differential diagnosis i told you there was a\u00a0 laundry list of them generalized anxiety disorder\u00a0\u00a000:49:01<\/a>in gad excessive anxiety is about a variety of\u00a0 things for at least six months separation anxiety\u00a0\u00a0 the worry or the anxiety is about\u00a0 separation from the attachment figure\u00a0\u00a0 okay that’s pretty clear agoraphobia the\u00a0 fear is about being trapped or helpless\u00a0\u00a000:49:20<\/a>in situations in which escape is difficult the\u00a0 fear surrounds being away from their safe place\u00a0\u00a0 not being away from a person they want\u00a0 to be in a place where they feel safe\u00a0\u00a0 and it needs to be not specific to one setting\u00a0 so being trapped or helpless in a situation00:49:46<\/a>i give the example of an mri those\u00a0 closed mris oh my gosh i can’t stand them\u00a0\u00a0 i’m terrified of them but that is specific to one\u00a0 setting and i’m not afraid to leave the house for\u00a0\u00a0 fear of being trapped or helpless in a situation\u00a0 social anxiety the anxiety is about being judged\u00a0\u00a000:50:10<\/a>negatively and illness anxiety and this illness\u00a0 anxiety actually falls under the somatic disorders\u00a0\u00a0 but illness anxiety the worry is about the\u00a0 illness not separation judgment or being away\u00a0\u00a0 from your safe place so that’s differential\u00a0 diagnosis of your basic anxiety disorders\u00a0\u00a000:50:34<\/a>in terms of other disorders because there’s\u00a0 that criteria not better explained by another\u00a0\u00a0 mental health or medical disorder psychotic\u00a0 disorders people who have hallucinations and\u00a0\u00a0 delusions may also have anxiety but their worry\u00a0 or fear surrounds hallucinations or delusions\u00a0\u00a000:50:53<\/a>and is not reversed by context or the presence of\u00a0 an attachment figure so a person with psychotic\u00a0\u00a0 disorders if their major attachment figure shows\u00a0 up that doesn’t help them feel more comfortable\u00a0\u00a0 if they turn on the light to eliminate the shadows\u00a0 that doesn’t make them feel more comfortable\u00a0\u00a000:51:15<\/a>and the hallucinations are not due to the with\u00a0 psychotic disorders the hallucinations are not\u00a0\u00a0 due to something that are actually present\u00a0 eating disorders avoidance behavior is only\u00a0\u00a0 related to food and food-related cues according\u00a0 to the dsm however one of the main criteria\u00a0\u00a000:51:41<\/a>for your eating disorders is a excessive fear\u00a0 about weight shape and size and it’s important\u00a0\u00a0 to recognize that because people with eating\u00a0 disorders may avoid mirrors and scales and\u00a0\u00a0 food obviously certain foods and that could all be\u00a0 related to their eating disorder body dysmorphic\u00a0\u00a000:52:11<\/a>disorder the fears are only related to people\u00a0 being offended by a particular perceived flaw\u00a0\u00a0 in obsessive-compulsive disorder the fear is an\u00a0 object or situation as a result of obsessions so\u00a0\u00a0 if they start thinking about germs on their\u00a0 hands and they keep thinking about it then\u00a0\u00a000:52:33<\/a>they start developing a fear of getting germs\u00a0 on their hands so the fear becomes the object\u00a0\u00a0 of their obsessions or their their obsessions turn\u00a0 cause what they’re thinking about to become a fear\u00a0\u00a0 in autism spectrum the person lacks\u00a0 sufficient age-appropriate relationships\u00a0\u00a000:52:57<\/a>and social communication capacity in\u00a0 anxiety disorders the person often has\u00a0\u00a0 sufficient age-appropriate relationships\u00a0 and can communicate socially socially\u00a0\u00a0 understand others just fine what we’re\u00a0 looking at in anxiety is fear of being judged00:53:25<\/a>conduct disorder school avoidance is a\u00a0 very common symptom of conduct disorder\u00a0\u00a0 but school avoidance is not due to worry or\u00a0 fear in conduct disorder school avoidance\u00a0\u00a0 and conduct disorder is due to not wanting\u00a0 to be told what to do thank you very much\u00a0\u00a000:53:44<\/a>in oppositional defiant disorder the oppositional\u00a0 behaviors occur in response to multiple situations\u00a0\u00a0 not just separation or situational anxiety\u00a0 not just in response to an anxiety provoking\u00a0\u00a0 threat so if somebody has separation anxiety they\u00a0 may become oppositional about leaving their major\u00a0\u00a000:54:06<\/a>attachment figure if somebody has social phobia\u00a0 they may become oppositional about engaging in\u00a0\u00a0 situations that would prompt that anxiety or if\u00a0 they have a specific phobia maybe they’re afraid\u00a0\u00a0 of snakes they may become oppositional\u00a0 about doing something like going hiking\u00a0\u00a000:54:25<\/a>because they are actively\u00a0 avoiding that phobic stimulus if they are actively avoiding a phobic\u00a0 stimulus or an anxiety provoking stimulus\u00a0\u00a0 it’s probably not oppositional defiant now\u00a0 you can have both you can have them co-occur\u00a0\u00a000:54:45<\/a>but you do want to differentiate what is the cause\u00a0 of the behavior prolonged grief is characterized\u00a0\u00a0 by intense longing and yearning for the deceased\u00a0 not fear of separation from them now you can have\u00a0\u00a0 prolonged grief and separation anxiety\u00a0 co-occur you can’t have somebody who develops\u00a0\u00a000:55:11<\/a>a fear of separation from others after a\u00a0 particularly particularly traumatic loss\u00a0\u00a0 that can happen but you do want to\u00a0 differentiate and diagnose appropriately\u00a0\u00a0 and in depression and bipolar a lot of people\u00a0 who are in a major depressive episode may have\u00a0\u00a000:55:32<\/a>reluctance to leave home but this is due to lack\u00a0 of motivation and energy to engage and apathy\u00a0\u00a0 it’s not due to fear of something out there they\u00a0 just they don’t care or they don’t have the energy personality the person with dependent personality\u00a0 relies too much on others it’s not that they fear\u00a0\u00a000:55:55<\/a>uh their safety or loss of attachment figures and\u00a0 avoidant personality disorder broader avoidance\u00a0\u00a0 patterns and a pervasive negative self-concept\u00a0 differentiate avoidant personality disorder from\u00a0\u00a0 anxiety related disorders not in the dsm i’m\u00a0 bringing up for differential diagnosis anxiety\u00a0\u00a000:56:22<\/a>is related to apprehension and vigilance\u00a0 of physiological sensations and may have\u00a0\u00a0 an onset after a concussion pots is a postural\u00a0 orthostatic tachycardia and when people have it\u00a0\u00a0 when they stand up their heart rate will jump\u00a0 30 or more beats just from when they move from\u00a0\u00a000:56:46<\/a>sitting to standing and that can feel very scary\u00a0 they can also get light-headed they can faint\u00a0\u00a0 hypoglycemia can also produce symptoms\u00a0 of anxiety and sweating and agitation\u00a0\u00a0 in people so we want to differentially diagnose\u00a0 i believe i read a study that more than 25\u00a0\u00a000:57:07<\/a>of americans are pre-diabetic and don’t know it co-morbidity anxiety disorders are comorbid\u00a0 with each other so if you have one you probably\u00a0\u00a0 have some of its buddies it’s also comorbid\u00a0 with depression bipolar ptsd prolonged grief\u00a0\u00a000:57:27<\/a>obsessive-compulsive disorder\u00a0 obsessive-compulsive personality disorder\u00a0\u00a0 somatic symptom related disorders so\u00a0 any of your physical symptom disorders\u00a0\u00a0 anti-social personality specifically social\u00a0 anxiety common commonly may co-occur with\u00a0\u00a000:57:49<\/a>anti-social oppositional defiant\u00a0 disorder and substance use disorders physically autoimmune diseases may increase the\u00a0 risk of psychiatric disorders partially due to\u00a0\u00a0 thyroid dysfunction when that hpa axis goes\u00a0 offline it also affects the functioning of\u00a0\u00a000:58:10<\/a>the thyroid cardiovascular issues\u00a0 like supraventricular tachycardia\u00a0\u00a0 can also be misdiagnosed and is\u00a0 often misdiagnosed for panic disorder\u00a0\u00a0 hormone level fluctuations especially extreme\u00a0 hormone fluctuations can contribute to anxiety\u00a0\u00a000:58:32<\/a>related symptoms high levels of estrogen or\u00a0 testosterone nutrient deficiencies or toxicities\u00a0\u00a0 so too much or too little of certain vitamins\u00a0 and minerals can also cause anxiety like symptoms\u00a0\u00a0 environmentally poverty is a high risk factor for\u00a0 the development of anxiety disorders for obvious\u00a0\u00a000:58:57<\/a>reasons and socially adverse childhood experiences\u00a0 that include abuse neglect abandonment or mental\u00a0\u00a0 illness in the household are all risk factors for\u00a0 the development of anxiety disorders later in life anxiety disorders represent an anxiety\u00a0 response that is developmentally\u00a0\u00a000:59:21<\/a>culturally and contextually excessive\u00a0 it’s persistent or recurrent and causes\u00a0\u00a0 clinically significant distress so\u00a0 that differentiates it from people’s\u00a0\u00a0 run-of-the-mill anxiety if you will\u00a0 multiple anxiety disorders are common\u00a0\u00a000:59:41<\/a>this presentation covered some of the more\u00a0 common anxiety disorders but did not cover\u00a0\u00a0 selective mutism substance induced anxiety or\u00a0 other specified and unspecified anxiety disorders\u00a0\u00a0 finally it is important to rule out or\u00a0 diagnose comorbidly any physiological causes\u00a0\u00a0
Source : Youtube<\/a><\/div><\/div>","protected":false},"excerpt":{"rendered":"

https:\/\/www.youtube.com\/watch?v=D7qZ66inJQY00:00:01Hey there everybody and welcome to this\u00a0 presentation on diagnosing anxiety and panic\u00a0\u00a0 in the dsm-5tr i’m your host dr donnelly snipes\u00a0 in this presentation very briefly we’re going\u00a0\u00a0 to review the diagnostic criteria for anxiety\u00a0 disorders or at least most of them in the dsm 5 tr00:00:24so let’s talk a little bit about anxiety\u00a0 … Continue reading Anxiety Disorders in the DSM 5 TR | Symptoms and Diagnosis<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":152198,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[96],"tags":[],"class_list":["post-152197","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-tech"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2024\/03\/1709495322-maxresdefault.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/152197","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=152197"}],"version-history":[{"count":0,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/152197\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/152198"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=152197"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=152197"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=152197"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}