Anxiety Disorders

  • F40 PHOBIC ANXIETY DISORDERS
  • F40.0 Agoraphobia

A. Marked and consistently manifest fear in or avoidance of at least two of the following situations:
(1) crowds;
(2) public places;
(3) travelling alone;
(4) travelling away from home.

B.   Symptoms of anxiety in the feared situation at some time since the onset of the disorder, with at least two  symptoms present together, on at least one occasion, from the list below, one of which must have been  from items (1) to (4):

Autonomic arousal symptoms
(1) Palpitations or pounding heart, or accelerated heart rate.
(2) Sweating.
(3) Trembling or shaking.
(4) Dry mouth (not due to medication or dehydration).

Symptoms concerning chest and abdomen
(5) Difficulty breathing.
(6) Feeling of choking.
(7) Chest pain or discomfort.
(8) Nausea or abdominal distress (e.g. churning in stomach).

Symptoms concerning brain and mind
(9)     Feeling dizzy, unsteady, faint or light-headed.
(10)    Feelings that objects are unreal (derealization), or that one's self is distant or "not really here" (depersonalization).
(11)    Fear of losing control, going crazy, or passing out.
(12)    Fear of dying.

 

General symptoms
(13)    Hot flushes or cold chills.
(14)    Numbness or tingling sensations.

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

D.   Symptoms are restricted to or predominate in the feared situations or when thinking about them.
E.   Most commonly used exclusion criteria: criterion A is not due to delusions, hallucinations, or other  symptoms of disorders such as organic mental disorders (F0), schizophrenia and related disorders  (F20-F29), affective disorders (F30-F39), or obsessive compulsive disorder (F42), and are not secondary to  cultural beliefs. The presence or absence of panic disorder (F41.0) on a majority of occasions when in the agoraphobicb  situation may be specified by using a fifth character:

  • F40.00 Agoraphobia without panic disorder
  • F40.01 Agoraphobia with panic disorder
  • F41.0 Panic disorder [episodic paroxysmal anxiety]

A.   Recurrent panic attacks, that are not consistently associated with a specific situation or object, and often occurring spontaneously (i.e. the episodes are unpredictable). The panic attacks are not associated with marked exertion or with exposure to dangerous or life-threatening situations.

B.   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 must be present from the list below, one of which must be from items (1) to (4):

Autonomic arousal symptoms
(1) Palpitations or pounding heart, or accelerated heart rate.
(2) Sweating.
(3) Trembling or shaking.
(4) Dry mouth (not due to medication or dehydration).

Symptoms concerning chest and abdomen
(5) Difficulty breathing.
(6) Feeling of choking.
(7) Chest pain or discomfort.
(8) Nausea or abdominal  distress (e.g. churning in stomach).

Symptoms concerning brain and mind
(9)     Feeling dizzy, unsteady, faint or light-headed.
(10) Feelings that objects are  unreal (derealization), or that one's self is distant or "not really here" (depersonalization).
(11)    Fear of losing control, going  crazy, or passing out.
(12)    Fear of dying.

General symptoms
(13)    Hot flushes or cold chills.
(14)    Numbness or tingling sensations

F41.1 Generalized anxiety disorder
Note: For children different criteria may be applied (see F93.80).

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

B.   At least four symptoms out of the following list of items must be present, of which at least one from items  (1) to (4).
Autonomic arousal symptoms

(1) Palpitations or pounding heart, or accelerated heart rate.
(2) Sweating.
(3) Trembling or shaking.
(4) Dry mouth (not due to medication or dehydration).

Symptoms concerning chest and abdomen
(5) Difficulty breathing.
(6) Feeling of choking.
(7) Chest pain or discomfort.
(8) Nausea or abdominal distress (e.g. churning in stomach).

Symptoms concerning brain and mind
(9)     Feeling dizzy, unsteady, faint or light-headed.
(10)    Feelings that objects are unreal (derealization), or that one's self is distant or "not really here" (depersonalization).
(11)    Fear of losing control, going crazy, or passing out.
(12)    Fear of dying.

General symptoms
(13)    Hot flushes or cold chills.
(14)    Numbness or tingling sensations.

Symptoms of tension
(15)    Muscle tension or aches and pains.
(16)    Restlessness and inability to relax.
(17)    Feeling keyed up, or on edge, or of mental tension.
(18)    A sensation of a lump in the throat, or difficulty with swallowing.

Other non-specific symptoms
(19)    Exaggerated response to minor surprises or being startled.
(20)    Difficulty in concentrating, or mind going blank, because of worrying or anxiety.
(21)    Persistent irritability.
(22)    Difficulty getting to sleep because of worrying.

C.   The disorder does not meet the criteria for panic disorder (F41.0), phobic anxiety disorders (F40.-),obsessive-compulsive disorder (F42.-) or hypochondriacal disorder (F45.2).

D. Most commonly used exclusion criteria: not sustained by a physical disorder, such as hyperthyroidism, an  organic mental disorder (F0) or psychoactive substance-related disorder (F1), such as excess consumption  of amphetamine-like substances, or withdrawal from benzodiazepines.

F42 OBSESSIVE-COMPULSIVE DISORDER
A.   Either obsessions or compulsions (or both), present on most days for a period of at least two weeks.
B.   Obsessions (thoughts, ideas or images) and compulsions (acts) share the following features, all of which  must be present:

(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 if very long-standing, resistance to some obsessions or compulsions may be minimal). 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. (This should be distinguished from the temporary relief of tension or anxiety).

C.   The obsessions or compulsions cause distress or interfere with the subject's social or individual functioning, usually by wasting time.
D.   Most commonly used exclusion criteria: not due to other mental disorders, such as schizophrenia and  related disorders (F2), or mood [affective] disorders (F3).

The diagnosis may be specified by the following four character codes:

  • F42.0 Predominantly obsessional thoughts and ruminations
  • F42.1 Predominantly compulsive acts
  • F42.2 Mixed obsessional thoughts and acts
  • F42.8 Other obsessive-compulsive disorders
  • F42.9 Obsessive-compulsive disorder, unspecified

F43 REACTION TO SEVERE STRESS, AND ADJUSTMENT DISORDERS
F43.0 Acute stress reaction

A.   Exposure to an exceptional mental or physical stressor.
B.   Criterion A is followed by an immediate onset of symptoms (within one hour).
C.   Two groups of symptoms are given; the acute stress reaction is graded as:

F43.00 Mild if only (1) is fulfilled;
F43.01 Moderate for (1) plus any two symptoms of (2), and
F43.02 Severe for either - (1) plus any four from (2)  Or - dissociative stupor.

(1) The criteria B, C and D for generalized anxiety disorder (F41.1).
(2) a) withdrawal from expected social interaction;
b)   narrowing of attention;
c)   apparent disorientation;
d)   anger or verbal aggression;
e)   despair or hopelessness;
f)    inappropriate or purposeless over-activity;
g)   uncontrollable and excessive grief (judged by local cultural standards).

D.   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.
E.   Most commonly used exclusion criteria: without the current presence of any other mental or behavioural disorder in ICD-10, (except for F41.1 (generalized anxiety disorder), and F60 (personality disorders)), and  not within three months of the end of an episode of any other mental or behavioural disorder.

F43.1 Post-traumatic stress disorder
A.   Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or  catastrophic nature, which is likely to cause pervasive distress in almost anyone.
B.   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.
C.   Actual or preferred avoidance of circumstances resembling or associated with the stressor (not present  before exposure to the stressor).
D.   Either (1) or (2):

(1) Inability to recall, either partially or completely, some important aspects  of the period of exposure to the stressor
(2) Persistent symptoms of increased psychological sensitivity and arousal (not present before exposure to the stressor) shown by any two of the following:
a)   difficulty in falling or staying asleep;
b)   irritability or outbursts of anger;
c)   difficulty in concentrating;
d)   hyper-vigilance;
e)   exaggerated startle response.

E.   Criteria B, C and D all occurred within six months of the stressful event, or the end of a period of stress. (For some purposes, onset delayed more than six months may be included but this should be clearly specified separately.)

F43.2 Adjustment disorders
A.   Experience of an identifiable psycho-social stressor, not of an unusual or catastrophic type, within one month of the onset of symptoms.
B.   Symptoms or behaviour disturbance of types found in any of the affective disorders (except for delusions and hallucinations), any disorders in F4 (neurotic, stress related and somatoform disorders) and  conduct disorders, so long as the criteria of an individual disorder are not fulfilled. Symptoms may be  variable in both form and severity.

F44 DISSOCIATIVE [CONVERSION] DISORDERS
G1. No evidence of a physical disorder that can explain the symptoms that characterize the disorder (but  physical disorders may be present that give rise to other symptoms).
G2. Convincing associations in time between the symptoms of the disorder and stressful events, problems or needs.

F44.0 Dissociative amnesia
A.   The general criteria for dissociative disorder (F44) must be met.
B.   Amnesia, either partial or complete, for recent events or problems that were or still are traumatic or stressful.
C. The amnesia is too extensive and persistent to be explained by ordinary forgetfulness, (although its depth  and extent may vary from one assessment to the next), or by intentional simulation.

F44.1 Dissociative fugue
A.   The general criteria for dissociative disorder (F44) must be met.
B.   An unexpected yet normally organized journey away from home or the ordinary places of work and  social activities, during which self-care is largely maintained.
C.   Amnesia, either partial or complete, for the journey, also meeting criterion C as for dissociative amnesia  (F44.0).

F44.2 Dissociative stupor
A.   The general criteria for dissociative disorder (F44) must be met.
B.   Profound diminution or absence of voluntary movements and speech, and of normal responsiveness to light, noise and touch.
C.   Maintenance of normal muscle tone, static posture, and breathing (and often limited coordinated eye movements).

F44.3 Trance and possession disorders
A. The general criteria for dissociative disorder (F44) must be met.
B. Either (1) or (2):

(1) Trance: Temporary alteration of the state of consciousness, shown by any two of:
a)   Loss of the usual sense of personal identity.
b)   Narrowing of awareness of immediate surroundings, or unusually narrow and selective focussing on environmental stimuli.
c)   Limitation of movements, postures, and speech to repetition of a small repertoire.

(2) Possession disorder: Conviction that the individual has been taken over by a spirit, power, deity or other person.
C. Both criterion B.1 and B.2 must be unwanted and troublesome, occurring outside or being a prolongation of similar states in religious or other culturally accepted situations.
D. Most commonly used exclusion criteria: not occurring at the same time as schizophrenia or related disorders (F20- F29), or mood [affective] disorders with hallucinations or delusions (F30- F39).

F44.4 Dissociative motor disorders
A. The general criteria for dissociative disorder (F44) must be met.
B. Either (1) or (2):

(1) Complete of partial loss of the ability to perform movements that are normally under voluntary control  (including speech).
(2) Various or variable degrees of incoordination or ataxia or inability to stand unaided.

F44.5 Dissociative convulsions
A.   The general criteria for dissociative disorder (F44) must be met.
B.   Sudden and unexpected spasmodic movements, closely resembling any of the varieties of epileptic seizures, but not followed by loss of consciousness.
C.   Criterion B is not accompanied by tongue-biting, serious bruising or laceration due to falling, or incontinence of urine.

F44.6 Dissociative anaesthesia and sensory loss
A.   The general criteria for dissociative disorder (F44) must be met.
B.   Either (1) or (2):
(1) Partial or complete loss of any or all of the normal cutaneous sensations over  part or all of the body (specify: touch, pin prick, vibration, heat, cold).
(2) Partial or complete loss of vision, hearing or smell (specify).
F44.7 Mixed dissociative [conversion] disorders
F44.8 Other dissociative [conversion] disorders
This residual code may be used to indicate other dissociative and conversion states that meet criteria A and B for F44, but do not meet the criteria for F44.0 - F44.8 listed above.

F44.80 Ganser's syndrome (approximate answers)
F44.81 Multiple personality disorder
A.   The existence of two or more distinct personalities within the individual, only one being evident at a time.
B.   Each personality has its own memories, preferences and behaviour  patterns, and at some time (and recurrently) takes full control  of the individuals behaviour.
C.   Inability to recall important personal information, too extensive to be explained by ordinary forgetfulness.

D.         Not due to organic mental disorders (F0) (e.g. in epileptic disorders) or  psychoactive substance-related disorders (F1) (e.g. intoxication or withdrawal).

F45 SOMATOFORM DISORDERS
F45.0 Somatization disorder
A.   A history of at least two years complaints of multiple and variable physical symptoms that cannot be explained by any detectable physical disorders. (Any physical disorders that are known to be present do not explain the severity, extent, variety and persistence of the physical complaints, or the associated social  disability). If some symptoms clearly due to autonomic arousal are present, they are not a major feature of the disorder, in that they are not particularly persistent or distressing.
B.    Preoccupation with the symptoms causes persistent distress and leads the patient to seek repeated (three or more) consultations or sets of investigations with either primary care or specialist doctors. In the  absence of medical services within either the financial or physical reach of the patient, persistent self-medication or multiple consultations with local healers must be present.
C.  Persistent refusal to accept medical advice that there is no adequate physical cause for the physical  symptoms, except for short periods of up to a few weeks at a time during or immediately after medical investigations.
D.    A total of six or more symptoms from the following list, with symptoms occurring in at least two separate  groups:

Gastro-intestinal symptoms
(1) abdominal pain;
(2) nausea;
(3) feeling bloated or full of gas;
(4) bad taste in mouth, or excessively coated tongue;
(5) complaints of vomiting or regurgitation of food;
(6) complaints of frequent and loose bowel motions or discharge of fluids from anus;

Cardio-vascular symptoms
(7) breathlessness without exertion;
(8) chest pains;

Genito-urinary symptoms
(9)     dysuria or complaints of frequency of micturition;
(10)    unpleasant sensations in or around the genitals;
(11)    complaints of unusual or copious vaginal discharge;

Skin and pain symptoms
(12)    complaints of blotchiness or discolouration of the skin;
(13)    pain in the limbs, extremities or joints;
(14)    unpleasant numbness or tingling sensations.

E.   Most commonly used exclusion criteria: not occurring only during any of the schizophrenic or related  disorders (F20-F29), any of the mood (affective) disorders (F30-F39), or panic disorder (see F41.0).

F45.3 Somatoform autonomic dysfunction
A. Symptoms of autonomic arousal that are attributed by the patient to a physical disorder of one or more of  the following systems or organs:
(1) heart and cardiovascular system;
(2) upper gastrointestinal tract (oesophagus and stomach);
(3) lower gastrointestinal tract;
(4) respiratory system;
(5) genitourinary system.
B.   Two or more of the following autonomic symptoms:
(1) palpitations;
(2) sweating (hot or cold);
(3) dry mouth;
(4) flushing or blushing;
(5) epigastric discomfort or "butterflies" or churning in the stomach.

C.   One or more of the following symptoms:
(1) chest pains or discomfort in and around the precordium;
(2) dyspnoea or hyperventilation;
(3) excessive tiredness on mild exertion;
(4) aerophagy, or hiccough, or burning sensations in chest or epigastrium;
(5) reported frequent bowel movements;
(6) increased frequency of micturition or dysuria;
(7) feeling of being bloated, distended or heavy.
D.   No evidence of a disturbance of structure or function in the organs or systems about which patient is concerned.
E.   Not only in the presence of phobic disorders (F40.0-F40.3) or panic disorder (F41.0).

The fifth character is to be used to classify the individual disorders in this group, indicating the organ or  system regarded by the patient as the origin of the symptoms:
F45.30 Heart and cardiovascular system (includes: cardiac neurosis, neurocirculatory asthenia, Da Costa  syndrome).
F45.31 Upper gastro-intestinal tract (includes: psychogenic aerophagy, hiccough, gastric neurosis).
F45.32 Lower gastro-intestinal tract (includes: psychogenic irritable bowel syndrome, psychogenic diarrhoea, gas syndrome).
F45.33 Respiratory system (includes: hyperventilation).
F45.34 Genitourinary system (includes: psychogenic increase of frequency of micturition and dysuria).
F45.38 Other organ or system
F45.4 Persistent somatoform pain disorder
A. Persistent (at least six months, continuously on most days) severe and distressing pain, in any part of the  body, which cannot be explained adequately by evidence of a physiological process or a physical disorder, and which is consistently the main focus of the patient's attention.

F48 OTHER NEUROTIC DISORDERS
F48.0 Neurasthenia
A. Either (1) or (2):

(1) Persistent and distressing complaints of feelings of exhaustion after minor mental effort (such as performing or attempting to perform every-day tasks that do not require unusual mental effort).
(2) Persistent and distressing complaints of feelings of fatigue and bodily weakness after minor physical effort.

B. Irritability, and at least one of the following:
(1) feelings of muscular aches and pains;
(2) dizziness;
(3) tension headaches;
(4) sleep disturbance;
(5) inability to relax.
C.   Inability to recover from A.1 or A.2 by normal periods of rest, relaxation or entertainment.
D.   The duration of the disorder is at least 6 months.
E.   Most commonly used exclusion criteria: not occurring in the presence of organic emotionally labile  disorder (F06.6), postencephalitic syndrome (F07.1), postconcussional syndrome (F07.2), mood [affective]  disorders (F30-F39), panic disorder (F41.0), or generalized anxiety disorder (F41.1).
F48.1 Depersonalization - derealization syndrome

A. Either (1) or (2):
(1) Depersonalization. The patient complains of a feeling of being distant, "not really here" (for example he  may complain that his emotions, or feelings, or experience of his inner self are detached, strange, not his own, or unpleasantly lost, or that his emotions or movements feel as if they belong to someone else, or that he feels as if acting in a play).

(2) Derealization. The patient complains of a feeling of unreality (for example he may complain that the  surroundings or specific objects look strange, distorted, flat, colourless, lifeless, dreary, uninteresting, or  like a stage upon which everyone is acting).

DSM-IV Criteria for Somatoform Disorders, Factitious Disorder, and Malingering

SOMATIZATION DISORDER
 A history of many physical complaints beginning before age 30 years that occur
over a period of several years and result in treatment being sought or significant
impairment of functioning.
 Each of the following criteria must have been met, with individual symptoms
occurring at any time during the course of the disturbance.
o 4 pain symptoms: a history of pain related to at least 4 different sites or functions
o 2 gastrointestinal symptoms: a history of at least 2 gastrointestinal symptoms
other than pain
o 1 sexual symptom: a history of at least 1 sexual or reproductive symptom other
than pain
o 1 pseudoneurological symptom: a history of at least 1 symptom or deficit
suggesting a neurological condition not limited to pain
 Either:
o After appropriate investigation, each of the symptoms cannot be fully
explained by a known general medical condition or the direct effects of a
substance OR
o When there is a related general medical condition, the physical complaints or
resulting social or occupational impairment are in excess of what would be
expected from the history, physical examination, or laboratory findings
 The symptoms are not intentionally produced or feigned.

CONVERSION DISORDER
 1 or more symptoms or deficits affecting voluntary motor or sensory function that
suggest a neurological or other general medical condition
 Psychosocial factors are judged to be associated with the symptom or deficit because
the initiation or exacerbation of the symptom or deficit is preceded by conflicts or
other stressors
 The symptom or deficit is not intentionally produced or feigned.
 The symptom or deficit cannot, after appropriate investigation, be fully explained
by a known general medical condition or the direct effects of a substance, or as a
culturally sanctioned behavior or experience.
 The symptom or deficit causes clinically significant distress or impairment in
functioning, or warrants medical evaluation.
 The symptom or deficit is not limited to pain or sexual dysfunction, does not occur
during the course of Somatization Disorder, and is not better accounted for by
another medical disorder.

BODY DYSMORPHIC DISORDER
 Preoccupation with an imagined defect in appearance.  If a slight physical anomaly
is present, the person’s concern is markedly excessive.
 The preoccupation causes clinically significant distress or impairment in
functioning.

HYPOCHONDRIASIS
 Preoccupation with fears of having, or the idea that one has, a serious disease based
on the person’s misinterpretation of bodily symptoms.
 The preoccupation persists despite appropriate medical evaluation and reassurance.
 The preoccupation is not of delusional intensity and is not restricted to a
circumscribed concern about appearance.
 The preoccupation causes clinically significant distress or impairment in
functioning.
 The duration of the disturbance is at least 6 months.

FACTITIOUS DISORDER
 Intentional production or feigning of physical or psychological signs or symptoms.
 The motivation for the behavior is to assume the sick role.
 External incentives for the behavior are absent.

MALINGERING
 Intentional production of false of grossly exaggerated physical or psychological
symptoms.
 The motivation for the behavior involves external incentives.