How are Anxiety disorders classified in the ICD 10?

In this blog we will discuss what Anxiety disorders in the ICD 10.

We will also briefly discuss what is the diagnostic criteria for anxiety in ICD 10 and the various anxiety disorders categorised in the ICD10.

How are Anxiety disorders classified in the ICD 10?

Anxiety disorders in the International Classification of Diseases and Related Health Problems (ICD-10) have been categorised together with other stress realtor disorders, somatoform disorders and neurotic disorders.

This has been done because these three disorders have a shared link with neurological causes as well as neuropsychological causation due to which classification has been done together. 

Another reason why the classification is in one cluster is because of the similarity in symptoms and the similarities in treatment options for these conditions. 

Though the classification of the anxiety disorders are different from the DSM 5, anxiety in the ICD-10 and other psychological disorders are diagnosed and differentially diagnosed on the basis of criteria in Diagnostic and Statistical Manual of Disorder (DSM-V).

The criteria for the diagnosis is more or less the same however there are differences in the classification with other disorders, coding, and reporting systems for both of these two classification systems. 

What is the diagnostic criteria for Anxiety in ICD-10?

The 10th revision of the International Statistical Classification of Disease (ICD-10) provides similar diagnostic criteria as the DSM 5 however, there are some small differences in terms of reporting systems and coding.

Let us consider the diagnostic criteria for General Anxiety disorder in the ICD 10:

There should be a  period of at least six months with prominent tension, worry, and feelings of apprehension, about everyday events and problems.

The individual should manifest at least four symptoms out of the following list of items:

Autonomic arousal symptoms

  • Palpitations or pounding heart, or accelerated heart rate.
  • Sweating.
  • Trembling or shaking.
  • Dry mouth (not due to medication or dehydration).

Symptoms concerning chest and abdomen

  • Difficulty breathing.
  • Feeling of choking.
  • Chest pain or discomfort.
  • Nausea or abdominal distress (e.g. churning in the stomach).

Symptoms concerning brain and mind

  • Feeling dizzy, unsteady, faint or light-headed.
  • Derealization Depersonalization.
  • Fear of losing control, going crazy, or passing out.
  • Fear of dying.

General symptoms

  • Hot flashes or cold chills.
  • Numbness or tingling sensations.

Symptoms of tension

  • Muscle tension or aches and pains.
  • Restlessness and inability to relax.
  • Feeling keyed up, or on edge, or of mental tension.
  • A sensation of a lump in the throat or difficulty with swallowing.

What are the Anxiety disorders categorised in ICD 10?

The various anxiety disorders that has been classified and recognised in the ICD 10 include the following:

F40: Phobic anxiety disorders 

Phobic anxiety disorders refer to a group of disorders where people experience intense anxiety only when they are faced with their triggers and their reaction is inappropriate to the danger presented by these situations. 

Due to intense anxiety, people tend to avoid these situations or triggers or endure them with dread while experiencing symptoms like palpitations or feeling faint and is often associated with secondary fears of dying, losing control, or going mad. 

Phobic anxiety and depression often coexist and in some cases can cause disruption of daily life and cause social and occupational dysfunction in some. 

F40.0 Agoraphobia 

Agoraphobia refers to the anxiety disorder that is marked by the fear of public spaces but now its usage has increased to the aspects related to open spaces.

People with this disorder often perceive environments that are too open or crowded to be dangerous. This sense of danger and fear is driven by an irrational fear of being anxious, humiliated, having a panic attack or being trapped with no source of help. 

Such a condition comes with high anxiety of crowded spaces and can often lead to panic attacks which can further result in more fear and anxiety leading them to actively avoid engaging with such circumstances and often becoming shut-ins. 

According to the ICD10 panic disorders are also strongly associated with thai disorder and often people who are able to avoid trigger situations experience little anxiety. 

F40.1 Social phobias

Social anxiety disorder, also called social phobia, is characterised by an overwhelming fear of social situations that usually begin during teenage years and might persist unless there is effective intervention. 

This particular disorder is plagued by various thoughts related to social situations and an intense and deliberate aversion and avoidance of social situations. 

It affects the person’s daily functioning and causes disruption in one’s life, sense of self, work, and relationships. The symptoms of this disorder include:

  • worry about everyday activities, such as meeting strangers, starting conversations, speaking on the phone, working or shopping
  • avoid or worry a lot about social activities
  • find it difficult to do things when others are watching 
  • Preoccupied with the thought that they are being judged.
  • fear being criticised
  • avoid eye contact
  • or have low self-esteem
  • often have symptoms like sweating, trembling or a pounding heartbeat (palpitations) in social situations.
  • panic attacks

This disorder can be discrete (i.e. it is restricted to public speaking, or to eating in public places, or to encounters with opposite sex) or it can be diffuse which mean the sufferer avoids all type of social situations outside of family circle.

People with this disorder often have very low self esteem and often believe that their physical and behavioural reactions or symptoms are also part of the problem.

F40.2 Specific (isolated) phobias

This particular diagnosis is given when an individual experiences anxiety due to phobias that are highly specific situations such as proximity to particular animals, heights, thunder, darkness, flying, closed spaces, urinating or defecating in public toilets, eating certain foods, dentistry, or the sight of blood or injury. 

Certain phobias under this diagnostic category include:

  • Acrophobia
  • Animal phobias
  • Claustrophobia
  • Simple phobia

The onset is often childhood or early adulthood usually due to negative experiences and associations created due to traumatic and negative experiences with these situations and triggers.

A person will develop symptoms of the phobia when they get into a situation in which they could end up alone and these symptoms include:

  • Spending to much time obsessively worrying about triggers
  • a feeling of extreme terror when alone or in a situation they are forced to be in that situatation.
  • an overwhelming desire to avoid triggers

When Individual feel threatened or triggered by they might experience the following physical symptoms:

  • sweating
  • trembling
  • hot flashes or chills
  • shortness of breath or difficulty breathing
  • a choking sensation
  • rapid heartbeat (tachycardia)
  • pain or tightness in the chest
  • nausea
  • headaches and dizziness
  • feeling faint
  • numbness or pins and needles
  • dry mouth
  • ringing in your ears
  • confusion or disorientation
  • hyperventilation

F41.0 Panic disorder 

In this disorder, the ICD10 identifies recurrent panic attacks as an essential feature marked by severe anxiety that is not specific to any particular situation or circumstances and is unpredictable in nature.

Individuals who experience panic attacks tend to also experience other symptoms such as:

  • Heightened vigilance for their own physical symptoms
  • Anxious and irrational thinking
  • A strong feeling of dread
  • Fear of going mad, losing control, or dying
  • Feeling lightheaded and dizzy
  • Tingling and chills, particularly in the arms and hands
  • Trembling
  • Sweating
  • Hot flushes
  • Accelerated heart rate
  • A feeling of constriction in the chest
  • Breathing difficulties, including shortness of breath 
  • Nausea or abdominal distress
  • Tense muscles
  • Dry mouth
  • Depersonalization and derealisation.

Individuals who experience panic attacks also develop this intense anxiety and fear of the panic attacks reoccurring that this anxiety and worry eventually leads to a panic attack because of heightened stress. When it recurs frequently over a short amount of time, the individual is believed to have Panic Disorder. 

F41.1 Generalised anxiety disorder

Generalised anxiety also known as Free-floating anxiety refers to an anxiety disorder where the anxiety is not specific to a situation or object.

This anxiety disorder is characterised by persistent and excessive worry about a number of different things. 

People who are affected by this disorder experience worry and anxiety that is more severe than normal levels of worry and this particular experience persists for long periods of time, sometimes even years. 

They worry often about anticipated disasters, concerns about money, family members, and loved ones, health, and other various worries that are often inappropriate to the real levels of threat. 

People who have this particular disaster worry even when there is no actual threat and their anxiety and worry often affect their health, their relationships, their ability to work, and also socialise with others. 

They find it hard to control this worry and anxiety and it often affects their day to day activities including being able to focus on tasks at hand and also their sleep. 

People experience excessive anxiety and worry occurring more days than not for at least 6 months about a number of events and activities such as performance at work, health, disasters etc)

The individual finds it difficult to control the worry.

The anxiety and worry symptoms are also associate with three or more of the following symptoms that have been present for more days than not for at least 6 months:

  • Restlessness, feeling keyed up or on edge.
  • Being easily fatigued.
  • Difficulty concentrating or mind going blank.
  • Irritability.
  • Muscle tension.
  • Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

F41.2 Mixed anxiety and depressive disorder

This diagnosis is given when an individual manifests symptoms of anxiety ICD-10 and depression but symptoms are interconnected.

This means that the individual meets the criteria for generalised anxiety disorder and also has prominent features of disorders of the same anxiety cluster along with depression symptoms.

Here, the symptoms of anxiety and depression are both present, but neither is clearly predominant and neither of the symptoms are severe enough to justify a diagnosis if considered separately. 

In the case that both anxiety and depressive symptoms are severe enough to justify a single, individual diagnosis, both diagnoses should be recorded and this diagnosis should not be used. 

F41.3 Other mixed anxiety disorders

This diagnosis is applied when there are observable symptoms of anxiety mixed with features of other disorders in F42-F48 but the symptoms are not severe enough to justify a diagnosis separately.

Conclusion

In this blog we discussed what Anxiety disorders in the ICD 10.

We also briefly discussed what is the diagnostic criteria for anxiety in ICD 10 and the various anxiety disorders categorised in the ICD10.

References

World Health Organisation. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organisation.

International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for ;2016. Retrieved on 22nd March 2022. https://icd.who.int/browse10/2016/en#F40.0

Andrews G, Slade T. The classification of anxiety disorders in ICD-10 and DSM-IV: a concordance analysis. Psychopathology. 2002 Mar-Jun;35(2-3):100-6. doi: 10.1159/000065127. PMID: 12145492.

Please give us feedback

Leave a Reply

Your email address will not be published.