Table 3.
Distinguishing developmentally appropriate anxiety features from symptoms of anxiety disorders
| Anxiety disorders (typical age of onset) | Developmentally appropriate fears and worries | Symptoms suggestive of anxiety disorder |
|---|---|---|
| Separation anxiety disorder (Preschool) | Self-limiting distress around new separations from parent (e.g., for child care) | − Clinging or closely following aparent − Inconsolable distress, somatization during transitions − Unfounded worries about parent injury, illness, or death |
| Selective mutism (Preschool) | Taking time to ‘warm up’ in social situations | − Being unable to speak in specific situations (e.g., in school) |
| Specific phobia (Preschool to school age) | Time-limited fear of new objects or situations (e.g., dogs, noise, or high places) | − Fears persist and appear out of proportion to actual risk, leading to avoidance and diminishing quality of life or function |
| Social anxiety disorder (social phobia) (Late school age, early adolescence) | Discomfort or hesitation around social events or requests to ‘perform’ | − Excessive, persistent fear of scrutiny − Avoidance (e.g., of school, social events) or compromised involvement in family or community activities − Somatization with social interactions or performance |
| Panic disorder (Adolescence, young adulthood) | Transient concerns about physiological symptoms (e.g., worrying about recurrence after an episode of vertigo) | − Recurrent panic attacks (feeling out of control, with somatic symptoms) − Fear of panic attacks and avoidance of associated situations − Worries about associated health risks(e.g., for heart attack) |
| Agoraphobia (Late adolescence, young adulthood) | Transient reluctance to use public transportation, to be in crowded or enclosed places, crowds, or to be outside of the home alone | − Persistent avoidance of two or more locations based on fears of not being able to escape or summon help |
| Generalized anxiety disorder (Late school age through young adulthood) | Transient worries about grades, health, or world events that do not impair participation in school, family, or community | − Constant, excessive worry about risk that impairs participation in multiple events or activities − Trouble sleeping, physical restlessness, irritability, trouble concentrating, muscle tension |