A presentation on anxiety disorder from dsm 5

1. History
0f DSM
Presented By:
MUSFIRA ASGHAR
Hafsa shafique
M. Muzammil
M. Naseem
Saddique Shah
Maham Tahir
M. Hassan

2. Contents:
01
02
03
04
Introduction to DSM
Revision of DSM
Conclusion
References
Editions of DSM

3. Introduction to DSM
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was created
in 1952 by the American Psychiatric Association so that mental health professionals
in the United States would have a common language to use when diagnosing
individuals with mental disorders.
It is the handbook used by health care professionals as the authoritative guide
to the diagnosis of mental disorders.
DSM contains descriptions, symptoms, and other criteria for diagnosing mental
disorders.
Used by clinicians and researchers to diagnose and classify mental disorders,
the criteria are concise and explicit, intended to facilitate an objective assessment of
symptom presentations in a variety of clinical settings—inpatient, outpatient,
partial hospital, consultation-liaison, clinical, private practice, and primary care.

4. Revision of DSM
The APA prepared for the revision of DSM for nearly a decade, with an unprecedented
process of research evaluation that included a series of white papers and 13 scientific
conferences supported by the National Institutes of Health.
This preparation brought together almost 400 international scientists and produced a
series of monographs and peer-reviewed journal articles.
1952
1968
1980
1987
1994
DSM-I
DSM-II DSM-III-R
DSM-III
DSM-IV-TR
DSM-IV 2000 DSM-5
2013

5. Diagnostic and Statistical Manual of Mental Disorders (DSM)
Edition Publication
Date
Number of
Pages
Number of
Diagnoses
Number of
Disorders
DSM-I 1952 132,130 128 106,60
DSM-II 1968 119,134 193 182
DSM-III 1980 494 228 265
DSM-III-R 1987 567 253 292
DSM-IV 1994 886 383 297,410
DSM-IV-TR 2000 943 383
DSM-5 2013 947 541 312

6. DSM-I (1952)
The first edition of DSM (1952) was titled 'Diagnostic and Statistical Manual
of Mental Disorders'. It did not carry any number attached to its title.
DSM-I was created after World War II, and was partially a reaction to the return
of military veterans from the war. Many veterans showed non-psychotic but non-
physical disorders, and a number of military medical officers from World War II
turned their attention to the treatment of these disorders.
(Baker & Pickren, 2007; Pickren & Schneider, 2005).
The DSM-I contained 128 categories. Organizationally, it had a hierarchical system
in which the initial node in the hierarchy was differentiating organic brain syndromes
from “functional” disorders which were subdivided into psychotic versus neurotic
versus character disorders.
DSM contained a glossary of descriptions of the diagnostic categories and was the
first official manual of mental disorders to focus on clinical use.

7. DSM-II (1968)
DSM II listed 182 disorders, and was 134 pages long. It was quite similar to the DSM-I.
The term "reaction" was dropped, but the term "neurosis" was retained.
In the 1960s, there were many challenges to the concept of mental illness itself. These
challenges came from sociologists,behavioural psychologists and psychiatrists like
Thomas Szasz, who argued mental illness was a myth used to disguise moral conflicts.
Unlike the DSM-I, many of the new categories added in the DSM-II were categories
of relevance to outpatient mental health efforts. Anxiety disorders, depressive
disorders, personality disorders (PDs), and disorders of childhood/adolescence were
larger subsets than they had been in the DSM-I.
LIMITATIONS:
Fleiss and Spitzer concluded "there are no diagnostic categories for which reliability is
uniformly high. Reliability appears to be only satisfactory for three categories:
mental deficiency, organic brain syndrome, and alcoholism.

8. Sixth printing of the DSM-II (1968)
As described by Ronald Bayer, a psychiatrist and gay rights activist,
specific protests by gay rights activists against the APA began in 1970.
After a vote by the APA trustees in 1973, and confirmed by the wider
APA membership in 1974, the diagnosis was replaced with the category
of "sexual orientation disturbance".
Homosexuality removed as a mental disorder following the protests
at the 1974 annual convention of the APA in San Francisco.

9. DSM-III (1980)
Work began on DSM–III in 1974, with publication in 1980.
 DSM-III heralded a paradigm shift in the history of psychiatric diagnosis, with its
incorporation of empirically-based, a theoretical and agnostic criteria for psychiatric
diagnosis.
 Other criteria, and potential new categories of disorder, were established by consensus
during meetings of the committee, as chaired by Spitzer.
DSM–III introduced a number of important innovations, including:
Explicit diagnostic criteria
A multiaxial diagnostic assessment system.
An approach that attempted to be neutral with respect to the causes of mental
disorders.
It was developed with the additional goal of providing precise definitions of mental
disorders for clinicians and researchers.

10. DSM-III-R (1987)
APA appointed a work group to revise DSM–III, which developed the
revisions and corrections that led to the publication of DSM–III–R in 1987.
Categories were renamed and reorganized, and significant changes in criteria
were made. Six categories were deleted while others were added.
Controversial diagnoses, such as pre-menstrual dysphoric disorder and
masochistic personality disorder, were considered and discarded.
"Ego-dystonic homosexuality" was also removed.

11. DSM-IV (1994)
Numerous changes were made to the classification (e.g., disorders were
added, deleted, and reorganized), to the diagnostic criteria sets, and to
the descriptive text.
A major change was the inclusion of a clinical significance criterion to
almost half of all the categories, which required symptoms cause "clinically
significant distress or impairment in social, occupational, or other impo
rtant areas of functioning".
Some personality disorder diagnoses were deleted or moved to the appendix.

12. Axis I:
Clinical
Syndromes
Described clinical
symptoms that cause
significant impairment.
Disorders were
grouped into different ca
tegories such as
mood disorders,
anxiety disorders, or
eating disorders.
Described long-term
problems in
functioning that were
not considered
discrete axis I
disorders.
These include
such things as
unemployment,
relocation,divorce,
or the death of a
loved one.
Allowed the clinician to
rate the client's overall
level of functioning.
Based on this
assessment, clinicians
could better understand
how the other four axis
interacted and the effect
on the individual's life.
DSM-IV-TR (2000)
The DSM-IV-TR described disorders using five different dimensions.
 This multiaxial approach was intended to help clinicians and psychiatrists make comprehensive
evaluations of a client's level of functioning because mental illnesses often impact many different life areas.
Axis II:
Personality
and
Mental Retardation
Axis III:
Medical
Conditions
Axis IV:
Psychosocial and
Environmental
Problems
Axis V:
Global Assessment of
Functioning or Child
Global Assessment of
Functioning
These included physical
and medical conditions
that influence or worsen
Axis 1 and Axis II
disorders.
Some examples include
HIV/AIDS and brain
injuries.

13. DSM-5 (2013)
Dr. Dilip Jeste, the then President of the American Psychiatric Association, released
the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders on May
18, 2013 at the 166 th Annual Meeting of the APA at San Francisco.
As the process of developing the manual progressed, the Roman numerical 'V' was
replaced by the alpha numerical '5'. This would facilitate subsequent revisions being
numbered as 5.1, 5.2 and so forth.
It is an authoritative volume that defines and classifies mental disorders in order to
improve diagnoses, treatment, and research. It does not claim to be the ultimate or
the final word in classification of mental disorders.
Some examples of categories included in the DSM-5 include anxiety disorders,
bipolar and related disorders, depressive disorders, feeding and eating disorders,
obsessive-compulsive and related disorders, and personality disorders.

14. DSM-5
It is a 947 page manual, divided into three sections and an appendix:
Section
Includes:
Introduction, Instruction on
how to use the manual, and a
chapter on cautionary
of DSM 5.
statement for forensic use axis format and considers
the relevance of age,
gender, and culture.
Covers:
Self-rated cross-cutting
symptom measures for
adults, children, and
adolescents between
age 6 and 17 years.
01 02 03
Section Section
Lists:
Diagnostic criteria and
codes of 22 diagnostic
categories. It has a single

15. Changes in The DSM-5◻
It eliminated the axis system, instead listing categories of disorders along
with a number of different related disorders.
Asperger's disorder was removed and incorporated under the category of a
utism spectrum disorders.
Disruptive mood dysregulation disorder was added, in part to decrease
over-diagnosis of childhood bipolar disorders.
Several diagnoses were officially added to the manual including binge eating
disorder, hoarding disorder, and premenstrual dysphoric disorder.
It is based on explicit disorder criteria, which taken together constitute a
“nomenclature” of mental disorders, along with an extensive explanatory text
that is fully referenced for the first time in the electronic version of this DSM.

16. Conclusion
DSM serves as the principal authority for psychiatric
diagnoses.
It also provides a common language for researchers to
study the criteria for potential future revisions and to aid in
the development of medications and other interventions.
DSM is an important tool for those who have received
specialized training and possess sufficient experience are
qualified to diagnose and treat mental illnesses.
The strength of each of the editions of DSM has been
"reliability". The weakness is its lack of validity .
While DSM has been described as a "Bible" for the field,
it is, at best, a dictionary, creating a set of labels and
defining each.

17. References:
 American Psychiatric Association. Diagnostic and statistical manual of
mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013
 Alina Surís et al.(2016) The Evolution of the Classification of Psychiatric
Disorders
 VahiaV. N. Diagnostic and statistical manual of mental disorders 5: A quick
glance. Indian J Psychiatry 2013;55:220-3
 http://apsychoserver.psych.arizona.edu/JJBAReprints/PSYC621/Blashfield_etal
2014_ARCP.pdf
 https://dhss.delaware.gov/dsamh/files/si2013_dsm5foraddictionsmhandcrimi
naljustice.pdf
 http://pepsic.bvsalud.org/pdf/psipesq/v8n1/09.pdf
 https://tpb.psy.ohio-state.edu/5681/notes/dsm/01.htm
 https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm
 https://www.verywellmind.com/the-diagnostic-and-statistical-manual-dsm-
2795758
 https://www.sciencedirect.com/topics/social-sciences/diagnostic-and-
statistical-manual-of-mental-disorder

18. ANXIETY DISORDERS
Diagnostic and Statistical Manual of Mental Disorders
-fifth edition
Name = MUSFIRA
ASGHAR

19. BASED ON THE CURRENT DSM-5
9 MENTAL DISORDERS
UNDER ANXIETY CATEGORY
1. Separation Anxiety Disorder 2.
Selective Mutism
3. Specific Phobia
4. Social Anxiety Disorder
5. Panic Disorder
6. Agoraphobia
7. Generalized Anxiety Disorder
g-58. Substance/Medication-Induced Anxiety Disorder
9. Anxiety Disorder Due to Another Medical Condition
-Panic Attack

20. SEPARATION ANXIETY DISORDER
• The individual is fearful or
anxious about separation from
attachment figures to a degree
that is
developmentally inappropriate.
There is
persistent fear or anxiety about
harm coming to attachment
figures and events that could lead
to loss of or separation from
attachment figures and
reluctance to go away from
attachment figures,as well as

21. SPECIFIC PHOBIA
• Individuals with specific phobia
are fearful or anxious about or
avoidant of circumscribed objects
or situations. A specific cognitive
ideation is not featured in this
disorder, as it is in other anxiety
disorders . The fear, anxiety,or
avoidance is almost always
immediately induced by the
phobic situation,to the
degree that is persistent an out of
proportion to the actual risk
posed. There are various types of

22. SOCIAL ANXIETY DISORDER
• The individual is fearful or
anxious about or avoidant of
social interactions and
situations that involve the
possibility of being scrutinized.
These include social
interactions such as meeting
unfamiliar people, situations in
which
the individua l may be observed
eating or drinking,and
situations in which
the individual performs in front of

23. PANIC DISORDER
• The individua l experiences recurrent
unexpected panic attacks and is
persistently concerned or worried about
having more panic attacks or changes his
or her behavior in maladaptive ways
because of the panic attacks
{e.g.avoidance of exercise or of unfamiliar
locations). Panic attacks are abrupt surges
of intense fear or intense discomfort that
reach a peak within minutes, accompanied
by physical and/or cognitive symptoms.
Limited-symptoms panic attacks include
fewer than four symptoms. Panic attacks
may be expected,such as in response to a

24. SELECTIVE MUTISM
• Is characterized by a consistent
failure to speak in social
situations in which there is an
expectation to speak (e.g. school)
even though the individual
speaks in other situations. The
failure to speak has significant
consequences on achievement in
academic or occupational
settings or otherwise interferes
with normal social
communication.

25. GENERALIZED ANXIETY DISORDER
• The key features of GAD are
persistent and excessive anxiety
and worry about various
domains, including work and
school performance, that the
individual finds difficult to
control. In addition, the individual
experiences physical symptoms
including restlessness or feeling
keyed up or on edge; being easily
fatigued, difficulty concentrating
or mind going
blank,irritability,muscle
tension,and sleep disturbance.

26. AGORAPHOBIA
• Individuals with agoraphobia
are fearful and anxious about
two or more of the following
situations: using public
transportation,being in open
spaces, being in enclosed
places, standing in line or being
in a crowd, or being outside of
the home alone in other
situations.

27. SUBSTANCE/MEDICATION-INDUCED
ANXIETY DISORDER
• This disorder involves
anxiety due to substance
intoxication or withdrawal or
to a medication treatment.

28. • Other Specified Anxiety Disorder :-
It may be diagnosed if you have most but
not all of the criteria for an anxiety
disorder.
• UNSPECIFIED ANXIETY DISORDER
Not meeting full criteria for any of the disorders in
the diagnostic class.

29. ANXI ETY DISOR DER DUE TO ANOTHER
MEDI
CAL CONDITION
• Anxiety symptoms are the physiological
consequence of another medical
condition:
Examples:
• Endocrine disease: hyperthyroidism,
hypoglycemia, hyperadrenalcorticolism.
• Cardiovascular disorders: congestive
heart failure,arrhythmia,pulmonary
embolism.
• Respiratory illness: asthma,pneumonia.
• Metabolic disturbances : B12 df,
porphyria
• Neurological illnesses: neoplasms,
encephalitis, seizure disorder.

30. In Summary
• The Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) identifies 9 disorders in the Anxiety category.
• DSM-5 guides practitioners in diagnosing anxiety disorders.
• DSM-5 states causes, symptoms and best treatments for
these conditions.
Separation Anxiety Disorder
Social Anxiety Disorder
Generalized Anxiety D/O
Selective Mutism
Panic Disorder
Specific Phobia
Agoraphobia
Substance/Med-i nduced D/O
Anxiety D/O due to another medical condition

31. Humor is a great
antidote for
anxiety!
Hl'm fine.I want you to t II me how to ch ng
v ryon I
."

32. Thank you for
your
participation!
{Relax}.