Term
300.01 Panic Disorder With / Without Agoraphobia
Diagnostic Criteria |
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Definition
A) Both 1 and 2
1 - recurrent unexpected Panic Attacks
2 - at least one of the attacks has been followed by at least 1 month of one of the following:
a- persistent concern about having additional attacks
b- worry about the implications of the attack or its consequences (losing control, having a heart attack, "going crazy")
c a significant change in behavior related to the attacks
B) Presence or absence of Agoraphobia
C) The Panic Attacks are not due to the direct physiological effects of a substance or a general medical condition
D) The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia, Specific Phobia, OCD, PTSD, or Separation Anxiety Disorder |
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Term
Panic Attack
Criteria (not a codable disorder) |
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Definition
A discrete period of intense fear or discomfort, in which four of the following symptoms developed abruptly and reached a peak within 10 minutes:
1 - palpitations, or accelerated heart rate
2 - sweating
3 - trembling or shaking
4 - sensations of shortness of breath or smothering
5 - feeling of choking
6 - chest pain or discomfort
7 - nausea or abdominal distress
8 - feeling dizzy, unsteady, lightheaded, or faint
9 - derealization (feelings of unreality) or depersonalization (detached from self)
10 - fear of losing control or going crazy
11 - fear of dying
12 - paresthesias (numbness or tingling sensations)
13 - chills or hot flushes |
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Term
Agoraphobia
Criteria (not a codable disorder) |
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Definition
A) Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.
Note: Consider the diagnosis of Specific Phobia if the avoidance is limited to one or only a few specific situations, or Social Phobia if the avoidance is limited to social situations.
B) The situations are avoided or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.
C) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia, Specific Phobia, OCD, PTSD, or Separation Anxiety Disorder. |
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Term
300.22 Agoraphobia Without History of Panic Disorder
Diagnostic Criteria |
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Definition
A) The presence of Agoraphobia related to fear of developing panic-like symptoms
B) Criteria have never been met for Panic Disorder
C) The disturbance is not due to the direct physiological effects of a substance or a general medical condition.
D) If associated general medical condition is present, the fear described in Criterion A is clearly in excess of that usually associated with the condition. |
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Term
300.29 Specific Phobia
Diagnostic Criteria |
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Definition
A) Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (flying, heights, animals, injections, 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 is avoided or else is endured with intense anxiety or distress.
E) The avoidance, anxious anticipation, or distress in the feared situation 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 (ie fear of dirt w/ obsession about contamination), PTSD, Separation Anxiety Disorder, Social Phobia, Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder.
Specify type:
Animal Type
Natural Environment Type (heights, storms, water, etc)
Blood-Injection Type
Situational Type (elevators, airplanes)
Other Type |
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Term
300.23 Social Phobia
Diagnostic Criteria |
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Definition
A) A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. NOTE: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.
B) Exposure to the feared social situation almost invariably provokes anxiety, 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 shrinking from social situations with unfamiliar people.
C) The person recognizes that the fear is excessive or unreasonable. NOTE: In children, this feature may be absent.
D) The feared social or performance situations are avoided or else are endured with intense anxiety or distress.
E) The avoidance, anxious anticipation, or distress in the feared social or performance situation interferes significantly with the person's normal routine, occupational functioning, or social activities or relationships, or there is marked distress about having the phobia.
F) In individuals under at 18, the duration is at least 6 months.
G) The fear or avoidance is not due to the direct physiological effects of a substance or a general medical condition and is not better accounted for by another mental disorder.
H) If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of Stuttering, or the fear trembling in Parkinsons's disease, etc.
Specify if,
GENERALIZED: if the fears include most social situations (also consider the additional diagnosis of Avoidant Personality Disorder) |
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Term
300.3 Obsessive-Compulsive Disorder
Diagnostic Criteria |
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Definition
A) Either obsessions or compulsions:
Obsessions as defined by 1,2,3, and 4:
1 - recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
2 - the thoughts, impulses, or images are not simply excessive worries about real-life problems
3 - the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
4 - the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
Compulsions defined by 1 and 2:
1 - repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2 - the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
B) At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. NOTE: This does not apply to children.
C) The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational functioning, or usual social activities or relationships.
D) If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g. preoccupation with food in the presence of an Eating Disorder)
E) The disturbance is not due to the direct physiological effects of a substance or a general medical condition.
Specify if:
With Poor Insight: if, for most of the time during the current episode, the person does not recognize that the obsessions are compulsions are excessive or unreasonable |
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Term
309.81 Posttraumatic Stress Disorder
Diagnostic Criteria |
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Definition
A) The person has been exposed to a traumatic event in which both of the following were present:
1 - the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
2 - the person's response involved intense fear, helplessness, or horror. NOTE: In children, this may be expressed instead by disorganized or agitated behavior
B) The traumatic event is persistently reexperienced in at least one of the following ways:
1 - recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. NOTE: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
2 - recurrent distressing dreams of the event. NOTE: In children, there may be frightening dreams without recognizable content.
3 - acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). NOTE: In young children, trauma-specific reenactment may occur.
4 - intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
5 - physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
C) Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least THREE of the following:
1 - efforts to avoid thoughts, feelings, or conversations associated with the trauma
2 - efforts to avoid activities, places, or people that arouse recollections of the trauma
3 - inability to recall an important aspect of the trauma
4 - markedly diminished interest or participation in significant activities
5 - feeling of detachment or estrangement from others
6 - restricted range of affect
7 - sense of a foreshortened future (does not expect to have a career, marriage, children, or a normal life span)
D) Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least TWO of the following:
1 - difficulty falling or staying asleep
2 - irritability or outbursts of anger
3 - difficulty concentrating
4 - hypervigilance
5 - exaggerated startle response
E) Duration of the disturbance (Criteria B, C, and D) is more than one month.
F) The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor. |
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Term
308.3 Acute Stress Disorder
Diagnostic Criteria |
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Definition
A) The person has been exposed to a traumatic event in which both of the following were present:
1 - the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
2 - the person's response involved intense fear, helplessness, or horror
B) Either while experiencing or after experiencing the distressing event, the individual has three or more of the following dissociative symptoms:
1 - a subjective sense of numbing, detachment, or absence of emotional responsiveness
2 - a reduction in awareness of his or her surroundings (being in a daze)
3 - derealization
4 - depersonalization
5 - dissociative amnesia (inability to recall an important aspect of the trauma)
C) The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.
D) Marked avoidance of stimuli that arouse recollections of he trauma (Thoughts, feelings, conversations, activities, places, people).
E) Marked symptoms of anxiety or increased arousal (difficulty sleeping, irritability, exaggerated startle response, restlessness, etc.)
F) The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.
G) The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event.
H) The disturbance is not due to the direct physiological effects of a substance or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder. |
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Term
30002 Generalized Anxiety Disorder
Diagnostic Criteria |
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Definition
A) Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)
B) The person finds it difficult to control the worry.
C) The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). NOTE: Only one symptom is required in children.
1 - restlessness or feeling keyed up or on edge
2 - being easily fatigued
3 - difficulty concentrating or mind going blank
4 - irritability
5 - muscle tension
6 - sleep disturbance
D) The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (Social Phobia), etc., and the anxiety and worry do not occur exclusively during PTSD.
E) The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
F) The disturbance is not due to the direct physiological effects of a substance or a general medical condition and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder. |
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Term
293.84 Anxiety Disorder Due to ... [Indicate the General Medical Condition]
Diagnostic Criteria |
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Definition
A) Prominent anxiety, Panic Attacks, or obsessions or compulsions predominate in the clinical picture.
B) There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
C) The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder With Anxiety in which the stressor is a serious general medical condition).
D) The disturbance does not occur exclusively during the course of a delirium.
E) The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
With Generalized Anxiety: if excessive anxiety or worry about a number of events or activities predominates in the clinical presentation
With Panic Attacks: if Panic Attacks predominate in the clinical presentation
With Obsessive-Compulsive Symptoms: if obsessions or compulsions predominate in the clinical presentation
Coding note: Include the name of the general medical condition on Axis I; also code the general medical condition on Axis III. |
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Term
291.89 or 292.89 Substance-Induced Anxiety Disorder
Diagnostic Criteria |
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Definition
A) Prominent anxiety, Panic Attacks, or obsessions or compulsions predominate in the clinical picture.
B) There is evidence from the history, physical examination, or laboratory findings of either 1 or 2:
1 - the symptoms in Criterion A developed during, or within 1 month of, Substance Intoxication or Withdrawal
2 - medication use is etiologically related to the disturbance
C) The disturbance is not better accounted for by an Anxiety Disorder that is not substance induced. Evidence that the symptoms are better accounted for by an Anxiety Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use: or there is other evidence suggestion the existence of an independent non-substance-induced Anxiety Disorder (history of recurrent non-substance-related episodes).
D) The disturbance does not occur exclusively during the course or a delirium.
E) The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
NOTE: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the anxiety symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the anxiety symptoms are sufficiently sever to warrant independent clinical attention.
Code [Specific Substance]-Induced Anxiety Disorder
291.89 Alcohol; 292.89 Amphetamine (or like substance); 292.89 Cannabis; 292.89 Cocaine; 292.89 Hallucinogen; 292.89 Sedative; 292.89Hypnotic, or Anxiolytic; 292.89Other [or Unknown] Substance)
Specify if:
With Generalized Anxiety
With Panic Attacks
With Obsessive-Compulsive Syptoms
With Phobic Symptoms
Specify if:
With Onset During Intoxication
With Onset During Withdrawal |
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Term
300.00 Anxiety Disorder Not Otherwise Specified
Diagnostic Criteria |
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Definition
This category includes disorders with prominent anxiety or phobic avoidance that do not meet criteria for any specific Anxiety Disorder, Adjustment Disorder With Anxiety, or Adjustment Disorder With Mixed Anxiety and Depressed Mood. Examples include
1 - Mixed anxiety-depressive disorder; clinically significant symptoms of anxiety and depression, but the criteria are not met for either a specific Mood Disorder or a specific Anxiety DIsorder
2 - Clinically significant social phobic symptoms that are related to the social impact of having a general medical condition or mental disorder (e.g., Parkinson's disease, dermatological conditions, Stuttering, etc.)
3 - Situations in which the disturbance is severe enough to warrant a diagnosis of an Anxiety Disorder but the individual fails to report enough symptoms for the full criteria for any specific Anxiety Disorder to have been met; for example, and individual who reports all of the features of Panic Disorder Without Agoraphobia except that the Panic Attacks are all limited-symptom attacks
4 - Situations in which the clinician has concluded that an Anx9iety Disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced |
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Term
309.0-9 Adjustment Disorders
Diagnostic Criteria |
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Definition
A) The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)
B) These symptoms or behaviors are clinically significant as evidenced by either of the following:
1 - marked distress that is in excess of what would be expected from exposure to the stressor
2 - significant impairment in social or occupational functioning
C) The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.
D) The symptoms do not represent Bereavement.
E) Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Specify if:
Acute: if the disturbance lasts less than 6 months
Chronic: if the disturbance lasts for 6 months or longer
Adjustment Disorders are coded based on the subtype, which is selected according to the predominant symptoms.The specific stressor(s) can be specified on Axis IV.
309.0 With Depressed Mood
309.24 With Anxiety
309.28 With Mixed Anxiety and Depressed Mood
309.3 With Disturbance of Conduct
309.4 With Mixed Disturbance of Emotions and Conduct
309.9 Unspecified |
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