DSM 5 diagnostic criteria for anxiety disorder due to another medical condition

What are the DSM 5 diagnostic criteria for anxiety disorder due to another medical condition?

• A. Panic attacks or anxiety is predominant in the clinical picture.
• B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
• C. The disturbance is not better explained by another mental disorder.
• 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.

What are the Symptoms of Anxiety Disorder Due To Another Medical Condition?

Core Symptoms of Anxiety Disorder Due to Another Medical Condition

These symptoms mirror general anxiety but occur as a physiological result of another medical condition. They include:

Emotional/Cognitive Symptoms

• Excessive worry, fear, or panic
• Restlessness or feeling “on edge”
• Irritability
• Difficulty concentrating or “mind going blank”
• Feeling of impending doom

Physical Symptoms

• Palpitations or racing heart
• Shortness of breath
• Sweating
• Trembling or shaking
• Dizziness or light-headedness
• Nausea or GI upset
• Muscle tension
• Chest discomfort or tightness

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Diagnostic Criteria (DSM-5 Highlights)

To diagnose Anxiety Disorder Due to Another Medical Condition, all the following must be met:

1. Prominent anxiety or panic symptoms
2. Evidence from history, physical, or labs that the symptoms are a direct result of a medical condition
3. The symptoms are not better explained by another mental disorder
4. The symptoms cause significant distress or impairment
5. Not occurring exclusively during delirium

In anxiety due to another medical condition, the most frequently displayed symptom is anxiety in some form, even though there is another medical condition present that underlies and leads to the anxiety.

Latest Developments in DSM-5 Diagnostic Criteria for Anxiety Disorder Due to Another Medical Condition

Recent Updates and Coding Changes

ICD-10-CM Code Stability
The primary diagnostic code for Anxiety Disorder Due to Another Medical Condition remains F06.4 in both DSM-5 and DSM-5-TR. This code falls under the broader category “Mental disorders due to known physiological condition” (F06) and has remained unchanged through recent updates.

September 2024 DSM-5-TR Updates
The September 2024 update to DSM-5-TR did not include specific changes to the diagnostic criteria for Anxiety Disorder Due to Another Medical Condition. The primary focus of this update was on adjustment disorder subtype definitions and other diagnostic categories.

Coding Requirements
An important coding requirement specifies that an additional code indicating the etiological medical condition must immediately precede the diagnostic code F06.4. This ensures proper documentation of both the anxiety disorder and its underlying medical cause.

Differential Diagnostic Considerations

Differentiation from substance/medication-induced anxiety: Clinicians must distinguish between anxiety due to another medical condition and substance/medication-induced anxiety disorder. The key distinction lies in the source: medical conditions versus drugs, medications, or substances. This differentiation requires careful assessment of medication history, including timing of anxiety onset relative to medication initiation or dose changes. Both diagnoses can coexist if criteria for each are independently met.^[1]

Differentiation from primary anxiety disorders: Unlike primary anxiety disorders (such as generalized anxiety disorder or panic disorder), which have no established medical cause, anxiety disorder due to another medical condition has a clear medical etiology. In primary anxiety disorders, the anxiety appears to arise from neurobiological vulnerabilities and psychological factors rather than another disease process.^[2]

Differentiation from delirium: As noted in the diagnostic criteria, if anxiety occurs only during delirium, this diagnosis should not be applied. However, if anxiety occurs in the context of dementia or other chronic medical conditions without delirium, the diagnosis remains appropriate.^[1]

Key Clinical Considerations

Temporal Relationship Requirement
A critical diagnostic requirement is establishing a close temporal association between the medical condition and anxiety symptoms. The anxiety symptoms must occur close in time to the onset, worsening, or improvement of the medical condition. This temporal relationship helps distinguish this diagnosis from primary anxiety disorders.

Medical Conditions Commonly Associated
The most frequently implicated medical conditions include:

Endocrine disorders: Hyperthyroidism, hypothyroidism, hypoglycemia, hyperadrenocorticism (Cushing’s syndrome)

Cardiovascular conditions: Congestive heart failure, arrhythmias, myocardial infarction

Respiratory disorders: COPD, pneumonia, hyperventilation, asthma

Neurological conditions: Encephalitis, brain neoplasms, complex partial seizures

Other conditions: Pheochromocytoma, mitral valve prolapse

General characteristics of anxiety include muscle tension, heart palpitations, sweating, dizziness, or difficulty catching the breath.

In addition to these physical symptoms, anxiety in general also leads to restlessness, possibly a fear of something impending that will be catastrophic, or fear of being embarrassed or humiliated.

Evidence that anxiety disorders are associated with general medical conditions is growing. While it is known that medical and mental conditions are often comorbid, research demonstrates that there may be underlying causal mechanisms. Furthermore, comorbid anxiety and general medical conditions are associated with poorer patient outcomes than either condition alone.

Comorbid general medical and mental disorders not only affect individual patient health but also strain existing medical systems. Growing health care expenditures and increasing time pressures on clinicians create a challenging environment for intensive therapy in traditional settings.

Effective screening, diagnosis, and treatment of individuals with comorbid conditions require health systems that are based on interprofessional collaboration, including integrative and collaborative care services. 

While some of these Anxiety Disorder Due to Another Medical Condition symptoms may be recognized by family, teachers, legal and medical professionals, and others, only properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis.

A multitude of factors are considered in addition to the psychological symptoms in making a proper diagnosis, including medical and psychological testing considerations. 

The lifetime prevalence of any anxiety disorder is high. Furthermore, several general medical conditions are highly prevalent, especially with the growing older adult population.

For example, it is estimated that the number of individuals in the United States with arthritis may reach 67 million by 2030, a sizable portion of the population.

Given these high rates, it is reasonable to question whether individuals with anxiety who later develop a general medical condition do so because of mere probability or whether a causal relationship exists.

An analysis of World Mental Health surveys in 2015 revealed that the presence of any major anxiety disorder increased the risk of chronic general medical conditions, including arthritis, chronic pain, heart disease, stroke, hypertension, asthma, and peptic ulcers.

Longitudinal research with older adults has identified that anxiety disorders and posttraumatic stress disorder (PTSD) are predictive of incident gastrointestinal conditions. Similarly, Härter and colleagues determined that anxiety disorders predict cardiac disorders, gastrointestinal problems, genitourinary problems, and migraines.

Anxiety disorders are among the most prevalent reported mental disorders. In 2014, a systematic review of anxiety epidemiology literature suggested a worldwide prevalence ranging from 3.8% to 25%.

The wide range of estimates is likely due to a range of factors, including methodological differences in epidemiologic studies and potentially real differences between countries in the prevalence of anxiety disorders. With data from the U.S.

National Comorbidity Survey, lifetime prevalence of anxiety disorders is estimated to be 16% 

Anxiety Disorder Due to Another Medical Condition is a specific subtype of anxiety disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is characterized by the presence of clinically significant anxiety symptoms that are directly caused by an underlying medical condition or the physiological effects of a medical condition.

Here are key points about Anxiety Disorder Due to Another Medical Condition:

1. Anxiety Symptoms: The individual experiences symptoms of anxiety, such as excessive worry, restlessness, irritability, muscle tension, sleep disturbances, or difficulty concentrating.
2. Causal Relationship: The anxiety symptoms are determined to be a direct physiological consequence of a medical condition, such as a cardiovascular disease, respiratory disorder, endocrine disorder, neurological condition, or other medical conditions.
3. Disturbance is Not Better Explained: The anxiety symptoms are not better explained by another primary mental disorder, such as generalized anxiety disorder or panic disorder.
4. Substantial Distress or Impairment: The anxiety symptoms cause significant distress or impairment in the individual’s daily functioning, social interactions, or other areas of life.

Examples of medical conditions that can cause anxiety symptoms include cardiovascular diseases (e.g., heart disease, arrhythmias), respiratory disorders (e.g., chronic obstructive pulmonary disease), endocrine disorders (e.g., hyperthyroidism, adrenal gland disorders), neurological conditions (e.g., epilepsy, traumatic brain injury), and certain substance-related or medication-related conditions.

Treatment for Anxiety Disorder Due to Another Medical Condition focuses on addressing the underlying medical condition. Managing and treating the medical condition itself can help alleviate anxiety symptoms. Additionally, various psychotherapeutic approaches, such as cognitive-behavioral therapy (CBT), relaxation techniques, and stress management strategies, can be beneficial in managing anxiety symptoms.

It’s important to consult with healthcare professionals, such as a physician and mental health provider, to assess and diagnose Anxiety Disorder Due to Another Medical Condition accurately. They can evaluate the relationship between the anxiety symptoms and the underlying medical condition, develop an appropriate treatment plan, and coordinate care to address both the medical and mental health aspects of the condition.