Anxiety Disorder Due To Another Medical Condition DSM-5 293.84 (ICD-10-CM Multiple Codes)
DSM-5 Category: Anxiety Disorders
In general, anxiety disorders are normal reactions to stress that have become excessive. The anxiety is shown as significant and possibly intense dread or uneasiness
coming from a person’s assessment of a threatening event or situation. This state of fear leads to decreased ability to function in daily life. It may also come from the expectation of a future threat (American Psychiatric Association, 2013). When a person suffers from anxiety disorder due to another medical condition, the presence of that medical condition leads directly to the anxiety experienced. The anxiety is the predominant feature and may take the form of panic attacks, obsessive-compulsive behavior, or generalized anxiety.
Symptoms of Anxiety Disorder Due To Another Medical Condition
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. 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.
Anxiety due to another medical condition may exhibit several symptom pictures. For example, if the anxiety shows itself as panic disorder, symptoms may include sudden onset of terror with no specific precipitating event (NIMH, n.d.). Along with the terror, a pounding heart, sweating, feeling faint, or dizziness may be
experienced. The patient with panic may have physical symptoms that suggest a heart attack, also. These include feeling chilled, numbness in hands, nausea, chest
pain, and feelings of smothering. A sense of loss of touch with reality, fear of some impending doom, and fear of losing control add to the impact of panic. Many people who experience panic attacks are convinced they are having a heart attack and seek medical attention at emergency rooms.
If the anxiety is experienced as generalized anxiety, a feeling of increased worry and tension with little or no precipitating factor prevails. These people expect disaster to occur and have increasing concern about health, money, family problems, or work. They can’t relax, have an exaggerated startle response, and can’t concentrate well. Physical symptoms that accompany generalized anxiety include feeling tired, headaches, muscle aches, irritability, sweating, nausea, feeling lightheaded, and difficulty breathing.
If the anxiety is felt as obsessive-compulsive symptoms, there will be intrusive thoughts that the person doesn’t want to have and that bring on anxiety. This leads the person to perform certain behaviors or rituals that decrease the anxiety temporarily. The rituals may reach the point of controlling the person’s behavior. Checking things, touching things in a certain order, and counting are among the most common of these rituals. The thoughts that trigger anxiety many times have to do with harming loved ones, performing sexual acts that are unacceptable to the person, or thinking about things that go against the person’s religious beliefs.
In order to give this diagnosis to a patient, there must be evidence that shows the anxiety, regardless of the way it is exhibited, is due to the direct physiologic effects of another medical condition (American Psychiatric Association, 2013). History, physical examination, or laboratory findings are used to establish this direct effect. Anxiety due to another medical condition is not better explained by another mental disorder and does not occur only during the course of delirium. Clinically significant distress must be present, and the functioning of the person in social, occupational, or other areas of life must be impaired.
Careful and thorough medical evaluation must be conducted to determine the presence of the medical condition that leads to the anxiety (Gagarina, 2011). Some of the
medical conditions that may be involved in this disorder are hyperthyroidism, hypothyroidism, hypoglycemia, and hyperadrenocorticism . Heart related problems may also underlie this disorder. Some of these conditions are congestive heart failure and arrhythmia. Breathing problems such as COPD, pneumonia, and hyperventilation also can initiate anxiety. Neurological conditions like encephalitis or neoplasms can lead to anxiety (Bourne, 2014).
There must be a close association between the medical condition and anxiety in order for this diagnosis to be appropriate. That is, the anxiety symptoms must occur
close in time to the onset, worsening, or lessening of the medical condition. If the features of anxiety that are seen are not typical for a primary anxiety disorder, and there is a medical condition present, this is an indication that anxiety due to another medical condition may be an appropriate diagnosis.
One of the major considerations in diagnosing anxiety due to another medical condition is to be certain the anxiety doesn’t occur just during the course of delirium. It
is appropriate to make the diagnosis if the anxiety occurs directly due to dementia, however.
Differentiation of anxiety due to the effects of continuing substance use or abuse must be considered, also (Gagarina, 2011). Withdrawal from a substance or exposure to a toxic substance would lead to a diagnosis of Substance-Induced Anxiety. Medical examination including drug screens would be useful in this situation. It is possible to have a dual diagnosis of Anxiety Due to Another Medical Condition and Substance-Induced Anxiety disorder if criteria for both diagnoses are met.
A primary anxiety disorder or an adjustment disorder with anxiety are two other conditions that must be differentiated from anxiety due to another medical disorder. In the first of these, there is no direct link to a medical condition that causes the anxiety. In the other, onset of the anxiety at a later age or a family or personal history of anxiety should suggest an adjustment disorder.
Treatment of Anxiety Disorder Due To Another Medical Condition
Most of the time, anxiety disorders are treated effectively with medications. Specific types of psychotherapy are also useful. Many times, these treatment approaches
are used together. Without treatment, anxiety disorders tend to become chronic (Karl, 2013).
In the case of anxiety due to another medical condition, treatment of the anxiety may have to be postponed until the underlying medical condition is successfully treated.
This depends on the medical condition and whether it is potentially life-threatening. Often, treatment of both conditions can occur simultaneously. Whether this happens may depend on the treatment conditions for the medical disorder (NIMH, n.d.).
Medications used in the treatment of anxiety do not cure anxiety, but do keep the symptoms under control while the patient is undergoing psychotherapy to deal with the
root of the anxiety. Primary medications used in treating anxiety are antidepressants, anti-anxiety medications, and beta-blockers.
Antidepressants originally developed to help with symptoms of depression also have a positive effect on anxiety. They frequently require several weeks before getting into the bloodstream at a sufficient level to reduce symptoms. Thus, it is important they be given a sufficient trial.
SSRIs such as fluoxetine, sertraline, escitalopram, paroxetine, and citalopram are useful in treating some anxiety symptoms. Venlafaxine is useful for generalized
anxiety disorder symptoms. Tricyclics such as imipramine and clomipramine are used, as well.
Anti-anxiety medications specifically designed to deal with anxiety symptoms include benzodiazepines, typically prescribed for short durations. Clonazepam, lorazepam, and alprazolam are also prescribed for some anxiety symptoms. Buspirone has some effect on generalized anxiety disorder symptoms and must be taken for at least two weeks for its effects to be seen.
Beta-blockers like propranolol, used to treat some heart conditions, can decrease some of the physical symptoms that come with anxiety disorders.
Psychotherapy is very effective in the treatment of anxiety disorders. Cognitive behavioral therapy (CBT) is most often used and may be considered the psychotherapy of choice for anxiety. Basically, this therapy approach is two-pronged. It directly changes the thinking patterns that continue anxiety of those suffering from this condition. It also works directly on the behaviors that can help people change the reactions they have to situations that provoke anxiety.
CBT typically lasts around 12 weeks. Patients are seen either individually or in groups. Homework assignments support the therapy in between sessions and strengthen the ideas and skills learned during the therapy sessions. Research seems to indicate the benefits of CBT outlast those of the medications for some types of anxiety disorders.
Self-help or support groups are beneficial in continuing the effects of therapy. Stress management techniques are also useful. Avoiding some over-the-counter medications and caffeine is important, as well.
It is important for therapists working with patients suffering anxiety symptoms to keep in mind the possibility of suicide if the anxiety becomes severe. Also,
some research (Sood, Mendez, & Kendall, 2012) suggests that anxiety disorders are most commonly seen in youth, with a median onset of 11 years of age.
American Psychiatric Association. (2013). The diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bourne, E. (2014). Help for anxiety. Retrieved from http://www.helpforanxiety.com/dsm-iv-tr.html
Gagarina, A.K. (2011). Anxiety disorder due to a general medical condition. Retrieved from http://www.health.am/psy/more/anxiety_disorder_due_to_a_general_medical_condition/
Karl, S. (2013). Anxiety disorders in the DSM-5. [Power Point slides]. Retrieved from http://www.eo2.commpartners.com/users/counseling/downloads/130717_Slides.pdf.
National Institute of Mental Health. (n.d.). Anxiety disorders. Retrieved from http://www.nimh.hih.gov/health/publications/anxiety-disorders/index.shtml?wvsessionid=wv650bd.
Sood, E.D., Mendez, J.L., & Kendall, P.C. (2012). Accurlturation, religiosity, and ethnicity predict mother’s causal beliefs about separation anxiety disorder and
preferences for help seeking. Journal of Cross-Cultural Psychology, 43(3) 393-409.
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