R46.6 - Undue concern and preoccupation with stressful events

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

• Undue concern and preoccupation with stressful events

Convert to ICD-9 Code

Patient Education

Anxiety

What is anxiety?

Anxiety is a feeling of fear, dread, and uneasiness. It might cause you to sweat, feel restless and tense, and have a rapid heartbeat. It can be a normal reaction to stress. For example, you might feel anxious when faced with a difficult problem at work, before taking a test, or before making an important decision. It can help you to cope. The anxiety may give you a boost of energy or help you focus. But for people with anxiety disorders, the fear is not temporary and can be overwhelming.

What are anxiety disorders?

Anxiety disorders are conditions in which you have anxiety that does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

What are the types of anxiety disorders?

There are several types of anxiety disorders, including:

• Generalized anxiety disorder (GAD).People with GAD worry about ordinary issues such as health, money, work, and family. But their worries are excessive, and they have them almost every day for at least 6 months.
• Panic disorder. People with panic disorder have panic attacks. These are sudden, repeated periods of intense fear when there is no danger. The attacks come on quickly and can last several minutes or more.
• Phobias. People with phobias have an intense fear of something that poses little or no actual danger. Their fear may be about spiders, flying, going to crowded places, or being in social situations (known as social anxiety).

What causes anxiety disorders?

The cause of anxiety is unknown. Factors such as genetics, brain biology and chemistry, stress, and your environment may play a role.

Who is at risk for anxiety disorders?

The risk factors for the different types of anxiety disorders can vary. For example, GAD and phobias are more common in women, but social anxiety affects men and women equally. There are some general risk factors for all types of anxiety disorders, including:

• Certain personality traits, such as being shy or withdrawn when you are in new situations or meeting new people
• Traumatic events in early childhood or adulthood
• Family history of anxiety or other mental disorders
• Some physical health conditions, such as thyroid problems or arrhythmia

What are the symptoms of anxiety disorders?

The different types of anxiety disorders can have different symptoms. But they all have a combination of:

• Anxious thoughts or beliefs that are hard to control. They make you feel restless and tense and interfere with your daily life. They do not go away and can get worse over time.
• Physical symptoms, such as a pounding or rapid heartbeat, unexplained aches and pains, dizziness, and shortness of breath
• Changes in behavior, such as avoiding everyday activities you used to do

Using caffeine, other substances, and certain medicines can make your symptoms worse.

How are anxiety disorders diagnosed?

To diagnose anxiety disorders, your health care provider will ask about your symptoms and medical history. You may also have a physical exam and lab tests to make sure that a different health problem is not the cause of your symptoms.

If you don't have another health problem, you will get a psychological evaluation. Your provider may do it, or you may be referred to a mental health professional to get one.

What are the treatments for anxiety disorders?

The main treatments for anxiety disorders are psychotherapy (talk therapy), medicines, or both:

• Cognitive behavioral therapy (CBT) is a type of psychotherapy that is often used to treat anxiety disorders. CBT teaches you different ways of thinking and behaving. It can help you change how you react to the things that cause you to feel fear and anxiety. It may include exposure therapy. This focuses on having you confront your fears so that you will be able to do the things that you had been avoiding.
• Medicines to treat anxiety disorders include anti-anxiety medicines and certain antidepressants. Some types of medicines may work better for specific types of anxiety disorders. You should work closely with your health care provider to identify which medicine is best for you. You may need to try more than one medicine before you can find the right one.

NIH: National Institute of Mental Health

Stress

What is stress?

Stress is how your brain and body respond to a challenge or demand. When you are stressed, your body releases chemicals called hormones. The hormones make you alert and ready to act. They can raise your blood pressure, heart rate, and blood sugar levels. This response is sometimes called a "fight or flight" response.

Everyone gets stressed from time to time. There are different types of stress. It can be short-term or long-term. It can be caused by something that happens once or something that keeps happening.

Not all stress is bad. In fact, it can help you survive in a dangerous situation. For example, one kind of stress is the jolt you may feel when a car pulls out in front of you. This jolt of hormones helps you quickly hit the brakes to avoid an accident. A little short-term stress can sometimes be helpful. For example, the stress of having a deadline for school or your job may push you to get your work done on time. Once you finish it, that stress goes away.

But stress that lasts a long time can harm your health.

What causes long-term stress?

Long-term stress, or chronic stress, lasts for weeks, months, or longer. As you go about your life, your body is acting as if you're being threatened.

Causes of long-term stress include:

• Routine stress from the demands of work, school, family needs, money problems, and other daily pressures that don't stop.
• Stress from sudden, difficult changes in your life, such as divorce, illness, losing your job, or other unhappy life events that often have a long impact.
• Traumatic stress, which may happen when you're in danger of serious harm or death. Examples include being in a bad accident, a war, a flood, earthquake, or other frightening event. This type of stress can cause a long-lasting problem called post-traumatic stress disorder (PTSD).

How can long term-stress harm my health?

People respond to stress in different ways. If you're stressed for a long time you may notice that you are:

• Getting sick more often than usual because stress weakens your body's ability to fight germs
• Having stomach problems or trouble digesting food
• Having trouble sleeping
• Having headaches
• Feeling sad, angry, or easily upset

When stress keeps going, your body acts as if you're always in danger. That's a lot of strain that may play a part in developing serious health problems, including:

• Depression
• Anxiety
• Heart disease
• High blood pressure
• Diabetes (high blood sugar)

It's possible to get used to the symptoms of stress and not even realize there's a problem. So when there's a lot of stress in your life, it's important to pay attention to how it affects you so you can do something about it.

How can I manage long-term stress?

Simple things that improve your mental health may be helpful in managing long-term stress, such as:

• Get regular exercise. A 30-minute daily walk can help you feel better and help keep your immune system strong, so you don't get sick.
• Try relaxing activities. You could look for an app or wellness program that uses breathing, meditation, or muscle relaxation exercises.
• Get enough sleep every night.
• Avoid too much caffeine.
• Decide what you need to do now and what can wait. And focus on what you got done each day, not on what you weren't able to do.
• Ask your family or friends for support.

When should I ask my health care provider for help with stress?

Get help if you're having severe symptoms for 2 weeks or more, including:

• Trouble sleeping
• Changes in your eating that cause unwanted changes in your weight
• Troubles getting out of bed because of your mood
• Difficulty focusing your thoughts
• Losing interest in things you usually enjoy
• Not being able to do your usual daily activities

Always get help right away if stress is causing you to:

• Have thoughts of harming yourself
• Feel you can't cope
• Use drugs or alcohol more often than usual

Your health care provider may refer you to a mental health professional such as a psychologist or social worker.

NIH: National Institute of Mental Health

Code History

• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)