DSM-5 anxiety disorders

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) groups conditions of excessive fear, anxiety, and avoidance into its anxiety disorders chapter. The core diagnoses are generalized anxiety disorder (GAD), panic disorder, specific phobia, social anxiety disorder, agoraphobia, separation anxiety disorder, and selective mutism. Notably, DSM-5 moved obsessive-compulsive disorder and PTSD out of this chapter into their own categories — a reclassification exams like to test.

Each diagnosis has a distinct pattern and duration requirement. GAD is persistent, hard-to-control worry across many domains on most days for at least six months, with symptoms like restlessness, fatigue, poor concentration, muscle tension, and sleep disturbance. Panic disorder features recurrent unexpected panic attacks — surges of intense fear with palpitations, sweating, shortness of breath, and fear of dying — followed by at least a month of worry about further attacks. Specific phobia and social anxiety disorder involve marked fear out of proportion to the actual danger, lasting six months or more, while agoraphobia is fear of situations where escape might be difficult.

In every case the symptoms must cause clinically significant distress or impairment and must not be better explained by a substance, medical condition, or another disorder — anxiety symptoms from hyperthyroidism or stimulant use are not an anxiety disorder. First-line treatments combine cognitive behavioral therapy with SSRIs or SNRIs.

USMLE Step 1 tests these diagnoses in behavioral science: vignettes hinge on duration criteria (six months for GAD, one month of worry after panic attacks), distinguishing the disorders from each other, and ruling out medical or substance-induced causes.