Anxiety & OCD

• Anxiety disorders


  • Anxiety
  • OCD
  • Phobia
  • Social anxiety
  • Panic disorder
  • Body dysmorphia
  • Agoraphobia
  • Hoarding
• Specific phobia


  A marked fear or anxiety about a specific object or situation
• Specific phobia diagnostic criteria

  1. A. Marked fear or anxiety about a specific object or situation

  2. B. Phobia object or situation almost always provokes immediate fear or anxiety

  3. C. Phobia object or situation is actively avoided or endured with intense fear or anxiety

  4. D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation

  5. E. The fear, anxiety, or avoidance is persistent, typically lasting 6 months or more

  6. F. The fear, anxiety, or avoidance causes clinically significant distress or impairment

  7. G. Disturbance is not better explained by other mental conditions
• Specific phobia specifiers


  • Animal
  • Natural environment
  • Blood-injection-injury
  • Situational/other
• Specific phobia differential diagnosis


  • Agoraphobia
  • Trauma-and stressor-related disorders
  • Social anxiety disorder
  • Eating disorders
  • Separation anxiety disorder
  • Schizophrenia spectrum & other psychotic disorders
  • Panic disorder
  • OCD
• Specific phobia comorbidities


  • Anxiety disorders
  • Somatic symptom disorder
  • Depression & bipolar
  • Personality disorders
  • Substance-related disorders
• Social anxiety disorder


  A marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others
• Social anxiety disorder diagnostic criteria

  1. A. Marked fear or anxiety about one or more social situations

  2. B. The individual fears they will act in a way or show anxiety symptoms that will be negatively evaluated

  3. C. The social situations almost always provoke fear or anxiety

  4. D. The social situations are avoided or endured with intense fear or anxiety

  5. E. The fear or anxiety is out of proportion to the actual threat posed

  6. F. The fear, anxiety, or avoidance is persistent, typically lasting 6 months or more

  7. G. The fear, anxiety, or avoidance causes clinically significant distress or impairment

  8. H. Not attributable to substance or other medical condition

  9. I. Not better explained by another mental health disorder
• Social anxiety disorder specifiers

  • Performance only
• Social anxiety disorder differential diagnosis


  • Normative shyness
  • Body dysmorphic disorder
  • Agoraphobia
  • Delusional disorder
  • Panic disorder
  • Autism spectrum disorder
  • Generalized anxiety disorder
  • Personality disorder
  • Specific phobias
  • Other mental disorder
  • Selective mutism
  • Other medical conditions
  • Major depressive disorder
  • Oppositional defiance disorder
• Social anxiety disorder comorbidities


  • Anxiety disorder
  • Autism
  • Major depressive disorder
  • Selective mutism
  • Substance abuse disorder
  • Chronic social isolation
  • Body dysmorphic disorder
• Panic disorder


  An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, during which time 4 or more of the listed symptoms occur
• Panic disorder diagnostic criteria

  1. A. Abrupt surge of intense fear or discomfort with 4+ symptoms

  2. B. At least one attack followed by 1+ month of persistent concern/worry or significant maladaptive change in behavior

  3. C. Disturbance not attributable to a substance or another medical condition

  4. D. Not better explained by another mental disorder
• Panic disorder differential diagnosis


  • Limited-symptom panic attacks
  • Anxiety disorder due to another medical condition
  • Substance/medication-induced anxiety disorder
  • Other mental disorders with panic attack as an associated feature
• Panic disorder comorbidities


  • Anxiety disorders
  • Major depressive disorder
  • Agoraphobia
  • Bipolar disorder
  • Alcohol use disorder
  • Illness anxiety
  • Medical conditions (dizziness, cardiac arrhythmias, hyperthyroidism, asthma, COPD, IBS)
• Generalized Anxiety Disorder


  Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities, with the individual finding it difficult to control the worry
• Generalized Anxiety Disorder diagnostic criteria


  1. A. Excessive anxiety and worry for at least 6 months

  2. B. The individual finds it difficult to control the worry

  3. C. The anxiety/worry are associated with 3+ of the listed symptoms

  4. D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment

  5. E. Not attributable to substance or other medical condition

  6. F. Not better explained by another mental disorder
• Generalized Anxiety Disorder differential diagnosis


  • Anxiety disorder due to another medical condition
  • Substance/medication-induced anxiety disorder
  • Illness anxiety or somatic symptom disorder
  • Social anxiety disorder
  • PTSD or adjustment disorder
  • Separation anxiety disorder
  • Depressive, bipolar, & psychotic disorders
  • Panic disorder
• Generalized Anxiety Disorder comorbidities


  • Other anxiety or unipolar depressive disorder
• Obsessive-Compulsive Disorder


  Presence of obsessions, compulsions, or both
• Obsessive-Compulsive Disorder diagnostic criteria


  1. A. Presence of obsessions and/or compulsions

  2. B. Obsessions or compulsions are time-consuming or cause clinically significant distress or impairment

  3. C. Not attributable to substance or medical condition

  4. D. Not better explained by another mental disorder
• Obsessive-Compulsive Disorder specifiers


  • With good or fair insight
  • With poor insight
  • With absent insight/delusional beliefs
  • Tic-related
• Obsessive-Compulsive Disorder differential diagnosis

  • Anxiety disorders
  • Tics & stereotyped movements
  • Major depressive disorder
  • Psychotic disorders
  • Other OCD & related disorders
  • Other compulsive-like behaviors
  • Eating disorders
  • Obsessive-compulsive personality disorders
• Obsessive-Compulsive Disorder comorbidities


  • Anxiety disorders
  • Body dysmorphic, trichotillomania, excoriation (skin-picking)
  • Depressive or bipolar disorders
  • Impulse control disorders
  • ADHD
  • Substance use disorders
  • Lifetime tic disorder
• Body Dysmorphic Disorder


  Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
• Body Dysmorphic Disorder specifiers


  • With muscle dysmorphia
  • With good or fair insight
  • With poor insight
  • With absent insight/delusional beliefs
• Body Dysmorphic Disorder differential diagnosis


  • Normal appearance concerns & clearly noticeable physical defects
  • Eating disorders
  • Psychotic disorders
  • Other OCD & related disorders
  • Gender dysphoria
  • Illness anxiety disorders
  • Major depressive disorder
  • Anxiety disorders
• Body Dysmorphic Disorder comorbidities


  • Major depressive disorder
  • Social anxiety
  • Substance-related disorders
• Hoarding Disorder


  Persistent difficulty discarding or parting with possessions, regardless of their actual value, due to a perceived need to save the items or distress associated with discarding them
• Hoarding Disorder diagnostic criteria


  1. A. Persistent difficulty discarding possessions

  2. B. Difficulty discarding is due to a perceived need to save the items or distress associated with discarding

  3. C. Difficulty discarding results in the accumulation of possessions that congest and clutter active living areas

  4. D. Hoarding causes clinically significant distress or impairment

  5. E. Not attributable to another medical condition

  6. F. Not better explained by another mental disorder
• Hoarding Disorder specifiers


  • With excessive acquisition
  • With good or fair insight
  • With poor insight
  • With absent insight/delusional beliefs
• Hoarding Disorder differential diagnosis


  • Other medical conditions
  • Neurodevelopmental disorders
  • Schizophrenia spectrum & other psychotic disorders
  • Major depressive episode
  • OCD
  • Neurocognitive disorders
• Hoarding Disorder comorbidities


  • Major depressive disorder
  • Social anxiety disorder
  • Generalized anxiety disorder
  • OCD
• Generalized Anxiety Disorder (GAD)


  • Marked by physical symptoms in various domains like work & school
  • Excessive anxiety + worry, more days than not, for at least 6 months
  • Individual finds it difficult to control worry
  • Anxiety + worry are associated with 3 of the following symptoms:
• Symptoms of GAD


  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep, or unsatisfying sleep)
• Diagnostic criteria for panic attack

  • Recurrent unexpected panic attack
  • During which time 4 (or more) of the following symptoms occur:
  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or Shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea, abdominal distress
  • Feeling dizzy, Unsteady, light-headed, or faint
  • Chills or heat sensations
  • Paresthesia (numbness or tingling sensations)
  • Derealization (unreality) or depersonalization
  • Fear of losing control or "going" crazy
  • Fear of dying
• Culture specific symptoms do not count toward 4 criteria but can be seen (e.g. tinnitus, neck soreness, headache, uncontrollable screaming or crying)
• At least one of the attacks has been followed by 1 month (or more) of one or both of the following


  • Persistent concern or worry about additional panic attacks or their consequences (losing control, heart attack, "going crazy")
  • A significant maladaptive change in behavior related to attacks
• Differential diagnosis


  • Limited-symptom panic attack (not meeting full criteria + not experience unexpected)
  • Anxiety due to another medical condition
  • Substance/medication induced anxiety disorder
  • Other mental disorder with panic attack as special feature
  • Substance use disorder
  • Bipolar disorder
  • Body dysmorphic disorder
  • Obsessive compulsive disorder
• Obsessive compulsive disorder


  • Characterized by the presence of obsessions and/or compulsions
  • Obsessions are recurrent persistent thoughts, urges, or images that are experienced as intrusive + unwanted
  • Compulsions are repetitive behaviors or mental acts that individual feels driven to perform in response to an obsession, according to rules that must be applied