How are anxiety disorders diagnosed?

Generalized Anxiety Disorder (GAD): GAD diagnosis is when an individual spends at least six months worried excessively about everyday problems. However, incapacitating or troublesome symptoms warranting treatment may exist for shorter periods of time.

Panic disorder: Panic disorder (or panic attack) is diagnosed by either four attacks within four weeks or one or more attacks followed by at least a month of persistent fear of having another attack. Also, a minimum of four of the symptoms listed for panic disorders developed during at least one of the attacks. Most panic attacks last only a few minutes and up to an hour in rare cases. They can occur at any time, even during sleep.

Phobias: Phobias present with extreme anxiety with exposure to the object or situation. The individual recognizes that his or her fear is excessive or unreasonable, and finds that normal routines, social activities, or relationships are significantly impaired as a result of these fears.

Obsessive-compulsive disorder (OCD): A mental health professional will diagnose obsessive-compulsive disorder after a thorough evaluation. Criteria are based upon the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a clinical book of mental illness diagnoses. OCD diagnosis is based upon recurrent and persistent thoughts, impulses or images that are intrusive and cause distress, thoughts that aren't simply excessive worries about real problems, an attempt to ignore or suppress these thoughts, images or impulses, and the recognition that these thoughts, images and impulses are a product of the mind.

Compulsions must meet specific criteria including repetitive behaviors, such as hand washing, or repetitive mental acts, such as counting silently, that the individual feels driven to perform. These behaviors or mental acts are meant to prevent or reduce distress about unrealistic obsessions.

Post traumatic stress disorder (PTSD): Although many of the symptoms of PTSD may be an appropriate initial response to a traumatic event, they are considered part of a disorder when they persist beyond three months.

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Your doctor will probably begin by asking you to describe exactly what you mean when you say that you feel anxious. Are you worried much of the time? Do you become frightened in particular circumstances? Do you have physical sensations, such as sweating or palpitations, along with emotional symptoms? The answers to these questions will help your doctor determine whether you have an anxiety disorder and, if so, which one.

Your doctor will also ask about your personal and family medical history. Have you or an immediate family member ever had an anxiety disorder? Have you been ill recently? Expect other questions about your personal habits. Which over-the-counter or prescription drugs do you take regularly? Do you smoke? Do you drink coffee, and if so, how many cups a day? These questions are important because certain medical conditions, medications, and substances (such as nicotine and caffeine) can cause anxiety symptoms.

Then the doctor will proceed with a general check-up to look for signs of physical illnesses, especially those with symptoms that mimic anxiety disorders.

As part of the check-up, the doctor will evaluate whether you have depression, since anxiety and depression often coexist. He or she may order a test to determine whether thyroid function is normal. You may be asked for a urine sample for tests to assess the functioning of your adrenal glands and to check for traces of illegal drugs. Abnormal thyroid or adrenal function can cause hormone imbalances that contribute to anxiety. Use of illicit drugs can also cause or exacerbate anxiety symptoms.

If a medical cause has been ruled out, your primary care physician may refer you to a psychiatrist or psychologist. There is no laboratory test or paper-and-pencil questionnaire to aid in diagnosing anxiety disorders. Instead, the mental health clinician makes the diagnosis after observing and talking with you. He or she will ask you to describe your experiences in detail, noting your main symptoms. He or she may also ask some of the following questions: Do you worry all the time, even about little things? Do you break out in a cold sweat when you have to meet new people? Is it hard for you to work up the courage to call someone you don't know well? Do you stutter and become visibly agitated when discussing certain memories? Each of these feelings or behaviors is a sign of a different anxiety disorder. In addition, you will probably be assessed for depression.