The tables in this section are from Hollander E, Simeon D, Concise Guide to Anxiety Disorders, Washington, DC, American Psychiatric Publishing, 2003, and from Stein D, ed, Clinical Manual of Anxiety Disorders, Washington, DC, American Psychiatric Publishing, 2004. Copyright 2003 and 2004, American Psychiatric Publishing, Inc. Reprinted with permission.
Table 1. Differential Diagnosis of Social Phobia| Personality disorder, such as avoidant, schizoid, paranoid |
| Axis I paranoid disorder, such as paranoid schizophrenia or paranoid delusional disorder |
| Depression-related social withdrawal secondary to anhedonia or feelings of defectiveness |
| OCD-related fears exacerbated in social settings (e.g., contamination) |
| Panic disorder with phobic avoidance not limited to social situations |
| Deficits or impaired social skills associated with schizophrenia and related disorders |
| Body dysmorphic disorder with secondary social phobia |
Table 2. Biological Models of Panic Disorder| Hyperreactivity of the locus coeruleus |
| Decreased GABA-benzodiazepine receptor complex binding |
| Dysregulated serotonergic modulation |
| HPA axis dysregulation |
| Hypersensitive brain stem carbon dioxide chemoreceptors |
| Hypersensitive conditioned fear network centered in the amygdala |
| Moderate genetic component |
Table 3. Cognitive and Behavioral Approaches to Treating Panic Disorder| Interoceptive exposure (to the somatic cues of panic attacks) |
| Situational exposure (to the settings that are phobically avoided) |
| Cognitive restructuring |
| Breathing retraining |
| Applied relaxation training |
Table 3. Cognitive and Behavioral Approaches to Treating Panic DisorderEnlarge table Table 4. Cognitive and Behavioral Approaches to Treating Generalized Anxiety Disorder| Exposure |
| Cognitive restructuring |
| Breathing retraining |
| Applied relaxation training |
Table 4. Cognitive and Behavioral Approaches to Treating Generalized Anxiety DisorderEnlarge table Table 5. Cognitive and Behavioral Approaches to Treating Social Phobia| Cognitive restructuring |
| Exposure (imaginal and/or in vivo) |
| Social skills training (modeling, rehearsal, role-playing, practice) |
Table 5. Cognitive and Behavioral Approaches to Treating Social PhobiaEnlarge table Table 6. Cognitive and Behavioral Approaches to Treating Obsessive-Compulsive Disorder| Graded exposure (imaginal and/or in vivo) |
| Flooding |
| Response prevention |
| Cognitive restructuring |
Table 6. Cognitive and Behavioral Approaches to Treating Obsessive-Compulsive DisorderEnlarge table Table 7. DSM-IV-TR Diagnostic Criteria for Specific Phobia| 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, receiving an injection, seeing blood). | | B. | Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging. | | C. | The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent. | | D. | The phobic situation(s) is avoided or else is endured with intense anxiety or distress. | | E. | The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. | | F. | In individuals under age 18 years, the duration is at least 6 months. | | G. | The anxiety, panic attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as obsessive-compulsive disorder (e.g., fear of dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., avoidance of stimuli associated with a severe stressor), separation anxiety disorder (e.g., avoidance of school), social phobia (e.g., avoidance of social situations because of fear of embarrassment), panic disorder with agoraphobia, or agoraphobia without history of panic disorder. |
|
| Specify type: |
| Animal type |
| Natural environment type (e.g., heights, storms, water) |
| Blood-injection-injury type |
| Situational type (e.g., airplanes, elevators, enclosed spaces) |
| Other type (e.g., fear of choking, vomiting, or contracting an illness; in children, fear of loud sounds or costumed characters) |
Table 7. DSM-IV-TR Diagnostic Criteria for Specific PhobiaEnlarge table Table 8. General Medical Disorders Associated With Anxiety Symptoms| Anemia |
| Arrhythmias |
| Angina |
| Asthma |
| Early dementia |
| Fibromyalgia |
| Gastroesophageal reflux disease |
| Hyperparathyroidism |
| Hyperthryroidism |
| Hypoglycemia |
| Irritable bowel syndrome |
| Mitral valve prolapse |
| Obstructive lung disease |
| Parkinson’s disease |
| Paroxysmal atrial fibrillation |
| Pheochromocytoma |
| Pulmonary embolus |
| Substance abuse/withdrawal (including narcotics, benzodiazepines, and beta-blockers) |
| Seizure disorders |
| Supraventricular tachycardia |
| Vestibular dysfunction |
Table 8. General Medical Disorders Associated With Anxiety SymptomsEnlarge table Table 9. Differential Diagnosis of Obsessive-Compulsive Disorder| Axis I |
| With obsessive-compulsive features |
| 1. | Major depressive disorder (with “obsessive” rumination) | | 2. | Delusional disorder (somatic obsessions) | | 3. | Body dysmorphic disorder | | 4. | Specific or social phobia | | 5. | Hypochondriasis | | 6. | Eating disorders | | 7. | Schizophrenia | | 8. | Other disorders with “compulsive” symptomatology (trichotillomania, paraphilias, pathological gambling, substance abuse) |
|
| With anxiety |
| 1. | Panic disorder | | 2. | Posttraumatic stress disorder | | 3. | Generalized anxiety disorder |
|
| Axis II |
| 1. | Pervasive developmental disorders | | 2. | Obsessive-compulsive personality disorder |
|
| Late onset (after 45 years) |
| Evaluate for neuromedical illness: history (especially family history and exposure to environmental toxins), neuroexamination, basic clinical workup, and neurodiagnostics as indicated |
| 1. | Neurodegenerative (e.g., Huntington’s chorea) | | 2. | Traumatic (rare anecdotal reports) | | 3. | Neoplastic and vascular |
|
Table 9. Differential Diagnosis of Obsessive-Compulsive DisorderEnlarge table 
