Other Anxiety-Related DisordersMatthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.Before diagnosing a particular anxiety disorder, it is important to rule-out other possible causes of anxiety symptoms. Anxiety symptoms can be due to: 1) an anxiety disorder, 2) another psychiatric disorder, 3) a medical disease or disorder, and 4) the use of, or withdrawal from, alcohol and other drugs. Moreover, as we have stressed throughout, anxiety is a normal and natural emotion that is the result of the way human beings are "wired" for survival. Thus, in order for an anxiety disorder to be diagnosed, the clinician must determine whether the anxiety symptoms are severe enough to result in significant distress, or impairment in functioning. This section discusses Anxiety due to a General Medical Condition; Substance Induced Anxiety Disorder (drugs); and a catch-all category, Anxiety Disorder Not Otherwise Specified. This diagnosis is used when symptoms create significant distress and/or impaired functioning but do not seem to meet the diagnostic criteria for any of the other anxiety disorders.
Anxiety Disorder Due to General Medical Condition
Certain medical disorders or diseases can cause psychiatric symptoms. A medical evaluation should be performed by a qualified, health care professional to determine if an underlying medical condition is causing the psychiatric symptoms. For example, individuals experiencing panic attacks may have thyroid disease or mitral valve prolapse. Likewise, children with OCD or Tourette's Disorder should be tested for infections to rule-out Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). PANDAS occur in a subset of children with OCD and may lead to a sudden onset of obsessions, compulsions, and/or tics. When symptoms such as panic attacks, generalized anxiety, or obsessions and compulsions are the direct effect of a medical condition, this would be referred to as an Anxiety Disorder Due to a General Medical Condition. This diagnosis is not used if their anxiety is due to realistic concerns about having a medical condition. For instance, if someone with cancer is worried about pain, this is a normal and rational worry, and would not be diagnosed as a mental disorder.
Substance-Induced Anxiety Disorder
When anxiety symptoms are a direct result of a prescription drug, over-the-counter drug, or street drug, then the correct diagnosis is Substance-Induced Anxiety Disorder. The anxiety may be caused by the proper and customary use of the drug; or it may occur as a result of misuse, intoxication, or withdrawal from a particular substance.
Prescription drugs which can cause anxiety as a side effect of the drug may include medications that contain amphetamines such as Benzedrine®, Dexedrine®, and Ritalin®. Certain high blood pressure (hypertensive) medications can also cause anxiety (clonidine and Methyldopa®). Steroidal drugs used to treat asthma and other respiratory disorders may create anxiety symptoms (albuteral, salmeterol, and theophylline). In addition, various hormonal medications (including thyroid medications) are known to cause anxiety symptoms. This list is not all-inclusive. Be sure to discuss the side effects of any prescription drugs you may be taking, particularly if you experience anxiety symptoms that are distressing to you.
Non-prescription drugs are also known to cause anxiety symptoms. This would include drugs which contain caffeine (Anacin®, Empirin®, Excedrin®). Many cold and flu medications list anxiousness as a side effect (particularly decongestants and cough syrups). While not typically considered drugs by most people, excessive caffeine use (coffee, teas, certain sodas) and nicotine use (cigarettes, "chew," and quit-smoking aids), and alcohol, have all been known to cause, or aggravate a pre-existing anxiety disorder. Similarly, withdrawal from these substances can precipitate anxiety symptoms.
The use and withdrawal from several street drugs are also implicated in precipitating, or worsening, an anxiety disorder. These include cocaine (including "crack"), methamphetamine ("meth"), and marijuana ("pot").
Anxiety Disorder Not Otherwise Specified (NOS)
While someone may not fully meet all the diagnostic criteria for a particular anxiety disorder, it may still be worth noting if the anxiety symptoms are accompanied by significant distress or impairment. For instance, someone who frequently experiences limited-symptom panic attacks, and is distressed by them, would not warrant a diagnosis of Panic Disorder, but could be diagnosed with Anxiety Disorder NOS. As mentioned previously, Hoarding is not yet considered a separate disorder but is often diagnosed using Anxiety Disorder NOS. This NOS category is a "catch all" that is used when symptoms are creating significant distress and/or impairment, but do not meet the full criteria threshold for another anxiety disorder. Anxiety and other psychiatric disorders
Since anxiety is a symptomatic feature of many different psychiatric disorders, the clinician must determine if the diagnosis of an anxiety disorder can best account for the symptoms; thus, the mere presence of some anxiety symptoms does not automatically indicate an anxiety disorder. For example, someone who is obsessed with food, dieting, and exercise, because of an extreme fear becoming fat, would be diagnosed with an eating disorder; not a Phobia, or Obsessive-Compulsive Disorder. Similarly, most of the substance-use disorders (alcohol and other drugs) have some anxious-obsessive features associated with obtaining and using the drug. Nonetheless, when all the symptoms are considered together, a substance-use disorder might be the most accurate diagnosis. As a general rule, in order to receive a diagnosis of an anxiety disorder, anxiety must be the key and primary feature that cannot be easily explained as resulting from something else (such as a medical condition, drug or alcohol use, or another psychiatric disorder).
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