Table 1.

Examples of anxiety-related symptoms exhibited in a medical setting.

DSM-5 Description *	Developmentally Typical/Appropriate	Signs of Anxiety Disorder	Presentation in Medical Setting
Specific phobia: Marked fear or anxiety about a specific object or situation (e.g., blood-injection-injury type)	Young child cries in anticipation of vaccination during routine well child visit	Child anticipates the need for an injection well ahead of a scheduled visit; seeks reassurance from parent; refuses to get in the car; requires parent or staff to restrain her	Child screams, lashes out, and tries to escape necessary blood draws; requires repeated physical restraint
Separation anxiety disorder: Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached	Child experiences tearfulness and clinginess on the first day of school or when staying with a sitter	Child refuses to attend school or requires escort from the car to the school building; child will not sleep alone; child must be in a room with an adult at all times, even at home	Parent must sleep in the hospital bed with the child; child will not allow parent to leave the room; child requires sedation before being taken from the parent’s presence for procedures
Generalized anxiety disorder (GAD): Excessive anxiety and worry (apprehensive expectation) about different events or activities. The child finds the worry difficult to control, and it is associated with behavioral or physical symptoms	Child has occasional difficulty falling asleep due to worries about grades or tests	Child is described as a “worry wart”, with worries across different domains; with insomnia, fatigue, restlessness, irritability, trouble concentrating, or muscle tension; excessive reassurance that fears will not be realized is needed	Child exhibits excessive worries, particularly treatment failure or death; requires constant reassurance; asks questions repeatedly; has difficulty falling asleep; demonstrates symptoms inconsistent with or in excess to what may be caused by the medical condition or its treatment (e.g., headache, stomachache)
Panic attack: An abrupt surge of intense fear or discomfort, during which time the following may be experienced: accelerated heart rate, sweating, shaking, shortness of breath, chest pain, sense of choking, GI distress, dizziness, feeling hot or having chills	Child experiences physiological sensations in anxiety-provoking situations	Child experiences physiological sensations in response to stress or “out of the blue”, along with catastrophic thoughts about symptoms and avoids situations in which similar symptoms may be anticipated	Child experiences physiological sensations catastrophic thoughts, and avoidance Symptoms may mimic those of medical illness Symptoms due to the underlying illness may trigger full panic attacks

* Adapted from the Diagnostic and Statistical Manual of Mental Disorders—5th Edition (DSM-5).