The Classification of Anxiety and Fear-Related Disorders in the ICD-11: Review: Anxiety and Fear-Related Disorders in ICD-11

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Anxiety disorders are the most prevalent mental disorders across the world with median lifetime prevalence of 14.3% and 12-month prevalence of 8.3%.

“Anxiety disorders are the most prevalent mental disorders across the world with median lifetime prevalence of 14.3% and 12-month prevalence of 8.3%.[1]”

• cites [1] Kessler, 2009, The WHO World Mental Health (WMH) Surveys, Psychiatrie sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The ICD-11 guidelines alert clinicians to the diversity of emotional reactions (e.g., shame, disgust, anger) that may manifest in anxiety and fear-related disorders.

“the ICD-11 guidelines also alert clinicians to the diversity of emotional reactions (e.g., shame, disgust, anger) that may manifest in these disorders.[42][43][44][45][46]”

• cites [42] Cisler, 2009, Disgust, fear, and the anxiety disorders: a critical review, Clin Psychol Rev sourcePartly supported

  The Introduction and Abstract say that disgust, in addition to fear and anxiety, can characterize certain anxiety disorders. They do not address ICD-11 guidelines or say that those guidelines alert clinicians to shame, disgust, and anger; the guidelines mentioned in the Abstract are recommendations for future research. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [43] Fergus, 2010, Shame- and guilt-proneness: relationships with anxiety disorder symptoms in a clinical sample, J Anxiety Disord sourceNot checked — no full text of the source
• cites [44] Hawkins, 2011, Anger problems across the anxiety disorders: findings from a population-based study, Depress Anxiety sourcePartly supported

  The Discussion (page unavailable) reports a relationship between anger and multiple anxiety disorders and suggests that clinicians assess anger. This supports anger as an emotional reaction in these disorders, but the paper does not address shame, disgust, or what the ICD-11 guidelines tell clinicians. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

• AssumptionRests on an assumption: The proposed changes to the ICD-11 classification of anxiety and fear-related disorders will improve clinical utility and global applicability.

May combine two claims.

Hypochondriasis (health anxiety disorder) is a condition characterized by distress and anxiety about bodily symptoms but is proposed for classification among the ICD-11 grouping of obsessive-compulsive and related disorders based on several lines of evidence.

“hypochondriasis (health anxiety disorder) is a condition characterized by distress and anxiety about bodily symptoms but that is proposed for classification among the ICD-11 grouping of obsessive-compulsive and related disorders based on several lines of evidence, [47,49]”

• cites [47] Stein, 2016, The classification of obsessive-compulsive and related disorders in the ICD-11, J Affect Disord sourceSupported
• cites [49] den Heuvel, 2014, Hypochondriasis: considerations for ICD-11, Rev Bras Psiquiatria sourceSupported

May combine two claims.

ICD-11 includes selective mutism in the classification of anxiety and fear-related disorders because it is considered to be a childhood presentation consistent with the features of anxiety and fear-related disorders.

“So, ICD-11 includes selective mutism (called elective mutism in ICD-10) in the classification of anxiety and fear-related disorders because it is considered to be a childhood presentation that is consistent with the features of anxiety and fearrelated disorders.[52]”

• cites [52] Bogels, 2010, Social anxiety disorder: questions and answers for the DSM-V, Depress Anxiety sourcePartly supported

  In 'Is Selective Mutism a Form of SAD?' the paper describes selective mutism as an early-onset childhood condition associated with anxiety. Its Conclusions say it may be a young child’s variant of social anxiety disorder. The paper does not establish that ICD-11 includes selective mutism among anxiety and fear-related disorders or give ICD-11’s reason for doing so. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

The essential features in ICD-11 represent a substantively different approach to operationalizing the diagnoses that is intended to be more clinically useful than the highly specified polythetic criteria sets in the American Psychiatric Association's classification.

“the essential features in ICD-11 represent a substantively different approach to operationalizing the diagnoses that is intended to be more clinically useful than the highly specified polythetic criteria sets in the American Psychiatric Association's classification.[18]”

• cites [18] First, 2015, The development of the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders, World Psychiatry sourceSupported

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Assigning multiple diagnoses is sometimes the best way to capture the complexity of clinical presentations and may be viewed in part as a marker of disorder severity.

“Assigning multiple diagnoses is sometimes the best way to capture the complexity of clinical presentations and may be viewed in part as a marker of disorder severity.[32]”

• cites [32] Maj, 2005, “Psychiatric comorbidity”: an artefact of current diagnostic systems?, Br J Psychiatry sourcePartly supported

  On p. 1, Maj says identifying clinical aspects beyond the principal diagnosis can improve clinical management. In “Psychiatric Comorbidity and the Nature of Psychopathology” (p. 2), he links greater clinical complexity to greater severity. He does not say that assigning multiple diagnoses is sometimes the best way to capture that complexity; he cautions that doing so can artificially split a condition and hinder a holistic view. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The rationale for introducing a separate obsessive-compulsive and related disorder grouping is based in part on common clinical features of repetitive unwanted thoughts and associated behaviors, as well as on emerging evidence from imaging, neurochemical, and genetic studies.

“The rationale for introducing a separate obsessivecompulsive and related disorder grouping has been reviewed elsewhere, [47] and is based in part on common clinical features of repetitive unwanted thoughts and associated behaviors, as well as on emerging evidence from imaging, neurochemical, and genetic studies.”

• cites [47] Stein, 2016, The classification of obsessive-compulsive and related disorders in the ICD-11, J Affect Disord sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The grouping of disorders specifically associated with stress brings together disorders in which the experience of an identifiable stressor is a requirement (though not sufficient) for manifestation of the condition.

“The grouping of disorders specifically associated with stress brings together disorders in which the experience of an identifiable stressor is a requirement (though not sufficient) for manifestation of the condition.[48]”

• cites [48] Maercker, 2013, Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11, World Psychiatry sourceSupported

May combine two claims.

Reification of distinctions between groupings has been mitigated by including practical guidance on how to differentiate between disorders with shared phenomenology and by omitting arbitrary non-evidenced based symptom counts or duration thresholds from the disorder guidelines.

“Reification of distinctions between groupings has also been mitigated by the inclusion of practical guidance on how to differentiate between disorders with shared phenomenology as well as by omitting arbitrary non-evidenced based symptom counts or duration thresholds from the disorder guidelines.[18]”

• cites [18] First, 2015, The development of the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders, World Psychiatry sourceSupported

Classified as probably not a substantial claim. May combine two claims.

Including additional qualifiers when there are no treatment implications is an example of overspecification that WHO is attempting to avoid in the ICD-11 diagnostic guidelines because it poses unnecessary demands for the clinician, thereby reducing the clinical utility of the classification.

“Including additional qualifiers when there are no treatment implications is an example of the type of overspecification that WHO is attempting to avoid in the ICD-11 diagnostic guidelines [18] because it poses unnecessary demands for the clinician, thereby reducing the clinical utility of the classification.”

• cites [18] First, 2015, The development of the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders, World Psychiatry sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Recent epidemiological data from 18 countries suggest that separation anxiety disorder is common, significantly impairing, predictive of adult emotional disorders when onset is during childhood, and, conversely, predicted by childhood emotional disorder when onset occurs in adulthood.

“Recent epidemiological data from 18 countries suggest that separation anxiety disorder is common, significantly impairing, predictive of adult emotional disorders when onset is during childhood, and, conversely, predicted by childhood emotional disorder when onset occurs in adulthood.[88]”

• cites [88] Silove, 2015, Pediatric-onset and adult-onset separation anxiety disorder across countries in the World Mental Health Survey, Am J Psychiatry sourcePartly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Andrews et al. point out that individuals with symptoms that have persisted for less than 3 months likely include those experiencing transient responses to life stressors.

“Andrews et al. [71] point out that individuals with symptoms that have persisted for less than 3 months likely include those experiencing transient responses to life stressors.”

• cites [71] Andrews, 2010, Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V, Depress Anxiety sourcePartly supported

  In “DSM-V Options for ‘A Number of Events or Activities’” (page unavailable), the review says the former 1-month threshold reduced GAD’s distinction from ordinary anxious reactions to life events. It does not say that people with symptoms lasting less than 3 months likely include those having transient responses to stressors; it presents the concern as a possible criticism of shorter thresholds while recommending a 3-month threshold. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The ICD is used for a range of purposes from making individual diagnoses at the encounter level to providing data for setting global health policy priorities.

“As a key public health instrument, the ICD is used for a range of purposes from making individual diagnoses at the encounter level to providing data for setting global health policy priorities.[37]”

• cites [37] International Advisory Group for the Revision of Mental and Behavioural Disorders, 2011, A conceptual framework for the revision of the ICD-10 classification of mental and behavioural disorders, World Psychiatry sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The Global Clinical Practice Network currently includes more than 12,600 health professionals from 150 countries who are participating in ICD-11 field studies.

“Participants in these internet-based studies are members of the Global Clinical Practice Network [93] (see http://gcp.network), which currently includes more than 12,600 health professionals from 150 countries who are participating in ICD-11 field studies.”

• cites [93] Reed, 2015, WHO's Global Clinical Practice Network for mental health, Lancet Psychiatry sourcePartly supported

  The paper’s main text says GCPN members participate in ICD-11 field studies. It reports more than 11,700 professionals from 139 countries, however, not the claimed more than 12,600 from 150 countries. No page number is available in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

The ICD-11 provides clinicians with essential features for a disorder that they could reasonably expect to see in all cases of the disorder.

“In contrast, the ICD-11 provides clinicians with essential features for a disorder that they could reasonably expect to see in all cases of the disorder, and which are intended to provide greater latitude for clinical judgment and cultural variation in presentation.[18]”

• cites [18] First, 2015, The development of the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders, World Psychiatry sourceSupported

May combine two claims.

The proposed ICD-11 diagnostic guidelines for anxiety and fear-related disorders are now being subjected to field testing in multiple languages using standardized case descriptions to evaluate whether clinicians interpret and are able to apply them as intended, sources of diagnostic disagreement, clinical utility, and which aspects may require additional development because they are ambiguous or

“The proposed ICD-11 diagnostic guidelines for anxiety and fear-related disorders are now been subjected to field testing in multiple languages using standardized case descriptions [91,92] to evaluate whether clinicians interpret and are able to apply them as intended, sources of diagnostic disagreement, clinical utility, and which aspects may require additional development because they are”

• cites [91] Keeley, 2016, Disorders specifically associated with stress: a case-controlled field study for ICD-11 Mental and Behavioural Disorders, Int J Clin Health Psychol sourcePartly supported

  The Field trial process and rationale and Method > Materials sections describe multilingual testing with standardized case descriptions to assess clinicians’ diagnostic decisions. The Discussion also addresses clinical utility and areas needing clarification. But this study tested Disorders Specifically Associated with Stress, not anxiety and fear-related disorders; our copy does not establish that the latter were being field-tested. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [92] Keeley, 2016, Developing a science of clinical utility in diagnostic classification systems field study strategies for ICD-11 mental and behavioral disorders, Am Psychol sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants in the internet-based ICD-11 field studies are members of the Global Clinical Practice Network.

“Participants in these internet-based studies are members of the Global Clinical Practice Network [93] (see http://gcp.network), which currently includes more than 12,600 health professionals from 150 countries who are participating in ICD-11 field studies.”

• cites [93] Reed, 2015, WHO's Global Clinical Practice Network for mental health, Lancet Psychiatry sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The 194 member states of the World Health Organization agree to use the ICD as a framework for reporting country-level health statistics.

“The ICD is the most widely used diagnostic health classification worldwide and the 194 member states of the World Health Organization agree to use this classification as a framework for reporting country-level health statistics.”

• cites [37] International Advisory Group for the Revision of Mental and Behavioural Disorders, 2011, A conceptual framework for the revision of the ICD-10 classification of mental and behavioural disorders, World Psychiatry sourcePartly supported

  The paper’s “health statistics uses” section says ICD-10 is used for mandatory statistical reporting by WHO member countries, supporting the reporting-framework claim. But its opening discussion says WHO had 193 member countries, not 194. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

The ICD-11 essential features are intended to provide greater latitude for clinical judgment and cultural variation in presentation.

“In contrast, the ICD-11 provides clinicians with essential features for a disorder that they could reasonably expect to see in all cases of the disorder, and which are intended to provide greater latitude for clinical judgment and cultural variation in presentation.[18]”

• cites [18] First, 2015, The development of the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders, World Psychiatry sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The ICD is the most widely used diagnostic health classification worldwide.

“The ICD is the most widely used diagnostic health classification worldwide and the 194 member states of the World Health Organization agree to use this classification as a framework for reporting country-level health statistics.”

• cites [37] International Advisory Group for the Revision of Mental and Behavioural Disorders, 2011, A conceptual framework for the revision of the ICD-10 classification of mental and behavioural disorders, World Psychiatry sourceSupported

May combine two claims.

Co-occurrence of agoraphobia and panic disorder is permitted in ICD-11, eliminating the need for ICD-10 without panic disorder and with panic disorder qualifiers.

“Co-occurrence of these disorders is also permitted in ICD-11, eliminating the need for ICD-10”

• AssumptionRests on an assumption: The proposed changes to the ICD-11 classification of anxiety and fear-related disorders will improve clinical utility and global applicability.

Classified as probably not a substantial claim. May combine two claims.

The name social anxiety disorder has been changed to reflect common usage in contemporary research literature and to avoid unnecessary differences with DSM-5.

“Name has been changed to reflect common usage in contemporary research literature and to avoid unnecessary differences with DSM-5.”

• AssumptionRests on an assumption: The proposed changes to the ICD-11 classification of anxiety and fear-related disorders will improve clinical utility and global applicability.

Probably not a substantial claim: may not pass S3 (load-bearing).

Worldwide median delays between disorder onset and treatment range from 3 to 30 years.

“with worldwide median delays between disorder onset and treatment ranging from 3 to 30 years.[10]”

• cites [10] Wang, 2007, Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative, World PsychiatryNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

ICD-11 describes possible physiological manifestations of generalized anxiety.

“possible physiological manifestations of generalized anxiety are described”

May combine two claims.

Examination of structural relationships among mood and anxiety disorders and higher-order latent variables suggests that including existing anxiety disorder categories as subordinate variables accounts for significant additional variance, suggesting these are valid and separable psychopathological entities.

“examination of the structural relationships among the mood and anxiety disorders and these variables suggests that including existing anxiety disorder categories as subordinate variables accounts for significant additional variance, [39] suggesting that these are indeed valid and separable psychopathological entities.”

• cites [39] Brown, 1998, Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal, J Abnorm Psychol sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The treatment gap between those needing help and those receiving it exceeds 50% for generalized anxiety disorder and panic disorder.

“the”

• cites [9] Kohn, 2004, The treatment gap in mental health care, Bull World Health OrganNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The ICD-11 definition of panic attacks is conceptually similar to ICD-10.

“Definition of panic attacks conceptually similar to ICD-10.”

Classified as probably not a substantial claim.

Worry about multiple areas of everyday life has been introduced in ICD-11 as an alternative essential feature to generalized apprehension for GAD.

“Worry about multiple areas of everyday life has been introduced as an alternative essential feature to generalized apprehension”

Classified as probably not a substantial claim.

The proposal for ICD-11 is for all disorders with anxiety or fear as the primary clinical feature to be brought together in a new and distinct grouping titled anxiety and fear-related disorders.

“The proposal for ICD-11 is for all disorders with anxiety or fear as the primary clinical feature to be brought together in a new and distinct grouping titled anxiety and fear-related disorders.”

• AssumptionRests on an assumption: The proposed changes to the ICD-11 classification of anxiety and fear-related disorders will improve clinical utility and global applicability.

Classified as probably not a substantial claim.

Under ICD-11, contact with the feared stimulus that is endured with great anxiety is an acceptable alternative to active avoidance for specific phobia.

“Under ICD-11, contact with the feared stimulus that is endured with great anxiety is an acceptable alternative to active avoidance.”

• AssumptionRests on an assumption: The proposed changes to the ICD-11 classification of anxiety and fear-related disorders will improve clinical utility and global applicability.

Probably not a substantial claim: may not pass S4 (based).

Generalized anxiety disorder has been redefined based on available evidence.

“Generalized anxiety disorder Disorder has been redefined based on available evidence.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In ICD-11, the same concept is communicated by referencing fear (instead of phobic) in addition to anxiety in the title of the grouping.

“In ICD-11, the same concept is communicated by referencing fear (instead of phobic) in addition to anxiety in the title of the grouping.”

• AssumptionRests on an assumption: The proposed changes to the ICD-11 classification of anxiety and fear-related disorders will improve clinical utility and global applicability.

Classified as probably not a substantial claim. May combine two claims.

The symptoms of anxiety disorders are continuous with normality, and the requirement of significant distress or impairment is necessary to distinguish clinical disorder from non-pathological presentations.

“The symptoms of anxiety disorders are continuous with normality, and this last feature is necessary in order to distinguish clinical disorder from non-pathological presentations.”

Probably not a substantial claim: may not pass S3 (load-bearing).

ICD-11 provides a symptom duration guideline for GAD.

“a symptom duration guideline is provided”

Probably not a substantial claim: may not pass S2 (checkable).

The current ICD-11 revision represents an opportunity to improve the detection and treatment of anxiety disorders by providing valid diagnostic guidelines that are clinically useful and applicable across a broad range of global settings.

“The current revision represents an opportunity to improve the detection and treatment of anxiety disorders by providing valid diagnostic guidelines that are clinically useful and applicable across a broad range of global settings”

• AssumptionRests on an assumption: The proposed changes to the ICD-11 classification of anxiety and fear-related disorders will improve clinical utility and global applicability.

Classified as probably not a substantial claim.

When panic attacks occur in the context of other Anxiety and Fear-Related Disorders, they are conceptualized as episodes of severe anxiety that occur specifically in response to exposure to or anticipation of exposure to the feared stimulus or stimuli, reflecting the focus of apprehension specific to the disorder.

“When panic attacks occur in the context of other Anxiety and Fear-Related Disorders, they are conceptualized as episodes of severe anxiety that occur specifically in response to exposure to or anticipation of exposure to the feared stimulus or stimuli (i.e., reflect the focus of apprehension specific to the disorder).”

• AssumptionRests on an assumption: The proposed changes to the ICD-11 classification of anxiety and fear-related disorders will improve clinical utility and global applicability.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Panic disorder can manifest independently or co-occur with agoraphobia.

“Disorder can manifest independently or co-occur with agoraphobia.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Economic costs associated with anxiety disorders are among the highest of all mental disorders studied.

“Economic costs associated with anxiety disorders are among the highest of all mental disorders studied.[2][3][4][5][6]”

• cites [2] DuPont, 1996, Economic costs of anxiety disorders, Anxiety sourceNot checked — no full text of the source
• cites [3] Greenberg, 1999, The economic burden of anxiety disorders in the 1990s, J Clin Psychiatry sourceNot checked — no full text of the source
• cites [4] Grupp, 2014, Cost measurement of mental disorders in Germany, J Ment Health Policy EconNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

A categorical classification is currently best suited for clinical applications, given that the evidence base for intervention is almost entirely comprised of work on categorical entities, and as a basis for public policies.

“A categorical classification is currently best suited for clinical applications, given that the evidence base for intervention is almost entirely comprised of work on categorical entities, and as a basis for public policies, which typically require categorical decisions related to treatment and eligibility.[38]”

• cites [38] Kessler, 2002, The categorical versus dimensional assessment controversy in the sociology of mental illness, J Health Soc Behav sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Anxiety disorders have an early onset and chronic course, and are associated with considerable disability.

“Anxiety disorders have an early onset and chronic course, and are associated with considerable disability.[7,8]”

• cites [7] Mendlowicz, 2000, Quality of life in individuals with anxiety disorders, Am J Psychiatry sourceNot checked — no full text of the source
• cites [8] Patel, 2016, Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition, Lancet sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Such disorders include but are not limited to most obsessive-compulsive and related disorders and some disorders specifically associated with stress.

“Such disorders include but are not limited to most obsessive-compulsive and related disorders (e.g., obsessive-compulsive disorder, body dysmorphic disorder) and some disorders specifically associated with stress (e.g., posttraumatic stress disorder).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Selective mutism is included in the ICD-11 anxiety and fear-related grouping based on ICD-11's lifespan approach.

“Included in the anxiety and fear-related grouping based on ICD-11's lifespan approach.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

Selective mutism is conceptually similar to ICD-10.

“Conceptually similar to ICD-10.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

In adults, the focus of apprehension in separation anxiety disorder is typically separation from children or romantic partners.

“when the focus of apprehension is typically separation from children or romantic partners.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

Hypochondriasis will also be cross-referenced in the grouping of anxiety and fear-related disorders.

“but that will also be cross-referenced in the grouping of anxiety and fear-related disorders.”

May combine two claims.

Unlike ICD-10, the proposed ICD-11 guidelines do not separate childhood from adult disorders and instead recognize that the same disorders occur across the life span albeit with developmentally distinct presentations.

“Unlike ICD-10, the proposed ICD-11 guidelines do not separate childhood from adult disorders and instead recognize that the same disorders occur across the life span albeit with developmentally distinct presentations.[50,51]”

• cites [50] Rutter, 2011, Research review: child psychiatric diagnosis and classification: concepts, findings, challenges and potential, J Child Psychol Psychiatry sourceNot checked — no full text of the source
• cites [51] Rutter, 2012, Classification issues and challenges in child and adolescent psychopathology, Int Rev Psychiatry sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Separation anxiety disorder is included in the ICD-11 anxiety and fear-related disorders grouping based on ICD-11's lifespan approach.

“Included in the anxiety and fear-related disorders grouping based on ICD-11's lifespan approach.”

Probably not a substantial claim: may not pass S4 (based).

The tacit assumption in ICD-10 is of a temporal relationship such that individuals with panic disorder are likely to develop agoraphobic avoidance with the evolution of the illness, as panic attacks become increasingly associated with agoraphobic situations.

“The tacit assumption in ICD-10 is of a temporal relationship such that individuals with panic disorder are likely to develop agoraphobic avoidance with the evolution of the illness, as panic attacks become increasingly associated with agoraphobic situations.”

Probably not a substantial claim: may not pass S4 (based).

Mixed anxiety and depressive disorder was reclassified to reflect greater symptomatic relationship with depressive disorders, especially in primary care settings.

“Reclassified to reflect greater symptomatic relationship with depressive disorders, especially in primary care settings.”

Classified as probably not a substantial claim.

According to the ICD-10 Clinical Descriptions and Diagnostic Guidelines, panic disorder should not be diagnosed if a phobic anxiety disorder is present.

“According to the ICD-10 Clinical Descriptions and Diagnostic Guidelines, [20] panic disorder should not be diagnosed if a phobic anxiety disorder (i.e., agoraphobia, social phobias, and specific phobias) is present.”

• cites [20] World Health Organization, 1992Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The proposed ICD-11 diagnostic guidelines acknowledge commonalities among groupings, including that emotional responses associated with these disorders often include fear and anxiety.

“The proposed ICD-11 diagnostic guidelines acknowledge commonalities among all these groupings, which include the fact that the emotional responses associated with these disorders often include fear and anxiety.”

Probably not a substantial claim: may not pass S3 (load-bearing).

ICD-11 introduces a new qualifier, with panic attacks, to provide an option to code the presence of panic attacks that occur in disorders other than panic disorder.

“ICD-11 introduces a new qualifier, with panic attacks to provide an option to code the presence of panic attacks that occur in disorders other than panic disorder.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mixed anxiety and depressive disorder is cross-referenced in the anxiety and fear-related disorders grouping.

“Also cross-referenced in the anxiety and fear-related disorders grouping.”

May combine two claims.

The ICD-10 hierarchical decision rules were essentially theoretically based diagnostic conventions and lacked specific empirical support.

“they were essentially theoretically based diagnostic conventions and lacked specific empirical support.”

May combine two claims.

Epidemiological studies demonstrate high co-occurrence of depressive disorders and anxiety disorders, with anxiety symptoms most commonly preceding the onset of depressive disorders.

“Epidemiological studies demonstrate high co-occurrence of depressive disorders and anxiety disorders, with anxiety symptoms most commonly preceding the onset of depressive disorders.[22,30]”

• cites [22] Merikangas, 1996, Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force, Br J Psychiatry sourceNot checked — no full text of the source
• cites [30] Andrade, 2003, The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys, Int J Meth Psychiatric Res sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

GAD can now co-occur with other mental and behavioral disorders in ICD-11.

“The disorder can now co-occur with other mental and behavioral disorders.”

May combine two claims.

Current evidence suggests that agoraphobia and panic disorder are distinct entities and can also co-occur.

“Current evidence suggests that agoraphobia and panic disorder are distinct entities and can also co-occur.[61]”

• cites [61] Wittchen, 2010, Agoraphobia: a review of the diagnostic classificatory position and criteria, Depress Anxiety sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Use of the with panic attacks qualifier points to treatment strategies that may specifically target the panic symptoms in the context of the other disorder.

“The use of this qualifier points to treatment strategies that may specifically target the panic symptoms in the context of the other disorder.”

Classified as probably not a substantial claim.

When panic attacks do not occur exclusively as a part of the clinical presentation of another mental and behavioural disorder and the full diagnostic requirements of both disorders are met, a separate cooccurring diagnosis of panic disorder may be assigned.

“When panic attacks do not occur exclusively as a part of the clinical presentation of another mental and behavioural disorder and the full diagnostic requirements of both disorders are met, a separate cooccurring diagnosis of panic disorder may be assigned.”

Classified as probably not a substantial claim. May combine two claims.

In ICD-10, for agoraphobia, a subtype of with panic disorder must be used to indicate co-occurrence of panic attacks and agoraphobia, but the qualifier should be applied only when the majority of panic attacks occur in response to agoraphobic situations.

“In the specific case of agoraphobia, a subtype of”

Classified as probably not a substantial claim.

ICD-10 appears to conceptualize GAD as a residual disorder defined more by exclusion rather than by a well-delineated description of symptoms.

“ICD-10 thus appears to conceptualize GAD as a residual disorder defined more by exclusion rather than by a well-delineated description of symptoms.”

Classified as probably not a substantial claim.

When recurrent panic attacks can be conceptualized entirely as a feature of another mental and behavioural disorder and unexpected panic attacks that are unrelated to the clinical phenomenology of that other disorder do not occur, a separate diagnosis of panic disorder is not warranted.

“When recurrent panic attacks can be conceptualized entirely as a feature of another mental and behavioural disorder and unexpected panic attacks that are unrelated to the clinical phenomenology of that other disorder do not occur, a separate diagnosis of panic disorder is not warranted”

May combine two claims.

Mixed anxiety and depressive disorder has been renamed mixed depressive and anxiety disorder and moved to the depressive disorders grouping, as this category primarily describes a subthreshold depressive syndrome that also has features of anxiety.

“Finally, mixed anxiety and depressive disorder has been renamed mixed depressive and anxiety disorder and moved to the depressive disorders grouping, as this category primarily describes a subthreshold depressive syndrome that also has features of anxiety.[53]”

• cites [53] Goldberg, 2012, The overlap between the common mental disorders: challenges for classification, Int Rev Psychiatry sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

ICD-10 indicates that GAD should not be diagnosed in the presence of depressive episode, a phobic anxiety disorder, panic disorder, or obsessive-compulsive disorder.

“Similarly, ICD-10 indicates that GAD should not be diagnosed in the presence of depressive episode, a phobic anxiety disorder, panic disorder, or obsessivecompulsive disorder.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Panic attacks coded with the with panic attacks qualifier are episodes of severe anxiety that meet the symptomatic description of panic attacks but occur specifically in response to exposure to or anticipation of exposure to the feared stimulus.

“These are episodes of severe anxiety that meet the symptomatic description of panic attacks, but that occur specifically in response to exposure to or anticipation of exposure to the feared stimulus or stimuli”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The name selective mutism was changed to reflect common usage in contemporary research literature and to avoid unnecessary differences with DSM-5.

“Name changed to reflect common usage in the contemporary research literature and to avoid unnecessary differences with DSM-5.”

Classified as probably not a substantial claim. May combine two claims.

A with panic attacks qualifier is provided in the ICD-11 diagnostic guidelines for relevant disorders in other mental and behavioral disorders groupings, and may be used when evidence supports the presence of panic attacks as a possible part of the clinical presentation of that disorder.

“A with panic attacks qualifier is provided in the ICD-11 diagnostic guidelines for relevant disorders in other mental and behavioral disorders groupings, and may be used when evidence supports the presence of panic attacks as a possible part of the clinical presentation of that disorder.”

Classified as probably not a substantial claim.

The proposed adjacent presentation of groupings is intended to be clinically meaningful rather than merely historic ordering.

“These interrelationships are in part communicated by proposing that these groupings be presented adjacently, which is intended to be clinically meaningful rather than the merely historic ordering of groupings in previous editions of the ICD.”

May combine two claims.

ICD-11 allows for co-occurrence of GAD with other anxiety and fear-related disorders as well as obsessive-compulsive disorder.

“ICD-11 allows for co-occurrence of GAD with other anxiety and fear-related disorders as well as obsessive-compulsive disorder.”

May combine two claims.

Since the late 1980s, empirical research has demonstrated that GAD is a chronic, serious illness that engenders significant social and economic costs and can be distinguished from other disorders including other anxiety disorders.

“since the late 1980s, a wealth of empirical research has demonstrated that GAD is a chronic, serious illness that engenders significant social and economic costs [54] and can be distinguished from other disorders (e.g., Kessler et al. [55] ) including other anxiety disorders.[56][57][58]”

• cites [54] Kessler, 2002Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Kessler et al. [55] Kessler, 2008, Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up, Psychol Med sourceNot checked — no full text of the source
• cites [56][57][58]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

The proposed ICD-11 diagnostic guidelines indicate that, in the context of anxiety disorders as well as some disorders in other groupings, panic attacks may occur in response to exposure to a stimulus that constitutes the focus of apprehension in that disorder.

“The proposed diagnostic guidelines for ICD-11 indicate that, in the context of anxiety disorders as well as some disorders in other groupings, panic attacks may occur in response to exposure to a stimulus that constitutes the focus of apprehension in that disorder”

May combine two claims.

The ICD-10 hierarchical decision rules were incompatible with a criteria-based approach to classification and have progressively been eliminated from successive versions of the DSM.

“They were also incompatible with a criteria-based approach to classification and have progressively also been eliminated from successive versions of the DSM.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Cross-referencing of specific categories across groupings is incorporated and intended to enhance clinical utility.

“Cross-referencing of specific categories across groupings is also incorporated and is intended to enhance clinical utility.”

Classified as probably not a substantial claim.

Some researchers have challenged the view that worry rather than the broader construct of general apprehensiveness should define GAD because there are patients who present with nonspecific dread and who are unable to articulate a cognitive aspect to their symptomatology.

“However, some researchers have challenged the view that worry rather than the broader construct of general apprehensiveness should define the disorder because there are patients who present with nonspecific dread and who are unable to articulate a cognitive aspect to their symptomatology.[67]”

• cites [67] Rickels, 2001, What is generalized anxiety disorder?, J Clin PsychiatryNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The ICD-11 guidelines differentiate the common experience of fear in social situations and normative expressions of the personality trait of shyness from social anxiety disorder on the basis of the distress or impairment associated with the disorder.

“Finally, the guidelines differentiate the common experience of fear in social situations and normative expressions of the personality trait of shyness from social anxiety disorder on the basis of the distress or impairment associated with the disorder.[72]”

• cites [72] Emmelkamp PMG, 2012, Specific and social phobias in ICD-11, World PsychiatryNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim. May combine two claims.

The proposed essential features for agoraphobia have been revised to improve their clinical utility and to make them consistent with the other anxiety and fear-related disorders.

“The proposed essential features for agoraphobia have been revised to improve their clinical utility and to make them consistent with the other anxiety and fear-related disorders (see Table 1).”

Classified as probably not a substantial claim.

Proposed ICD-11 diagnostic guidelines for social anxiety disorder have been revised to improve clinical utility and validity.

“Proposed ICD-11 diagnostic guidelines for social anxiety disorder (social phobias in ICD-10) have been revised to improve clinical utility and validity.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The addition of this cognitive component to the disorder description and a broader description of the outcomes that may be feared is expected to improve the reliability of the diagnosis, in particular assisting with the distinction between specific phobia and agoraphobia.

“The addition of this cognitive component to the disorder description and a broader description of the outcomes that may be feared is expected to improve the reliability of the diagnosis, in particular assisting with the distinction between specific phobia and agoraphobia.”

May combine two claims.

ICD-11 proposals do not include formal subtypes of specific phobia because results of differentiation studies do not consistently support their validity.

“ICD-11 proposals do not include formal subtypes of specific phobia [72] because results of differentiation studies do not consistently support their validity.[73,75]”

• cites [72] Emmelkamp PMG, 2012, Specific and social phobias in ICD-11, World PsychiatryNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [73] Emmelkamp, 2009 sourceNot checked — no full text of the source
• cites [75] LeBeau, 2010, Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V, Depress Anxiety sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The ICD-11 diagnostic guidelines clarify that the focus of apprehension in panic disorder is concern about recurrence of unexpected panic attacks or their significance.

“The ICD-11 diagnostic guidelines clarify that the focus of apprehension in this disorder is concern about recurrence of unexpected panic attacks or their significance.”

May combine two claims.

Although these additional complaints are also frequently endorsed in mood and other anxiety disorders, they are consistently found among those with GAD.

“Although these additional complaints are also frequently endorsed in mood and other anxiety disorders, they are consistently found among those with GAD.”

May combine two claims.

Multiple lines of research suggest that a central characteristic of GAD is worry about multiple aspects of everyday life rather than the more vaguely defined feature of anxious apprehension or free-floating anxiety described as the disorder's central characteristic in ICD-10.

“Multiple lines of research suggest that a central characteristic of GAD is worry about multiple aspects of everyday life rather than the more vaguely defined feature of anxious apprehension or”

• cites [59] Borkovec, 1985, Worry: a potentially valuable concept, Behav Res Ther sourceNot checked — no full text of the source
• cites [65] Borkovec, 1983, Preliminary exploration of worry: some characteristics and processes, Behav Res Ther sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

When panic attacks are part of the clinical picture but manifest exclusively in the context of specific agoraphobic situations, the with panic attacks qualifier should be used rather than an additional diagnosis of panic disorder.

“When panic attacks are part of the clinical picture but manifest exclusively in the context of specific agoraphobic situations, the with panic attacks qualifier should be used rather than an additional diagnosis of panic disorder.”

Classified as probably not a substantial claim.

Under ICD-11, enduring the presence of one or more feared objects or situations with intense fear or anxiety is introduced as an alternative to active avoidance as sufficient for meeting the requirements for specific phobia.

“Under ICD-11, enduring the presence of one or more feared objects or situations with intense fear or anxiety is introduced as an alternative to active avoidance as sufficient for meeting the requirements for the disorder, better reflecting the possible behavioral manifestations of specific phobia.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In ICD-11, it is proposed that separation anxiety disorder be renamed separation anxiety disorder and incorporated into the grouping of anxiety and fear-related disorders.

“In ICD-11, it is proposed that the disorder be renamed separation anxiety disorder and incorporated into the grouping of anxiety and fear-related disorders.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Inclusion of specific exemplars in the ICD-11 social anxiety disorder guidelines is intended to reflect the breadth of expression of the phenomenology across various cultures.

“Inclusion of specific exemplars is intended to reflect the breadth of expression of the phenomenology across various cultures.”

Probably not a substantial claim: may not pass S3 (load-bearing).

No major conceptual changes have been made to the proposed ICD-11 diagnostic guidelines for panic disorder as compared with ICD-10.

“No major conceptual changes have been made to the proposed ICD-11 diagnostic guidelines for panic disorder as compared with ICD-10.”

May combine two claims.

The rationale for changing the name of social anxiety disorder was to be consistent with the utilization of this disorder label in the current research literature as well as to harmonize ICD disorder nomenclature with that employed in DSM-5.

“The rationale for changing the name of the disorder was to be consistent with the utilization of this disorder label in the current research literature as well as to harmonize ICD disorder nomenclature with that employed in DSM-5.”

Classified as probably not a substantial claim.

The boundary between specific phobia and agoraphobia has been clarified given that both can involve significant fear or anxiety as well as avoidance of multiple situations.

“The boundary between specific phobia and agoraphobia has also been clarified given that both can involve significant fear or anxiety as well as avoidance of multiple situations.”

Classified as probably not a substantial claim.

The ICD-11 proposes that either worry or general apprehensiveness can fulfill the diagnostic requirement for GAD.

“Thus, the ICD-11 proposes that either worry or general apprehensiveness can fulfill this aspect of the diagnostic requirements of GAD (see Table 1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The proposed ICD-11 guidelines provide a more elaborated list of possible symptoms that can accompany general apprehensiveness or worry to reflect those endorsed by the majority of affected individuals.

“The proposed ICD-11 guidelines also provide a more elaborated list of possible symptoms that can accompany general apprehensiveness or worry to reflect those endorsed by the majority of affected individuals.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

The ICD-11 with panic attacks qualifier can be applied if panic attacks occur exclusively in response to exposure to agoraphobic situations with no evidence of unexpected panic attacks, which suggests a co-occurring panic disorder diagnosis.

“The ICD-11 with panic attacks qualifier can be applied if panic attacks occur exclusively in response to exposure to agoraphobic situations with no evidence of unexpected panic attacks, which suggests a co-occurring panic disorder diagnosis.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

This revision is expected to improve differentiation of panic disorder from other anxiety and fear-related conditions.

“This revision is expected to improve differentiation of this prevalent disorder from other anxiety and fear-related conditions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Differential diagnostic guidance, particularly to distinguish GAD from depressive disorders, is provided to assist clinicians in correctly attributing symptoms.

“Differential diagnostic guidance, particularly to distinguish GAD from depressive disorders, is provided to assist clinicians in correctly attributing symptoms.”

Classified as probably not a substantial claim. May combine two claims.

ICD-11 proposals require that GAD symptoms have persisted for several months and provide guidance to assist with the differentiation of normal reactions to stressors from adjustment disorder and GAD.

“In light of these findings, ICD-11 proposals require that symptoms have persisted for”

Classified as probably not a substantial claim.

ICD-11 extends the behavioral manifestations of agoraphobia beyond active avoidance of situations to include other commonly observed responses such as entering feared situations only under specific circumstances or enduring them with intense fear or anxiety.

“ICD-11 extends the behavioral manifestations of agoraphobia beyond active avoidance of situations to include other commonly observed responses such as entering feared situations only under specific circumstances (e.g., in the presence of a companion) or enduring them with intense fear or anxiety.”

May combine two claims.

This differentiation is based in part on findings that individuals with social anxiety disorder show impairment in occupational functioning, tend to have less elaborate social networks, and are at greater risk for suicide.

“This is based in part on findings that individuals with social anxiety disorder show impairment in occupational functioning, tend to have less elaborate social networks, and are at greater risk for suicide.[83][84][85]”

• cites [83][84][85]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

ICD-10 requires the presence of avoidance of the feared situations as a prominent feature.

“Finally, ICD-10 requires the presence of avoidance of the feared situations as a prominent feature.”

Classified as probably not a substantial claim.

An important clarification in ICD-11 is the focus of apprehension in social anxiety disorder, which is concern that the individual will act in a way, or show anxiety symptoms, that will be negatively evaluated by others.

“An important clarification in ICD-11 is the focus of apprehension, which is concern that the individual will act in a way, or show anxiety symptoms, that will be negatively evaluated by others (i.e., be humiliating, embarrassing, lead to rejection, or be offensive).[72]”

• cites [72] Emmelkamp PMG, 2012, Specific and social phobias in ICD-11, World PsychiatryNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Motor tension and autonomic overactivity are retained from ICD-10 because they are highly prevalent in GAD and characteristic of the disorder.

“Motor tension and autonomic overactivity are retained from ICD-10 because they are highly prevalent in GAD and characteristic of the disorder.[69]”

• cites [69] Aldao, 2010, Differential patterns of physical symptoms and subjective processes in generalized anxiety disorder and unipolar depression, J Anxiety Disord sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The essential features for specific phobia in ICD-11 have been elaborated to provide a more complete description of the phenomenology for this disorder and to differentiate it from other anxiety and fear-related conditions.

“The essential features for specific phobia in ICD-11 have been elaborated to provide a more complete description of the phenomenology for this disorder and to differentiate it from other anxiety and fear-related conditions.[72]”

• cites [72] Emmelkamp PMG, 2012, Specific and social phobias in ICD-11, World PsychiatryNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Data from neuroimaging studies do not differentiate among the various subtypes of specific phobia, although there is some evidence that blood-injury phobia/dental phobia is characterized by distinct underlying neural systems.

“Data from neuroimaging studies do not differentiate among the various subtypes, [76,77] although there is some evidence that blood-injury phobia/dental phobia is characterized by distinct underlying neural systems.[78]”

• cites [76] Del Casale, 2012, Functional neuroimaging in specific phobia, Psychiatry Res sourceNot checked — no full text of the source
• cites [77] Ipser, 2013, Meta-analysis of functional brain imaging in specific phobia, Psychiatry Clin Neurosci sourceNot checked — no full text of the source
• cites [78] Lueken, 2011, How specific is specific phobia? Different neural response patterns in two subtypes of specific phobia, Neuroimage sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

ICD-11 also mentions subjective nervousness, difficulties in concentrating, irritability, and sleep disturbances as possible symptoms of GAD.

“ICD-11 also mentions subjective nervousness, difficulties in concentrating, irritability, and sleep disturbances.”

May combine two claims.

Specific fears in children are common, developmentally typical, and generally resolve within a few months.

“Specific fears in children are common, developmentally typical, and generally resolve within a few months.[73,74]”

• cites [73] Emmelkamp, 2009 sourceNot checked — no full text of the source
• cites [74] Gullone, 2000, The development of normal fear: a century of research, Clin Psychol Rev sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The focus of apprehension in agoraphobia has been explicated as marked and excessive fear of specific negative outcomes such as panic attacks or other incapacitating or embarrassing physical symptoms in situations where escape may be difficult or help may not be available.

“Importantly, the focus of apprehension in agoraphobia has been explicated as marked and excessive fear of specific negative outcomes such as panic attacks or other incapacitating (e.g., falling) or embarrassing (e.g., incontinence) physical symptoms in situations where escape may be difficult or help may not be available.”

Classified as probably not a substantial claim.

ICD-10 conceptualizes GAD more as a residual disorder than one defined by a specific set of positive symptoms.

“As described above, ICD-10 conceptualizes GAD more as a residual disorder than one defined by a specific set of positive symptoms.”

Classified as probably not a substantial claim.

The first essential feature of agoraphobia is marked and excessive fear or anxiety that occurs in, or in anticipation of, multiple situations where escape might be difficult or help might not be available.

“The first essential feature of agoraphobia is marked and excessive fear or anxiety that occurs in, or in anticipation of, multiple situations where escape might be difficult or help might not be available”

Probably not a substantial claim: may not pass S4 (based).

Use of the with panic attacks qualifier is redundant and unnecessary in the context of a panic disorder diagnosis.

“Use of the with panic attacks qualifier is redundant and unnecessary in the context of a panic disorder diagnosis.”

Classified as probably not a substantial claim.

The key distinction between specific phobia and agoraphobia is the focus of apprehension, which in specific phobia is directly connected to the feared stimulus and not to a fear that escape might be difficult or help not available as in agoraphobia.

“The key distinction is the focus of apprehension, which in specific phobia is directly connected to the feared stimulus (e.g., being bitten by a dog) and not to a fear that escape might be difficult or help not available as in agoraphobia.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The second set of field studies evaluates the performance of the guidelines with patients in global clinical settings in which the ICD-11 is intended to be used.

“The second set of field studies evaluates the performance of the guidelines with patients in global clinical settings in which the ICD-11 is intended to be used.”

Classified as probably not a substantial claim.

Clinicians are expected to use their clinical judgment about exact symptom counts and duration in a manner consistent with the diagnostic guidance provided.

“Therefore, diagnoses in ICD are made on the basis of essential features that are consistent with currently available evidence, with an expectation that clinicians will use their clinical judgment about exact symptom counts and duration in a manner that is consistent with the diagnostic guidance provided.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

In adults, separation anxiety most often involves romantic partners or children.

“In adults, separation anxiety most often involves romantic partners or children.”

Classified as probably not a substantial claim.

According to the ICD-11 diagnostic guidelines, panic disorder is characterized by the presence of recurrent panic attacks, during which several characteristic symptoms are present (without a specific minimum number), which include but are not limited to a list of specific panic symptoms.

“In contrast, according to the ICD-11 diagnostic guidelines, panic disorder is characterized by the presence of recurrent panic attacks, during which several characteristic symptoms are present (without a specific minimum number), which include but are not limited to a list of specific panic symptoms.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The ICD-11 guidelines specify that the focus of apprehension in separation anxiety disorder is separation from attachment figures with whom the individual has a deep emotional bond.

“the ICD-11 guidelines specify that the focus of apprehension is separation from attachment figures with whom the individual has a deep emotional bond.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In children and youth, key attachment figures that are most commonly the focus of separation anxiety include parents, caregivers, or other family members.

“In children and youth, key attachment figures that are most commonly the focus of separation anxiety include parents, caregivers, or other family members.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The specific manifestations of fear or anxiety related to separation are conceptualized as varying according to the individual's developmental level.

“The specific manifestations of fear or anxiety related to separation are conceptualized as varying according to the individual's developmental level.”

Probably not a substantial claim: may not pass S3 (load-bearing).

At each step, the results of field trials inform further guideline revision prior to the publication of the ICD-11.

“At each step, the results of field trials inform further guideline revision prior to the publication of the ICD-11.”

May combine two claims.

The ICD-11 panic disorder criteria allow for other symptoms that are consistent with panic phenomenology as well as cultural variations in presentation.

“This allows for other symptoms that are consistent with panic phenomenology as well as cultural variations in presentation.[89,90]”

• cites [89] Hinton, 2002, Panic disorder, somatization, and the new cross-cultural psychiatry: the seven bodies of a medical anthropology of panic, Cult Med Psychiatry sourceNot checked — no full text of the source
• cites [90] Marques, 2011, Cross-cultural variations in the prevalence and presentation of anxiety disorders, Expert Rev Neurother sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Such minimum symptom counts and strict duration criteria force clinicians either to apply the category in contradiction to the diagnostic criteria or to use uninformative unspecified categories for cases that do not precisely fit the prescribed pattern, even when they believe that the diagnosis in question would be appropriately applied and not doing so could lead to withholding treatment that is

“Such minimum symptoms counts and strict duration criteria force clinicians either to apply the category in contradiction to the diagnostic criteria or to use uninformative unspecified categories for cases that do not precisely fit the prescribed pattern, even when they believe that the diagnosis in question would be appropriately applied and not doing so could lead to withholding treatment that is”

• AssumptionRests on an assumption: In DSM-5, panic attacks occurring in panic disorder must include at least four of a list of thirteen specific symptoms.
• AssumptionRests on an assumption: In DSM-5, at least one panic attack in panic disorder must be followed by persistent worry related to additional panic attacks or significant behavior change that lasts for at least one month.

Classified as probably not a substantial claim.

Diagnoses in ICD are made on the basis of essential features that are consistent with currently available evidence.

“Therefore, diagnoses in ICD are made on the basis of essential features that are consistent with currently available evidence, with an expectation that clinicians will use their clinical judgment about exact symptom counts and duration in a manner that is consistent with the diagnostic guidance provided.”