Tölle (1999) schreibt über die Kategorisierung der Ängste und Phobien in der ICD-10:

„Die Krankheitsbezeichnungen haben sich mit den Klassifikationssystemen verändert, ohne dass sich inhaltlich etwas Wesentliches geändert hätte. Anstelle der herkömmlichen Bezeichnung Angstneurose und Phobie bringt die ICD-10 unter dem Oberbegriff „Phobische Störung“ (im englischen Original: phobic anxiety disorders) eine Gliederung nach bestimmten Situationen bzw. Gegenständen der Angst (F40.0 bis 2; im einzelnen siehe unten) und ausserdem eine generalisierte Angststörung (F41.1)…
Den genannten, aber chronisch verlaufenden, Formen steht die akute und episodisch auftretende Panikstörung (F41.0) gegenüber, die der früheren Diagnose Herzphobie weitgehend entspricht. Es gibt Kombinationen akuter und chronischer phobischer Störungen, z.B. Panikattacken bei Agoraphobie (F40.01). Wenn organische Bedingungen deutlich ausgeprägt sind, sieht ICD 10 organische Angststörung (F06.4) vor.“ (Psychiatrie, S. 89)

Die ICD-10 unterscheidet in der Kategorie F41 folgende Angststörungen:

  • F41.0 Panikstörung (episodisch paroxysmale Angst)
  • F41.1 generalisierte Angststörung
  • F41.2 Angst und depressive Störung, gemischt

Eine Panikstörung kann gemäss ICD-10 auch auftreten in Verbindung mit einer Agoraphobie, weshalb sie bei den phobischen Störungen ICD-10 F40 wieder auftaucht.

Folgende Phobien werden in ICD-10 unterschieden:

  • F40.0 Agoraphobie
  • F40.00 ohne Panikstörung
  • F40.01 mit Panikstörung
  • F40.1 soziale Phobien
  • F40.2 spezifische (isolierte) Phobien

Zu Beginn der Diagnostik steht die Erhebung einer ausführlichen biographischen Anamnese (Lebensgeschichte) und vor allem auch die Erfragung der aktuellen Lebenssituation. Dies ist deshalb besonders wichtig, um unterscheiden zu können, ob es sich um eine „normale“ oder um eine „krankhafte“ Angst handelt. Zur Unterscheidung dient ferner die Einschätzung des Schweregrades der Symptomatik und den resultierenden sozialen Einschränkungen.

Die genauere Exploration der Ängste dient im weiteren dann vor allem auch der Differentialdiagnose zwischen den einzelnen Störungsformen (s.o.) sowie dem Ausschluss einer anderen psychischen Störung. Denn die Angstsymptomatuik kann sowohl auf eine Angststörung als Ursache verweisen, als auch Ausdruck einer Begleiterscheinung bei einer anderen Störung (auch einer somatischen Störung!) sein. Dabei folgt die Befragung den Leitlinien des jeweils zugrundegelegten Klassifikationsverfahrens, z.B. ICD-10 oder DSM-IV.

Zur Unterstützung der allgemeinen psychiatrischen Befunderhebung werden häufig auch testpsychologische Verfahren eingesetzt, z.B.

Fremdbeurteilungsskalen:
  • Hamilton-Angstskala (HAMA)
Selbstbeurteilungsskalen:
  • State-Trait-Anxiety-Inventory (STAI)

Differentialdiagnostik:

Besonders wichtig (wegen der Konsequenzen für die Wahl des Therapieregimes) ist die Unterscheidung zwischen Angst und Depression). Dies ist gleichzeitig besonders schwierig, weil die beiden Störungen oft ineinander übergehen, einander vorausgehen oder sich gegenseitig bedingen und verstärken.

Häufig treten Ängste als Begleitsymptomatik bei folgenden Störungen auf (nach Möller, Laux, Deister; 2001):

  • Nichtorganische psychotische Störungen
    • depressive Störungen
    • Dysthymie
    • Anpassungsstörungen, PTSD
    • schizophrene Psychosen
    • Zwangserkrankungen
    • Persönlichkeitsstörungen
    • Posttraumatischen Belastungsstörungen und Anpassungsstörungen
  • Organische psychische Störungen (d.h. es gibt eine nachweisbare körperliche Ursache für die psychische Störung)
    • Delir
    • organische Angststörung
    • organische wahnhafte Störung
    • organische depressive Störung
    • organische Persönlichkeitsstörung
  • Substanzabhängige Störungen
    • Medikamente
    • Amphetamine
    • Kokain
    • Halluzinogene
    • Alkohol
    • Nikotin
    • Koffein
    • Ecstasy
    • Opiate
  • Neurologische Erkrankungen
    • hirnorganische Anfallsleiden
    • Chorea Huntigton
    • Migräne
    • multiple Sklerose
    • zerebrale Minderdurchblutung
    • erhöhter Hirndruck
  • Internistische Erkrankungen
    • Angina pectoris/Herzinfarkt
    • Herzrhythmusstörungen
    • Hypoglykämie (Unterzuckerung)
    • Hypoxie (Sauerstoffmangel)
    • Lungenembolie
    • Hyperthyreose (Schilddrüsenüberfunktion)
    • Karzinoid (eine spezielle Krebsform)
    • Phäochromozytom
    • Anaphylaxie (allergischer Schock)

Der sichere Ausschluss einiger dieser Störungsmöglichkeiten können bei unklarer Befundlage Anlass zu grossflächigen Untersuchungen und Abklärungen, inkl. Laboruntersuchungen, sein.

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