1. Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
2. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack.
   Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
3. The person recognizes that the fear is excessive or unreasonable.
   Note: In children, this feature may be absent.
4. The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
5. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
6. In individuals under age 18 years, the duration is at least 6 months.
7. The anxiety, panic attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as obsessive-compulsive disorder (e.g., fear of dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., avoidance of stimuli associated with a severe stressor), separation anxiety disorder (e.g., avoidance of school), social phobia (e.g., avoidance of social situations because of fear of embarrassment), panic disorder with agoraphobia, or agoraphobia without history of panic disorder.

Specify type:
Animal type
Natural environment type (e.g., heights, storms, water)
Blood-injection-injury type
Situational type (e.g., airplanes, elevators, enclosed places)
Other type (e.g., fear of choking, vomiting, or contracting an illness; in children, fear of loud sounds or costumed characters)

1. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.
   Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.
2. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack.
   Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.
3. The person recognizes that the fear is excessive or unreasonable.
   Note: In children, this feature may be absent.
4. The feared social or performance situations are avoided or else are endured with intense anxiety or distress.
5. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
6. In individuals under age 18 years, the duration is at least 6 months.
7. The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., panic disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, a pervasive developmental disorder, or schizoid personality disorder).
8. If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it (e.g., the fear is not of stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in anorexia nervosa or bulimia nervosa).

Specify if:
Generalized: if the fears include most social situations (also consider the additional diagnosis of avoidant personality disorder)

1. Either obsessions or compulsions:
   Obsessions as defined by (1), (2), (3), and (4):

   1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
   2. the thoughts, impulses, or images are not simply excessive worries about real-life problems
   3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
   4. the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
   Compulsions as defined by (1) and (2):
   1. repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
   2. the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
2. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.
   Note: This does not apply to children.
3. The obsessions or compulsions cause marked distress, are time-consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.
4. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an eating disorder; hair pulling in the presence of trichotillomania; concern with appearance in the presence of body dysmorphic disorder; preoccupation with drugs in the presence of a substance use disorder; preoccupation with having a serious illness in the presence of hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a paraphilia; or guilty ruminations in the presence of major depressive disorder).
5. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify if:
With poor insight: if, for most of the time during the current episode, the person does not recognize that the obsessions and compulsions are excessive or unreasonable

1. The person has been exposed to a traumatic event in which both of the following were present:

   1. the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
   2. the person's response involved intense fear, helplessness, or horror.
      Note: In children, this may be expressed instead by disorganized or agitated behavior.
2. The traumatic event is persistently reexperienced in one (or more) of the following ways:
   1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
   2. recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
   3. acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
   4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
   5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
3. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
   1. efforts to avoid thoughts, feelings, or conversations associated with the trauma
   2. efforts to avoid activities, places, or people that arouse recollections of the trauma
   3. inability to recall an important aspect of the trauma
   4. markedly diminished interest or participation in significant activities
   5. feeling of detachment or estrangement from others
   6. restricted range of affect (e.g., unable to have loving feelings)
   7. sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
   1. difficulty falling or staying asleep
   2. irritability or outbursts of anger
   3. difficulty concentrating
   4. hypervigilance
   5. exaggerated startle response
5. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
6. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
Specify if:
With delayed onset: if onset of symptoms is at least 6 months after the stressor

1. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
2. The person finds it difficult to control the worry.
3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).
   Note: Only one item is required in children.
   1. restlessness or feeling keyed up or on edge
   2. being easily fatigued
   3. difficulty concentrating or mind going blank
   4. irritability
   5. muscle tension
   6. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
4. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during posttraumatic stress disorder.
5. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
6. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder.

1. Prominent anxiety, panic attacks, or obsessions or compulsions predominate in the clinical picture.
2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
3. The disturbance is not better accounted for by another mental disorder (e.g., adjustment disorder with anxiety in which the stressor is a serious general medical condition).
4. The disturbance does not occur exclusively during the course of a delirium.
5. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
With generalized anxiety: if excessive anxiety or worry about a number of events or activities predominates in the clinical presentation
With panic attacks: if panic attacks predominate in the clinical presentation
With obsessive-compulsive symptoms: if obsessions or compulsions predominate in the clinical presentation
Coding note: Include the name of the general medical condition on Axis I, e.g., anxiety disorder due to pheochromocytoma, with generalized anxiety; also code the general medical condition on Axis III.

1. Prominent anxiety, panic attacks, or obsessions or compulsions predominate in the clinical picture.
2. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2):
   1. the symptoms in Criterion A developed during, or within 1 month of, substance intoxication or withdrawal
   2. medication use is etiologically related to the disturbance
3. The disturbance is not better accounted for by an anxiety disorder that is not substance induced. Evidence that the symptoms are better accounted for by an anxiety disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence suggesting the existence of an independent non–substance-induced anxiety disorder (e.g., a history of recurrent non–substance-related episodes).
4. The disturbance does not occur exclusively during the course of a delirium.
5. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the anxiety symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the anxiety symptoms are sufficiently severe to warrant independent clinical attention.
Code [Specific substance]-induced anxiety disorder
      Alcohol; amphetamine (or amphetaminelike substance); caffeine; cannabis; cocaine; hallucinogen; inhalant; phencyclidine (or phencyclidinelike substance); sedative, hypnotic, or anxiolytic; other [or unknown] substance
Specify if:
With generalized anxiety: if excessive anxiety or worry about a number of events or activities predominates in the clinical presentation
With panic attacks: if panic attacks predominate in the clinical presentation
With obsessive-compulsive symptoms: if obsessions or compulsions predominate in the clinical presentation
With phobic symptoms: if phobic symptoms predominate in the clinical presentation
Specify if:
With onset during intoxication: if the criteria are met for intoxication with the substance and the symptoms develop during the intoxication syndrome
With onset during withdrawal: if criteria are met for withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal syndrome

This category includes disorders with prominent anxiety or phobic avoidance that do not meet criteria for any specific anxiety disorder, adjustment disorder with anxiety, or adjustment disorder with mixed anxiety and depressed mood. Examples include

1. Mixed anxiety-depressive disorder: clinically significant symptoms of anxiety and depression, but the criteria are not met for either a specific mood disorder or a specific anxiety disorder
2. Clinically significant social phobic symptoms that are related to the social impact of having a general medical condition or mental disorder (e.g., Parkinson's disease, dermatological conditions, stuttering, anorexia nervosa, body dysmorphic disorder)
3. Situations in which the disturbance is severe enough to warrant a diagnosis of an anxiety disorder but the individual fails to report enough symptoms for the full criteria for any specific anxiety disorder to have been met; for example, an individual who reports all of the features of panic disorder without agoraphobia except that the panic attacks are all limited-symptom attacks
4. Situations in which the clinician has concluded that an anxiety disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced

1. Persistent or recurrent dysphoric mood lasting at least 1 month.
2. The dysphoric mood is accompanied by at least 1 month of four (or more) of the following symptoms:
   1. difficulty concentrating or mind going blank
   2. sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
   3. fatigue or low energy
   4. irritability
   5. worry
   6. being easily moved to tears
   7. hypervigilance
   8. anticipating the worst
   9. hopelessness (pervasive pessimism about the future)
   10. low self-esteem or feelings of worthlessness
3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
5. All of the following:
   1. criteria have never been met for major depressive disorder, dysthymic disorder, panic disorder, or generalized anxiety disorder
   2. criteria are not currently met for any other anxiety or mood disorder (including an anxiety or mood disorder, in partial remission)
   3. the symptoms are not better accounted for by any other mental disorder

1. The presence of agoraphobia related to fear of developing panic-like symptoms (e.g., dizziness or diarrhea).
2. Criteria have never been met for panic disorder.
3. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
4. If an associated general medical condition is present, the fear described in Criterion A is clearly in excess of that usually associated with the condition.

1. Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.
   Note: Consider the diagnosis of specific phobia if the avoidance is limited to one or only a few specific situations, or social phobia if the avoidance is limited to social situations.
2. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.
3. The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social phobia (e.g., avoidance limited to social situations because of fear of embarrassment), specific phobia (e.g., avoidance limited to a single situation like elevators), obsessive-compulsive disorder (e.g., avoidance of dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., avoidance of stimuli associated with a severe stressor), or separation anxiety disorder (e.g., avoidance of leaving home or relatives).

1. Both (1) and (2):
   1. recurrent unexpected panic attacks
   2. at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
      1. persistent concern about having additional attacks
      2. worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)
      3. a significant change in behavior related to the attacks
2. The presence of agoraphobia
3. The panic attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
4. The panic attacks are not better accounted for by another mental disorder, such as social phobia (e.g., occurring on exposure to feared social situations), specific phobia (e.g., on exposure to a specific phobic situation), obsessive-compulsive disorder (e.g., on exposure to dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., in response to stimuli associated with a severe stressor), or separation anxiety disorder (e.g., in response to being away from home or close relatives).

1. Both (1) and (2):
   1. recurrent unexpected panic attacks
   2. at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
      1. persistent concern about having additional attacks
      2. worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)
      3. a significant change in behavior related to the attacks
2. Absence of agoraphobia
3. The panic attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
4. The panic attacks are not better accounted for by another mental disorder, such as social phobia (e.g., occurring on exposure to feared social situations), specific phobia (e.g., on exposure to a specific phobic situation), obsessive-compulsive disorder (e.g., on exposure to dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., in response to stimuli associated with a severe stressor), or separation anxiety disorder (e.g., in response to being away from home or close relatives).

1. The patient must have been exposed to an exceptional mental or physical stressor.
2. Exposure to the stressor is followed by an immediate onset of symptoms (within 1 hour).
3. Two groups of symptoms are given: the acute stress reaction is graded as:
   Mild
   Only Criterion (1) below is fulfilled.
   Moderate
   Criterion (1) is met, and there are any two symptoms from Criterion (2).
   Severe
   Either criterion (1) is met, and there are any four symptoms from criterion (2); or there is dissociative stupor.
   1. Criteria B, C, and D for generalized anxiety disorder are met.
   2. 1. Withdrawal from expected social interaction.
      2. Narrowing of attention
      3. Apparent disorientation
      4. Anger or verbal aggression
      5. Despair or hopelessness
      6. Inappropriate or purposeless overactivity
      7. Uncontrollable and excessive grief (judged by local cultural standards).
4. If the stressor is transient or can be relieved, the symptoms must begin to diminish after not more than 8 hours. If exposure to the stressor continues, the symptoms must begin to diminish after not more than 48 hours.
5. Most commonly used exclusion clause. The reaction must occur in the absence of any other concurrent mental or behavioral disorder in ICD-10 (except generalized anxiety disorder and personality disorders) and not within 3 months of the end of an episode of any other mental or behavioral disorder.

1. The patient must have been exposed to a stressful event or situation (either short- or long-lasting) of an exceptionally threatening or catastrophic nature, which would be likely to cause pervasive distress in almost anyone.
2. There must be persistent remembering or “reliving” of the stressor in intrusive “flashbacks,” vivid memories, or recurring dreams or in experiencing distress when exposed to circumstances resembling or associated with the stressor.
3. The patient must exhibit an actual or preferred avoidance of circumstances resembling or associated with the stressor, which was not present before exposure to the stressor.
4. Either of the following must be present:
   1. inability to recall, either partially or completely, some important aspects of the period of exposure to the stressor;
   2. persistent symptoms of increased psychological sensitivity and arousal (not present before exposure to the stressor), shown by any two of the following:
      1. difficulty in falling or staying asleep;
      2. irritability or outbursts of anger;
      3. difficulty in concentrating;
      4. hypervigilance;
      5. exaggerated startle response.
5. Criteria B, C, and D must all be met within 6 months of the stressful event or of the end of a period of stress. (For some purposes, onset delayed more than 6 months may be included, but this should be clearly specified.)

1. Either obsessions or compulsions (or both) are present on most days for a period of at least 2 weeks.
2. Obsessions (thoughts, ideas, or images) and compulsions (acts) share the following features, all of which must be present:
   1. They are acknowledged as originating in the mind of the patient and are not imposed by outside persons or influences.
   2. They are repetitive and unpleasant, and at least one obsession or compulsion that is acknowledged as excessive or unreasonable must be present.
   3. The patient tries to resist them (but resistance to very long-standing obsessions or compulsions may be minimal). At least one obsession or compulsion that is unsuccessfully resisted must be present.
   4. Experiencing the obsessive thought or carrying out the compulsive act is not in itself pleasurable. (This should be distinguished from the temporary relief of tension or anxiety.)
3. The obsessions or compulsions cause distress or interfere with the patient's social or individual functioning, usually by wasting time.
4. Most commonly used exclusion clause. The obsessions or compulsions are not the result of other mental disorders, such as schizophrenia and related disorders or mood [affective] disorders.

1. The individual experiences recurrent panic attacks that are not consistently associated with a specific situation or object and that often occur spontaneously (i.e., the episodes are unpredictable). The panic attacks are not associated with marked exertion or with exposure to dangerous or life-threatening situations.
2. A panic attack is characterized by all of the following:
   1. it is a discrete episode of intense fear of discomfort;
   2. it starts abruptly;
   3. it reaches a maximum within a few minutes and lasts at least some minutes;
   4. at least four of the symptoms listed below must be present, one of which must be from items (a) to (d):
      Autonomic arousal symptoms
      1. palpitations or pounding heart, or accelerated heart rate;
      2. sweating;
      3. trembling or shaking;
      4. dry mouth (not due to medication or dehydration);
      Symptoms involving chest and abdomen
      5. difficulty in breathing;
      6. feeling of choking;
      7. chest pain or discomfort;
      8. nausea or abdominal distress (e.g., churning in stomach);
      Symptoms involving mental state
      9. feeling dizzy, unsteady, faint, or light-headed;
      10. feeling that objects are unreal (derealization), or that the self is distant or “not really here” (depersonalization);
      11. fear of losing control, “going crazy,” or passing out;
      12. fear of dying;
      General symptoms
      13. hot flushes or cold chills;
      14. numbness or tingling sensations.
3. Most commonly used exclusion clause. Panic attccks are not due to a physical disorder, organic mental disorder, or other mental disorders, such as schizophrenia and related disorders, mood [affective] disorders, or somatoform disorders.

1. There must have been a period of at least 6 months with prominent tension, worry, and feelings of apprehension about everyday events and problems.
2. At least four of the symptoms listed below must be present, at least one of which must be from items (1) to (4):
   Autonomic arousal symptoms
   1. palpitations or pounding heart, or accelerated heart rate;
   2. sweating;
   3. trembling or shaking;
   4. dry mouth (not due to medication or dehydration);
   Symptoms involving chest and abdomen
   5. difficulty in breathing;
   6. feeling of choking;
   7. chest pain or discomfort;
   8. nausea or abdominal distress (e.g., churning in stomach);
   Symptoms involving mental state
   9. feeling dizzy, unsteady, faint, or light-headed;
   10. feelings that objects are unreal (derealization), or that the self is distant or “not really here” (depersonalization);
   11. fear of losing control, “going crazy,” or passing out;
   12. fear of dying;
   General symptoms
   13. hot flushes or cold chills;
   14. numbness or tingling sensations;
   Symptoms of tension
   15. muscle tension or aches and pains;
   16. restlessness and inability to relax;
   17. feeling keyed up, on edge, or mentally tense;
   18. a sensation of a lump in the throat, or difficulty in swallowing;
   Other nonspecific symptoms
   19. exaggerated response to minor surprise or being startled;
   20. difficulty in concentrating, or mind “going blank,” because of worrying or anxiety;
   21. persistent irritability;
   22. difficulty in getting to sleep because of worrying.
3. The disorder does not meet the criteria for panic disorder, phobic anxiety disorders, obsessive-compulsive disorder, or hypochondriacal disorder.
4. Most commonly used exclusion clause. The anxiety disorder is not due to a physical disorder, such as hyperthyroidism, an organic mental disorder, or a psychoactive substance-related disorder, such as excess consumption of amphetaminelike substances or withdrawal from benzodiazepines.

1. There is marked and consistently manifest fear in, or avoidance of, at least two of the following situations:
   1. crowds;
   2. public places;
   3. traveling alone;
   4. traveling away from home.
2. At least two symptoms of anxiety in the feared situation must have been present together, on at least one occasion since the onset of the disorder, and one of the symptoms must have been from items (1) to (4) listed below.
   Autonomic arousal symptoms
   1. palpitations or pounding heart, or accelerated heart rate;
   2. sweating;
   3. trembling or shaking;
   4. dry mouth (not due to medication or dehydration);
   Symptoms involving chest and abdomen
   5. difficulty in breathing;
   6. feeling of choking;
   7. chest pain or discomfort;
   8. nausea or abdominal distress (e.g., churning in stomach);
   Symptoms involving mental state
   9. feeling dizzy, unsteady, faint, or light-headed;
   10. feelings that objects are unreal (derealization), or that the self is distant or “not really here” (depersonalization);
   11. fear of losing control, “going crazy,” or passing out;
   12. fear of dying
   General symptoms
   13. hot flushes or cold chills;
   14. numbness or tingling sensations.
3. Significant emotional distress is caused by the avoidance or by the anxiety symptoms, and the individual recognizes that these are excessive or unreasonable.
4. Symptoms are restricted to, or predominate in, the feared situations or contemplation of the feared situations.
5. Most commonly used exclusion clause. Fear or avoidance of situations (Criterion A) is not the result of delusions, hallucinations, or other disorders such as organic mental disorders, schizophrenia and related disorders, mood [affective] disorders, or obsessive-compulsive disorder, and is not secondary to cultural beliefs.
   The presence or absence of panic disorder in a majority of agoraphobic situations may be specified by using a fifth character.
   Without panic disorder
   With panic disorder
   Options for rating severity
   Severity in agoraphobia may be rated by indicating the degree of avoidance, taking into account the specific cultural setting. Severity in social phobias may be rated by counting the number of panic attacks.

1. Either of the following must be present.
   1. marked fear of being the focus of attention, or fear of behaving in a way that will be embarrassing or humiliating;
   2. marked avoidance of being the focus of attention, or of situations in which there is fear of behaving in an embarrassing or humiliating way.
   These fears are manifested in social situations, such as eating or speaking in public, encountering known individuals in public or entering or enduring small group situations (e.g., parties, meetings, classrooms).
2. At least two symptoms of anxiety in the feared situation as defined in agoraphobia, Criterion B, must have been manifest at some time since the onset of the disorder, together with at least one of the following symptoms:
   1. blushing or shaking;
   2. fear of vomiting;
   3. urgency or fear of micturition or defecation.
3. Significant emotional distress is caused by the symptoms or by the avoidance, and the individual recognizes that these are excessive or unreasonable.
4. Symptoms are restricted to, or predominate in, the feared situations or contemplation of the feared situations.
5. Most commonly used exclusion clause. The symptoms listed in Criteria A and B are not the result of delusions, hallucinations, or other disorders such as organic mental disorders, schizophrenia and related disorders, mood [affective] disorders, or obsessive-compulsive disorder, and are not secondary to cultural beliefs.

1. Either of the following must be present:
   1. marked fear of a specific object or situation not included in agoraphobia or social phobia;
   2. marked avoidance of a specific object or situation not included in agoraphobia or social phobia.
      Among the most common objects and situations are animals, birds, insects, heights, thunder, flying, small enclosed spaces the sight of blood or injury, injections, dentists, and hospitals.
2. Symptoms of anxiety in the feared situation as defined in agoraphobia, Criterion B, must have been manifest at some time since the onset of the disorder.
3. Significant emotional distress is caused by the symptoms or by the avoidance, and the individual recognizes that these are excessive or unreasonable.
4. Symptoms are restricted to the feared situation or contemplation of the feared situation. If desired, the specific phobias may be subdivided as follows. —animal type (e.g., insects, dogs)
   —nature-forces type (e.g., storms, water)
   —blood, injection, and injury type.
   —situation type (e.g., elevators, tunnels)
   —other type

1. palpitations, pounding heart, or accelerated heart rate
2. sweating
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. feeling of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, lightheaded, or faint
9. derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. fear of losing control or going crazy
11. fear of dying
12. paresthesias (numbness or tingling sensations)
13. chills or hot flushes