Diagnostic criteria and clinical features

Marked and consistent fear or avoidance of at least two of the following situations: crowds; public places; travelling alone; travelling away from home.

Symptoms of anxiety in the feared situation at some time since the onset of the disorder, with at least two symptoms

Autonomic arousal symptoms

Palpitations, Sweating Trembling, Dry mouth

Symptoms concerning chest and abdomen

Difficulty breathing, Feeling of choking, Chest pain or discomfort, Abdominal distress

Symptoms concerning brain and mind

Feeling dizzy or light-headed

Derealization depersonalization

Fear of losing going crazy, Fear of dying.

General symptoms

Hot flushes or cold chills, Numbness or tingling sensations.

Significant emotional distress due to the avoidance or the anxiety symptoms, and a recognition that these are excessive or unreasonable.

Symptoms predominate in the feared situations or when thinking about them.

Panic Disorder

Lifetime prevalence – 1-4%

Women twice more likely to be affected

Mean age of presentation 25 years

Diagnostic Criteria

Recurrent panic attacks that are not consistently associated with a specific
situation or object and often occurring spontaneously

The panic attacks are not associated with marked exertion or with exposure to
dangerous or life-threatening situations.

A panic attack is characterized by all of the following:(a) it is a discrete episode of
intense fear or discomfort; (b) it starts abruptly; (c) it reaches a crescendo within a few minutes and lasts at least some minutes; (d) at least four symptoms of anxiety
must be present as described in phobic disorder above

Generalised Anxiety Disorder

A period of at least six months with prominent tension, worry and feelings of
apprehension, about every-day events and problems.

Four symptoms out of the following list

1. Autonomic arousal symptoms

Palpitations, Sweating Trembling, Dry mouth

2. Symptoms concerning chest and abdomen
Difficulty breathing, Feeling of choking, Chest pain or discomfort, Abdominal distress

3. Symptoms concerning brain and mind

Feeling dizzy or light-headed. Feelings that objects are unreal derealisation, depersonalization

Fear of losing going crazy, Fear of dying.

Obsessive Compulsive Disorder

Fourth most common psychiatric disorder

Equal prevalence in men and women

Mean age of onset in 20 years

Diagnostic criteria
Either obsessions or compulsions (or both), present on most days for a period of at least two weeks

Obsessions (thoughts, ideas or images) and compulsions (acts) share the following features

1. They are acknowledged as originating in the mind of the patient and are not imposed by outside persons or influences.

2. They are repetitive and unpleasant, and at least one obsession or compulsion must be present that is acknowledged as excessive or unreasonable.

3. The subject tries to resist them but at least one obsession or compulsion must be present which is unsuccessfully resisted.

4. Carrying out the obsessive thought or compulsive act is not in itself pleasurable.

The obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning, usually by wasting time.

Acute Stress Disorder

Exposure to an exceptional mental or physical stressor

Followed by an immediate onset of symptoms (within one hour)

(1) The criteria for symptoms as mentioned in generalized anxiety disorder

(2) Withdrawal from expected social interaction; narrowing of attention; apparent disorientation; anger or verbal aggression; despair or hopelessness; purposeless over-activity; uncontrollable and excessive grief (judged by local cultural standards).

If the stressor is transient or can be relieved, the symptoms must begin to diminish after not more than eight hours. If the stressor continues, the symptoms must begin to diminish after not more than 48 hours.

Post-Traumatic Stress Disorder

Exposure to a stressful event or situation of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone Persistent remembering or reliving the stressor by intrusive flash backs, vivid memories, recurring dreams, or by experiencing distress when exposed to circumstances resembling or associated with the stressor

Avoidance of circumstances resembling or associated with the stressor

(1) Inability to recall, either partially or completely, some important aspects of theperiod of exposure to the stressor

(2) Persistent symptoms of increased psychological sensitivity and arousal shown by any two of the following: difficulty in falling asleep, irritability, difficulty in concentrating; hyper-vigilance; exaggerated startle response.

Symptoms occurred within six months of the stressful event, or the end of a period of stress.