Diagnosing Anxiety

Anxiety disorders are a group of related conditions, each with distinct symptoms. However, they all share a common feature, every anxiety disorder has one thing in common: ongoing, excessive fear or worry in situations that are not actually dangerous. Individuals with anxiety disorders often experience one or more of the following symptoms: excessive fear or worry in situations that are not threatening.

Emotional Symptoms include:

• A sense of apprehension or impending dread
• Feelings of tension, nervousness, or jumpiness
• Restlessness or increased irritability
• Persistent worry, expecting the worst, and heightened alertness to potential threats

Physical symptoms include:

• Rapid or pounding heartbeat accompanied by shortness of breath
• Excessive sweating, trembling, or involuntary muscle twitches
• Frequent headaches, chronic fatigue, and difficulty sleeping
• Digestive issues such as nausea, stomach discomfort, frequent urination, or diarrhea

The diagnostic process involves several key steps:

1. Clinical Interview

An Empire State Psychiatry clinician will perform a detailed interview to assess the patient’s symptoms, medical history, and any contributing factors. They will ask about:

• The nature, frequency, and duration of anxiety symptoms.
• Triggers or situations that worsen symptoms.
• The impact of anxiety on daily life, work, and relationships.
• Any history of mental health conditions or substance use.
• Family history of anxiety or other psychiatric disorders.

2. Diagnosing the type of anxiety disorder

To diagnose an anxiety disorder, clinicians refer to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which outlines evidence – based criteria for different anxiety disorders, including:

• Generalized Anxiety Disorder (GAD): Excessive worry consuming hours each day, occurring most days for at least six months, accompanied by physical symptoms like restlessness, fatigue, difficulty concentrating, and muscle tension.
• Panic Disorder: Recurrent unexpected panic attacks and sudden feelings of terror with persistent fear of future panic attacks. This is often mistaken for a heart attack because it causes powerful physical symptoms like chest pain, heart palpitations, dizziness, shortness of breath and stomach upset. The terror causes many to go to desperate lengths to avoid an attack.
• Social Anxiety Disorder: This is more than shyness. It is an intense fear of social interaction often driven by irrational worries about humiliation due to fear of embarrassment or judgment.
• Specific Phobias: Extreme fear of a particular object or situation.
• Separation Anxiety Disorder: Excessive fear of separation from attachment figures, typically diagnosed in children but can occur in adults.

While clinical guidelines provide structured criteria, the diagnostic process requires a nuanced understanding of human emotions, behavior, and social context. The “art” of diagnosis lies in the clinician’s ability to interpret symptoms, distinguish an anxiety disorder from other conditions, and build trust with the patient to uncover underlying issues.

3. Psychological Questionnaires and Scales

To quantify symptoms and assess severity, clinicians may use standardized screening tools such as:

• Generalized Anxiety Disorder 7 (GAD-7): A brief self-report questionnaire assessing the severity of GAD.
• Beck Anxiety Inventory (BAI): Measures the intensity of anxiety symptoms.
• Hamilton Anxiety Rating Scale (HAM-A): Clinician-administered scale for assessing anxiety severity.

4. Physical Examination and Laboratory Tests

Since medical conditions like hyperthyroidism, heart disease, or neurological disorders can mimic anxiety symptoms, a physical exam and lab tests (such as thyroid function tests, blood glucose levels, and electrolyte panels) may be conducted to rule out underlying medical causes.

5. Differential Diagnosis

The clinician distinguishes anxiety disorders from other psychiatric conditions, such as depression, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD), which can present with overlapping symptoms.