Cognitive Connie
DSM-5 & ICD-10 Classification of Anxiety Disorders
Anxiety disorders are among the most prevalent mental health conditions worldwide, yet their classification has been revised substantially over recent decades. The two dominant systems — DSM-5 (American Psychiatric Association, 2013) and ICD-10 (World Health Organization) — agree on the broad landscape of anxiety disorders but differ in meaningful ways: which conditions belong in the chapter, how duration thresholds are set, whether conditions are bundled or split, and how much weight is given to autonomic versus cognitive symptoms.
Key figures
World Health Organization
ICD-10 in use since 1992The International Classification of Diseases (10th revision) groups most anxiety disorders under F40–F41 but retains Elective Mutism (F94.0) in childhood social functioning disorders and Hypochondriacal Disorder (F45.2) in somatoform disorders. ICD-11, published in 2019, realigns more closely with DSM-5 in several areas.
American Psychiatric Association
DSM-5 published 2013The fifth edition of the Diagnostic and Statistical Manual separated Agoraphobia from Panic Disorder, expanded Separation Anxiety to adults, reclassified Selective Mutism under Anxiety Disorders, and moved Illness Anxiety Disorder (formerly Hypochondriasis) to the Somatic Symptom chapter.
Key concepts
Separation Anxiety Disorder — DSM-5
Excessive fear or anxiety concerning separation from attachment figures, developmentally inappropriate and present for at least 4 weeks in children/adolescents or 6 months in adults. DSM-5 (2013) expanded the diagnosis across the lifespan, removing the earlier DSM-IV requirement that onset occur before age 18. Symptoms must cause significant distress or functional impairment.
Separation Anxiety Disorder — ICD-10 (F93.0)
Coded as F93.0 "Separation Anxiety Disorder of Childhood" within Chapter F93 (Emotional Disorders with Onset Specific to Childhood). ICD-10 restricts the diagnosis to childhood onset — a key difference from DSM-5, which recognises adult presentations. Symptoms include excessive distress upon separation, worry about losing attachment figures, and reluctance to be alone.
Selective Mutism — DSM-5
Consistent failure to speak in specific social situations (e.g., school) despite speaking in other contexts, present for at least 1 month (not limited to the first month of school), interfering with educational or occupational achievement. Classified under Anxiety Disorders in DSM-5, reflecting evidence that the behaviour is anxiety-driven rather than oppositional or volitional.
Elective Mutism — ICD-10 (F94.0)
The ICD-10 equivalent, coded F94.0 under F94 "Disorders of Social Functioning with Onset Specific to Childhood and Adolescence." ICD-10 retains the older term "Elective" (implying some element of choice), whereas DSM-5 renamed it "Selective" to reflect contextual specificity rather than volition. ICD-10 places it outside the anxiety disorders block.
Specific Phobia — DSM-5
Marked fear or anxiety about a specific object or situation, typically provoking immediate fear response, actively avoided or endured with intense anxiety, out of proportion to actual danger, and persistent (typically 6+ months). Five specifier types: Animal, Natural Environment, Blood-Injection-Injury, Situational, and Other. "Social type" is NOT a valid specifier — that is Social Anxiety Disorder.
Specific (Isolated) Phobias — ICD-10 (F40.2)
Coded F40.2 within the phobic anxiety disorders block (F40). F40 also contains F40.0 (Agoraphobia) and F40.1 (Social Phobias). ICD-10's term "isolated phobias" emphasises the discrete, circumscribed nature of the fear. The structure closely parallels DSM-5, though ICD-10 provides less prescriptive duration criteria.
Social Anxiety Disorder — DSM-5
Marked fear or anxiety about social situations in which the person may be scrutinised by others. The fear is that the person will act in a way that will be humiliating or embarrassing, or that anxiety symptoms will be negatively evaluated. Symptoms must persist for 6 months or more. DSM-5 added a "performance only" specifier for those whose fear is confined to public speaking/performance.
Social Phobia — ICD-10 (F40.1)
Coded F40.1 under Phobic Anxiety Disorders. Centres on a fear of scrutiny by other people leading to avoidance of social situations. ICD-10 does not specify a minimum 6-month duration (unlike DSM-5), and does not include the "performance only" specifier. Both systems recognise that the fear extends beyond shyness to significant avoidance and distress.
Panic Disorder — DSM-5
Recurrent unexpected panic attacks followed by at least 1 month of (a) persistent concern or worry about further attacks or their consequences, or (b) significant maladaptive behavioural change related to the attacks. In DSM-5, Panic Disorder and Agoraphobia are fully independent diagnoses — a key change from DSM-IV where Agoraphobia was a specifier of Panic Disorder.
Panic Disorder — ICD-10 (F41.0)
Also termed "Episodic Paroxysmal Anxiety" in ICD-10, coded F41.0 under Other Anxiety Disorders (F41). Unlike DSM-5, ICD-10 permits Agoraphobia to be coded with panic as a single category under F40.0. ICD-10 F41.0 thus represents Panic Disorder without significant agoraphobia, while F40.01 captures Agoraphobia with Panic Disorder.
Agoraphobia — DSM-5
Marked fear or anxiety about two or more of five situational categories: public transport, open spaces, enclosed places, queues/crowds, and being outside the home alone. The person fears these situations because escape might be difficult or help unavailable during a panic attack or incapacitating symptom. Situations are actively avoided or require a companion. DSM-5 codes Agoraphobia independently of Panic Disorder.
Agoraphobia — ICD-10 (F40.0)
Classified F40.0 within Phobic Anxiety Disorders. ICD-10 provides two subcategories: F40.00 (Agoraphobia without panic disorder) and F40.01 (Agoraphobia with panic disorder). The bundled coding contrasts with DSM-5's full separation. ICD-10 Agoraphobia includes fear of crowds, public places, and situations from which escape might be difficult.
Generalised Anxiety Disorder — DSM-5
Excessive anxiety and worry about numerous events or activities, occurring more days than not for at least 6 months, that the person finds difficult to control. Adults must show 3 of 6 associated symptoms: restlessness/on edge, easy fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance (children require only 1). The worry is not confined to a single theme.
Generalised Anxiety Disorder — ICD-10 (F41.1)
Coded F41.1 under Other Anxiety Disorders. Key difference from DSM-5: ICD-10 places greater emphasis on autonomic symptoms (palpitations, sweating, trembling, dry mouth) as part of the primary symptom cluster. ICD-10 does not specify a 6-month minimum with the same rigour, and gives a longer symptom checklist including motor tension and hypervigilance alongside autonomic features.
Anxiety Disorder Due to Another Medical Condition — DSM-5
Prominent anxiety or panic attacks that are the direct physiological consequence of another medical condition (e.g., hyperthyroidism, pheochromocytoma, cardiac arrhythmia, hypoglycaemia). Critically, a psychological reaction to having a medical illness does not qualify — the condition must cause anxiety through a direct biological mechanism. Specifiers indicate the dominant symptom type.
Substance/Medication-Induced Anxiety Disorder — DSM-5
Prominent anxiety or panic attacks that develop during or shortly after substance intoxication/withdrawal, or following exposure to a medication. The diagnosis is NOT made if symptoms are better explained by an independent anxiety disorder that preceded substance use, or if symptoms persist for a substantial period beyond acute withdrawal. Many substances (caffeine, stimulants, cannabis, alcohol withdrawal) can produce anxiety syndromes.
Illness Anxiety Disorder — DSM-5 (Somatic Symptom Chapter)
Preoccupation with having or acquiring a serious illness, with absent or mild somatic symptoms. The preoccupation causes significant distress or functional impairment and persists for at least 6 months. Importantly, DSM-5 places this under "Somatic Symptom and Related Disorders" — NOT the Anxiety Disorders chapter — reflecting the centrality of illness preoccupation over anxiety per se. It replaces much of what was previously called Hypochondriasis.
Hypochondriacal Disorder — ICD-10 (F45.2)
Coded F45.2 under Somatoform Disorders (F45) in ICD-10. Characterised by a persistent preoccupation with the possibility of having one or more serious disorders, despite medical reassurance. Like DSM-5's placement outside the anxiety chapter, ICD-10 also groups this with somatoform presentations rather than with F40–F41 anxiety disorders, recognising the distinct phenomenology of illness preoccupation.
Test your knowledge
Frequently asked questions
Why is Illness Anxiety Disorder not in the DSM-5 Anxiety Disorders chapter?+
DSM-5 moved Illness Anxiety Disorder (and its close relative Somatic Symptom Disorder) to a new chapter called "Somatic Symptom and Related Disorders." The rationale is that the defining feature of Illness Anxiety Disorder is preoccupation with the idea of having a serious illness — not anxiety per se. While anxiety is a common accompaniment, the cognitive content differs from prototypical anxiety disorders: the focus is on illness belief and health-seeking or avoidance behaviours, not threat appraisal in social, separation, or situational contexts. Placing it alongside somatic presentations better captures its clinical phenomenology and helps clinicians distinguish it from GAD (where worry ranges across many topics) and health-related OCD (where intrusive thoughts and compulsions are central).
How does DSM-5 differ from ICD-10 in its handling of Agoraphobia and Panic Disorder?+
This is one of the most clinically significant structural differences between the two systems. DSM-5 treats Panic Disorder and Agoraphobia as two entirely separate diagnoses that can occur independently or comorbidly. A person can have Agoraphobia without ever having a panic attack, and can have Panic Disorder without developing agoraphobic avoidance. ICD-10, by contrast, codes Agoraphobia under F40.0 with two subtypes: F40.00 (without panic disorder) and F40.01 (with panic disorder) — treating the combination as a specifier within a single category. Epidemiological data support the DSM-5 approach: community studies find that roughly one-third of people with Agoraphobia have no history of Panic Disorder.
What are the key duration criteria differences across DSM-5 anxiety disorders?+
Duration criteria vary considerably across disorders. Selective Mutism requires only 1 month. Separation Anxiety Disorder requires 4 weeks in children/adolescents but 6 months in adults. Social Anxiety Disorder, Specific Phobia, Agoraphobia, and GAD all require 6 months. Panic Disorder requires 1 month of persistent concern following the initial attack. Illness Anxiety Disorder requires 6 months. ICD-10 is generally less prescriptive about specific minimum durations, which can lead to earlier diagnosis but potentially lower specificity.
Sources
Last reviewed July 2025- 1.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). APA Publishing. https://doi.org/10.1176/appi.books.9780890425596
+About this source
Primary source for all DSM-5 diagnostic criteria, chapter placements, specifiers, and duration thresholds covered in this theme.
- 2.
World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO. https://www.who.int/publications/i/item/9241544228
+About this source
Primary source for all ICD-10 F-codes and diagnostic criteria described in this theme, including F40–F41, F45.2, F93.0, and F94.0.