Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.
Before diagnosing a particular anxiety disorder, it is important to rule-out other possible causes of anxiety symptoms. Anxiety symptoms can be due to: 1) an anxiety disorder, 2) another psychiatric disorder, 3) a medical disease or disorder, and 4) the use of, or withdrawal from, alcohol and other drugs. Moreover, as we have stressed throughout, anxiety is a normal and natural emotion that is the result of the way human beings are "wired" for survival. Thus, in order for an anxiety disorder to be diagnosed, the clinician must determine whether the anxiety symptoms are severe enough to result in significant distress, or impairment in functioning. This section discusses Anxiety Due to Another Medical Condition; Substance/Medication Induced Anxiety Disorder (drugs); and the catchall categories Other Specified and Unspecified Anxiety Disorder. These two diagnoses are used when symptoms create significant distress and/or impaired functioning but do not seem to meet the diagnostic criteria for any of the other anxiety disorders.
Anxiety Disorder Due to Another Medical Condition
Certain medical disorders or diseases can cause psychiatric symptoms. A medical evaluation should be performed by a qualified, health care professional to rule out a medical condition that may be causing the symptoms. For example, individuals experiencing panic attacks may have thyroid disease or mitral valve prolapse. When the fear and anxiety symptoms are the direct effect of a medical condition, this would be referred to as an Anxiety Disorder Due to Another Medical Condition. This diagnosis is not used if their anxiety is due to realistic concerns about having a medical condition. For instance, someone with cancer is reasonably worried about pain. This is a normal and rational worry. Therefore, it would not be diagnosed as a mental disorder.
Substance/Medication-Induced Anxiety Disorder
When anxiety symptoms are a direct result of a prescription drug, over-the-counter drug, or street drug, then the correct diagnosis is Substance/Medication-Induced Anxiety Disorder. The anxiety may be caused by the proper and customary use of the drug. It may also occur because of misuse, intoxication, or withdrawal from a particular substance.
Prescription drugs that can cause anxiety as a side effect of the drug may include medications containing amphetamines such as Benzedrine®, Dexedrine®, and Ritalin®. Certain high blood pressure (hypertensive) medications can also cause anxiety (clonidine and Methyldopa®). Steroidal drugs used to treat asthma and other respiratory disorders may create anxiety symptoms (albuterol, salmeterol, and theophylline). In addition, various hormonal medications (including thyroid medications) are known to cause anxiety symptoms. This list is not all-inclusive. Be sure to discuss the side effects of any prescription drugs you may be taking, particularly if you experience anxiety symptoms that are distressing to you.
Non-prescription drugs can also cause anxiety symptoms. This would include drugs that contain caffeine (Anacin®, Empirin®, Excedrin®). Many cold and flu medications list anxiousness as a side effect (particularly decongestants and cough syrups). While not typically considered drugs by most people, excessive caffeine use (coffee, teas, certain sodas); nicotine use (cigarettes, "chew," and quit-smoking aids); and alcohol, have all been known to cause, or aggravate a pre-existing anxiety disorder. Similarly, withdrawal from these substances can precipitate anxiety symptoms.
The use and withdrawal from several street drugs are also implicated in precipitating, or worsening, an anxiety disorder. These include cocaine (including "crack"), methamphetamine ("meth"), and marijuana ("pot").
Other Specified or Unspecified Anxiety Disorder
Someone may not fully meet the diagnostic criteria for a particular anxiety disorder. For instance, un-cued (unexpected) panic attacks are a diagnostic criterion for Panic Disorder. A person might meet all the diagnostic criteria for Panic Disorder except one. Instead of un-cued (unexpected) panic attacks, they experience limited symptom panic attacks. Although they do not meet the full criteria, it may still be worthwhile to note these anxiety symptoms if they cause significant distress or impairment. In this case, they could receive a diagnosis of Other Specified Anxiety Disorder.
Other Unspecified Anxiety Disorder is used when there are anxiety-like symptoms that cause significant distress or impaired functioning. However, there is insufficient information to determine what particular type of Anxiety Disorder may be present. This situation may occur in emergency room settings, where a complete history and full psychiatric evaluation are not always feasible.