DIFFERENTIAL DX

o Generalized Anxiety Disorder REPEATED INTENSE ANXIETY WHEN

o Panic Disorder o Agoraphobia o Conduct Disorder
AT LEAST AT LEAST THREE OF THE ANTICIPATING OR EXPERIENCING

o Social Anxiety Disorder ONE MONTH SEPARATION FROM HOME OR SIGNIFICANT

FOLLOWING CONDITIONS OTHERS
o PTSD o Illness Anxiety Disorder o Bereavement
o Depressive and Bipolar Disorders o ODD INCESSANT RUMINATION OVER THE
o Psychotic Disorders o Personality Disorders PROSPECT OF HARM COMING TO
SIGNIFICANT ATTACHMENTS

CHRONIC REFUSAL OR UNWILLINGLESS

SEPARATION TO VENTURE OUT AWAY FROM HOME

DUE TO FEAR OF SEPARATION,

ANXIETY DISORDER CHRONIC REFUSAL OR UNWILLINGLESS TO

VENTURE OUT AWAY FROM HOME DUE TO
FEAR OF SEPARATION

ASSESSMENTS
FEAR, ANXIETY, & AVOIDANCE - LASTING AT
LEAST 4 WEEKS IN CHILDREN AND ADOLESCENTS
o Anxiety Disorder Interview Schedule
AND TYPICALLY 6 MONTHS OR MORE IN ADULTS
for Children and Parents
o The Multidimensional Anxiety Scale
INTERVENTIONS
for Children /TECHNIQUES CHRONIC AND SIGNIFICANT ANXIETY
o The Separation Anxiety Subscale on ABOUT BEING LEFT ALONE AND SEPARATED
the Spence Children’s Anxiety Scale
o Beck Anxiety Inventory
SYMPTOMS FROM ATTACHMENT FIGURES,

o Adolescent Separation Anxiety Test REFUSAL OR UNWILLINGNESS TO

o Play Therapy SLEEP AWAY FROM HOME WHILE
o Adult Separation Anxiety Checklist fear of losing parents, refusal to go to school, SEPARATED FROM ATTACHMENT
o Separation Anxiety Symptom o Expressive Art Therapy
nightmares about being separated, clinging to FIGURES
Inventory o Behavioral Therapy
parents, and manifestation of physical
o Attachment Style Questionnaire o Child-Parent Relationship RECURRING NIGHTMARES ABOUT
o Beck Youth Inventories symptoms when separated. Often, parents SEPARATION
Therapy
o Child Attachment Interview worry excessively over the child.
o Revised Children’s Manifest Anxiety o Family Therapy (for
RECURRING PHYSICAL PROBLEMS
Scale children and adolescents) (HEADACHES, NAUSEA, GASTROINTESTINAL
o Conners Parent Rating Scale DISTRESS) WHEN ANTICIPATING OR
EXPERIENCING SEPARATION
o Child Behavioral Checklist
 DIFFERENTIAL DX
CONSISTENT FAILURE TO SPEAK IN SPECIFIC

LASTS AT SOCIAL SITUATIONS IN WHICH THERE IS AN

EXPECTATION FOR SPEAKING, DESPITE
o Communication Disorders
LEAST 1 SPEAKING IN OTHER SITUATIONS

MONTH CRITERIA INTERFERES WITH EDUCATIONAL OR

OCCUPATIONAL ACHIEVEMENT OR
WITH SOCIAL COMMUNICATION

NOT ATTRIBUTABLE TO A LACK OF

KNOWLEDGE OF, OR COMFORT WITH,
THE SPOKEN LANGUAGE REQUIRED IN
THE SOCIAL SITUATION

SELECTIVE MUTISM NOT BETTER EXPLAINED BY A

COMMUNICATION DISORDER AND DOES NOT
OCCUR EXCLUSIVELY DURING THE COURSE OF
AUTISM, SCHIZOPHRENIA, OR ANOTHER
PSYCHOTIC DISORDER

ASSESSMENTS

o The Selective Mutism

INTERVENTIONS
Questionnaire
SYMPTOMS /TECHNIQUES

o Hamilton Anxiety Scale o Family Therapy

o CBT
o Multidimensional Anxiety Characterized by reticence in situations o Behavioral Interventions
Scale for Children where speaking is expected; condition o Stimulus Fading
interferes with social, educational, or o Self-Modeling
vocational aspects of life; reticence is not due o Shaping
to difficulties with vocabulary or language o Contingency Management
o Role Playing
o Rehearsal
 DIFFERENTIAL DX
MARKED FEAR OR ANXIETY AROUND A
SPECIFIC OBJECT OR SITUATION (FLYING,
o Agoraphobia
FEAR & HEIGHTS, ANIMALS, RECEIVING AN
o Panic Disorder (Panic Attacks) INJECTION, SEEING BLOOD)

o PTSD AVOIDANCE
IN CHILDREN - THE FEAR OR ANXIETY
PERSISTS AT MAY BE EXPRESSED BY CRYING,
LEAST 6 TANTRUMS, FREEZING, OR CLINGING

MTHS
PHOBIC OBJECT OR SITUATION

SPECIFIC PHOBIA ALMOST ALWAYS PROVOKES

IMMEDIATE FEAR OR ANXIETY

PHOBIC OBJECT OR SITUATION IS

ACTIVELY AVOIDED OR ENDURED WITH
INTENSE FEAR OR ANXIET

INTERVENTIONS/
ASSESSMENTS TECHNIQUES

o Spider Questionnaire SYMPTOMS o Individual Therapy

o Behavior Therapy
FEAR OR ANXIETY IS OUT OF PROPORTION TO
THE ACTUAL DANGER POSED BY THE
o Systematic Desensitization SPECIFIC OBJECT/SITUATION & TO THE
o Snake Questionnaire o Flooding
SOCIOCULTURAL CONTEXT
Characterized by a disproportionate fear response to a specific
o Medical Fear Survey object or situation; the fear response is almost always
o Imaginal or In-Vivo Desensitization
FEAR, ANXIETY, OR AVOIDANCE CAUSES
o Exposure Therapy CLINICALLY SIGNIFICANT DISTRESS OR
o Minnesota Multiphasic immediately elicited by the presence of the phobic object or
IMPAIRMENT IN SOCIAL, OCCUPATIONAL, OR
o Imaginal Exposure
situation; the phobia producing entity is actively avoided or only
Personality Inventory 2 tolerated with great anxiety; the fear manifested is out of
o Biofeedback
OTHER IMPORTANT AREAS OF FUNCTIONING

o ERP
o Beck Anxiety Inventory proportion to the actual danger posed by the phobia-producing DISTURBANCE IS NOT BETTER
o Cognitive Restructuring
entity EXPLAINED BY SYMPTOMS OF
o Thought Stopping ANOTHER MENTAL DISORDER
o Assertiveness Training
o Role Play
o Psychoeducation on Panic
 DIFFERENTIAL DX
FEARS THAT SHE/HE WILL SHOW ANXIETY
SYMPTOMS THAT WILL BE NEGATIVELY
o Specific Phobia EVALUATED
o Panic Disorder
6 MTHS OR
o Generalized Anxiety Disorder
MORE SOCIAL SITUATIONS ALMOST ALWAYS
PROVOKE FEAR OR ANXIETY

SOCIAL ANXIETY SOCIAL SITUATIONS ARE AVOIDED

OR ENDURED WITH INTENSE FEAR

DISORDER OR ANXIETY

FEAR OR ANXIETY IS OUT OF

PROPORTION TO THE ACTUAL THREAT

INTERVENTIONS
ASSESSMENTS /TECHNIQUES

o Fear Survey Schedule for SYMPTOMS

Children o Individual Therapy
Social Phobia is characterized by a persistent and excessive fear
o ADIS-5 of social situations in which one is exposed to strangers and o CBT
o Reynolds Depression their scrutiny. The individual fears that he or she will humiliate or
o Anxiety management
embarrass himself or herself. The exposure invariably creates
Screening Inventory anxiety. Even though the person recognizes the fear is training
o Covi Anxiety Scale excessive, he or she will still attempt to avoid the situation o Guided imagery
altogether
o Functional Assessment o Relaxation training
Rating Scale o Exposure Therapy
 DIFFERENTIAL DX

RECURRENT AND UNEXPECTED

o Anxiety Disorder Due to Another Medical Condition
AT LEAST PANIC ATTACKS
o Substance/Medication-Induced Anxiety Disorder
o Other Specified Anxiety Disorder or Unspecified Anxiety ONE PANIC
CHRONIC WORRY ABOUT EXPERIENCING
Disorder ATTACK ADDITIONAL PANIC ATTACKS (AND THEIR
o Other Mental Disorders with Panic Attacks as an FOLLOW BY 1 POSSIBLE CONSEQUENCES), A MARKED
EFFORT TO ENGAGE IN BEHAVIORS TO AVOID
Associated Feature MTH OF 1 OF PANIC ATTACKS.

PANIC DISORDER OR BOTH OF DISTURBANCE IS NOT ATTRIBUTABLE TO

THE PHYSIOLOGICAL EFFECTS OF A
SUBSTANCE OR ANOTHER MEDICAL
CONDITION

DISTURBANCE IS NOT BETTER

a sudden, unexpected, intense fear response during EXPLAINED BY ANOTHER MENTAL
DISORDER
which anxiety rapidly escalates within minutes.

INTERVENTIONS
ASSESSMENTS /TECHNIQUES

SYMPTOMS o Individual Therapy

o Self Report Measures o CBT
at least 4 of the following symptoms MUST BE REPORTED:
o Medical Exam o Relaxation Techniques
rapid heartbeat, sweating, shaking, shortness of breath, choking
sensation, chest pain/discomfort, vertigo or sensation of loss of (Progressive Muscle
balance or feeling faint and light-headed, sensations of heat or Relaxation)
cold, paresthesias, derealization, fear of losing emotional
o Imaginal Desensitization
control, fear of dying
o Psychoeducation
o Introceptive Exposure
o Cognitive Restructuring
o Mindfulness
 DIFFERENTIAL DX
FEAR
MARKED FEAR OR ANXIETY ABOUT
RESPONSES TWO (OR MORE) OF FOLLOWING 5
o Social Anxiety Disorder (Social Phobia) TYPICALLY LAST SITUATIONS:

o Specific Phobia AT LEAST 6

1. USING PUBLIC TRANSPORTATION 2. BEING IN
MONTHS, OPEN SPACES 3. BEING IN ENCLOSED SPACES
4. STANDING IN LINE OR BEING IN A CROWD
5. BEING OUTSIDE OF THE HOME ALONE

AGORAPHOBIA INDIVIDUAL FEARS OR AVOIDS THESE SITUATIONS

BECAUSE OF THOUGHTS THAT ESCAPE MIGHT BE
DIFFICULT OR HELP MIGHT NOT BE AVAILABLE IN
THE EVENT OF DEVELOPING PANIC-LIKE, OR OTHER
INCAPACITATING OR EMBARRASSING SYMPTOMS

SITUATIONS ALMOST ALWAYS

intense anxiety or overwhelming fears PROVOKE FEAR OR ANXIETY

associated with two or more situations

ASSESSMENTS
INTERVENTIONS

o Multidimensional Anxiety SYMPTOMS /TECHNIQUES SITUATIONS ARE ACTIVELY AVOIDED,

REQUIRE THE PRESENCE OF A
COMPANION, OR ARE ENDURED WITH
o Acute Panic Inventory INTENSE FEAR OR ANXIETY
Significant anxiety about at least two of the following scenarios:
o Structural Assessment of o Rational emotive behavior FEAR OF ANXIETY IS OUT OF PROPORTION
utilizing public transportation, being in open spaces, being in
Stressful Experiences enclosed spaces, being in a crowd, being along outside one’s therapy
TO THE ACTUAL DANGER POSED BY THE
AGORAPHOBIC SITUATIONS AND TO THE
o Mobility Inventory for home. o Narrative
SOCIOCULTURAL CONTEXT

Agoraphobia NOTE: The above listed scenarios are avoided due to fear of o Cognitive-behavioral FEAR, ANXIETY, OR AVOIDANCE CAUSES

o Agoraphobic Cognitions being trapped or fear of experiencing symptoms of panic. CLINICALLY SIGNIFICANT DISTRESS OR
o Individual Therapy IMPAIRMENT IN SOCIAL, OCCUPATIONAL, OR
Agoraphobic scenarios almost always elicit distress and anxiety. OTHER IMPORTANT AREAS OF FUNCTIONING
Questionnaire

FEAR, ANXIETY, OR AVOIDANCE IS NOT

BETTER EXPLAINED BY SYMPTOMS OF
ANOTHER MENTAL DISORDER
 DIFFERENTIAL DX
OCCURRING
UNIDENTIFIABLE STRESSOR THAT
o Bipolar Disorder MORE DAYS TRIGGERS SYMPTOMS
o Adjustment Disorder with Anxiety THAN NOT AND
o Social Anxiety Disorder LASTING AT
EXCESSIVE ANXIETY AND WORRY
o Acute Stress Disorder LEAST 6
ABOUT A NUMBER OF EVENTS OR
o Obsessive-Compulsive Disorder MONTHS. ACTIVITIES
o Substance/Medication Induced Anxiety Disorder
GENERALIZED ANXIETY
INDIVIDUAL FINDS IT DIFFICULT TO
DISORDER (GAD) CONTROL THE WORRY

excessive anxiety and worry about a number of ANXIETY, WORRY, OR PHYSICAL SX

CAUSE SIGNIFICANT
events or activities. restless or feeling keyed up, DISTRESS/IMPAIRMENT IN IMPORTANT
AREAS OF FUNCTIONING
being easily fatigued, having difficulty
ASSESSMENTS concentrating, feeling irritable, and experiencing a
disturbance in sleep.
o Beck Anxiety Inventory
o Minnesota Multiphasic Personality INTERVENTIONS
Inventory 2
o Covi Anxiety Scale
SYMPTOMS /TECHNIQUES DISTURBANCE IS NOT ATTRIBUTABLE TO
THE PHYSIOLOGICAL EFFECTS OF A
SUBSTANCE OR MEDICAL CONDITION
o Hamilton Rating Scale o Individual Therapy
o State-Trait Anxiety Inventory
The person finds it difficult to not ruminate about worry-causing o Cognitive-behavioral DISTURBANCE IS NOT BETTER
o Anxiety Disorders Interview EXPLAINED BY ANOTHER MENTAL
scenarios. At least 3 of the following symptoms must be present therapy
Schedule DISORDER
o Generalized Anxiety Disorder agitation, loss of energy, difficulty focusing, irritability, muscular o Breathwork
Questionnaire tension, difficulty sleeping. o Psychiatric therapy
o Adolescents Note: Only 1 item is required for children o Rational emotive behavior
 Millon Adolescent Personality therapy (REBT)
Inventory
o Meditation
 Revised Children’s Manifest
o Psychoeducation
Anxiety Scale