Test Anxiety Dsm-5 Code

[Mandy Geise]

Testanxiety is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). However, it can sometimes occur as a manifestation of another anxiety disorder such as social anxiety disorder, generalized anxiety disorder, or specific phobia.

Three common causes of test anxiety include behavioral, biological, and psychological factors. Behaviors like failing to prepare can play a role, but the body's biological response to stress can also create feelings of anxiety. Mental factors, such as self-belief and negative thinking, can also lead to test anxiety.

Depending on the severity of your symptoms, your physician may also recommend cognitive-behavioral therapy (CBT), anti-anxiety medications, or a combination of both. CBT focuses on helping people change both the behaviors and underlying thoughts that contribute to unwanted behaviors or feelings.

If you or a loved one are struggling with an anxiety disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

Henderson RK, Snyder HR, Gupta T, Banich MT. When does stress help or harm? The effects of stress controllability and subjective stress response on stroop performance. Front Psychol. 2012;3:179. doi:10.3389/fpsyg.2012.00179

Test anxiety is a combination of physiological over-arousal, tension and somatic symptoms, along with worry, dread, fear of failure, and catastrophizing, that occur before or during test situations.[1] It is a psychological condition in which people experience extreme stress, anxiety, and discomfort during and/or before taking a test. This anxiety creates significant barriers to learning and performance.[2] Research suggests that high levels of emotional distress have a direct correlation to reduced academic performance and higher overall student drop-out rates.[2][3][4] Test anxiety can have broader consequences, negatively affecting a student's social, emotional and behavioural development, as well as their feelings about themselves and school.[5]

Highly test-anxious students score about 12 percentile points below their low anxiety peers.[6][7][8] Test anxiety is prevalent amongst the student populations of the world.[9][10] It has been studied formally since the early 1950s beginning with researchers George Mandler and Seymour Sarason.[11] Sarason's brother, Irwin G. Sarason, then contributed to early investigation of test anxiety, clarifying the relationship between the focused effects of test anxiety, other focused forms of anxiety, and generalized anxiety.[12]

Test anxiety can also be labeled as anticipatory anxiety, situational anxiety or evaluation anxiety. Some anxiety is normal and often helpful to stay mentally and physically alert.[13] When one experiences too much anxiety, however, it can result in emotional or physical distress, difficulty concentrating, and emotional worry. Inferior performance arises not because of intellectual problems or poor academic preparation, but because testing situations create a sense of threat for those experiencing test anxiety; anxiety resulting from the sense of threat then disrupts attention and memory function.[14][15][16][17] Researchers suggest that between 25 and 40 percent of students experience test anxiety.[18] Students with disabilities and students in gifted educations classes tend to experience high rates of test anxiety.[19] Students who experience test anxiety tend to be easily distracted during a test, experience difficulty with comprehending relatively simple instructions, and have trouble organizing or recalling relevant information.[1]

Researchers believe that feelings of anxiety arise to prepare a person for threats.[20] In humans, anxiety symptoms are distributed along a continuum and different symptom levels of anxiety predict outcomes. Responses consist of increased heart rate, stress hormone secretion, restlessness, vigilance, and fear of a potentially dangerous environment.[20] Anxiety prepares the body physically, cognitively, and behaviourally to detect and deal with threats to survival. As a result, a person's body begins to hyperventilate to allow more oxygen to enter the bloodstream, divert blood to muscles, and sweat to cool the skin.[20] In individuals, the degree to which an anxiety response is developed is based on the probability of bad things happening in the environment and the individual's ability to cope with them. In the case of test taking, this might be a failing exam grade that prevents the student from being accepted to a post-secondary institution. A person's beliefs about their own competencies are a form of self-knowledge, which plays an important role in analyzing situations that might be threatening. When a person has feelings of low competence about their abilities they are likely to anticipate negative outcomes such as failure, under uncertain conditions. Thus, evaluative situations including tests and exams, are perceived as more threatening by students who have low competencies.[21]

There is a difference between generalized anxiety disorders (GAD) and test anxiety. GAD is characterized by "trait anxiety" which results in a person experiencing high levels of stress across a wide range of situations. In contrast, people with test anxiety have a "state anxiety" which results in high levels of nervousness specific to testing.[22]

Symptoms of test anxiety can range from moderate to severe. "Students who exhibit moderate symptoms are still able to perform relatively well on exams. Other students with severe anxiety will often experience panic attacks."[23]

During states of excitement or stress, the body releases adrenaline. Adrenaline is known to cause physical symptoms that accompany test anxiety, such as increased heart rate, sweating, and rapid breathing.[24] In many cases having adrenaline is a good thing. It is helpful when dealing with stressful situations, ensuring alertness and preparation.[25] But for some people the symptoms are difficult or impossible to handle, making it impossible to focus on tests.

Other causes of test anxiety may include fear of failure, procrastination, and previous poor test performance.[27] As well, characteristics of the test environment such as: nature of the task, difficulty, atmosphere, time constraints, examiner characteristics, mode of administration and physical setting can affect the level of anxiousness felt by the student.[5][21] Researchers Putwain & Best (2011),[28] examined test performance among elementary children when the teacher put pressure on the students in an attempt to create a more high stress environment. Their findings showed that students performed worse in high threat situations and experienced more test anxiety and worrisome thoughts than when in a low threat environment.

Test anxiety is known to develop into a vicious cycle. After experiencing test anxiety on one test, the student may become so fearful of it happening again they become more anxious and upset than they would normally, or even than they experienced on the previous test. If the cycle continues without acknowledgement, or the student seeking help, the student may begin to feel helpless in the situation.[29]

Test anxiety can be diagnosed using the Diagnostic and Statistical Manual-IV, under the classification of social phobia.[8]Social phobias are characterized by a marked and persistent fear of social or performance situations in which embarrassment may occur. In order to be diagnosed as suffering from a social phobia, the DSM-IV states that the individual must present four different factors.[8]

Anxiety is defined as the "psychological mechanism whereby the current intensification of a dangerous drive results in the elicitation of defenses."[32] George Mandler and Seymour Sarason (1952), developed the theory that anxiety present in testing situations is an important determinant of test performance. Individuals that become highly anxious during tests typically perform more poorly on tests than low-test anxious persons, especially when tests are given under stressful evaluative conditions such as a post-secondary exam. The feelings of forgetfulness, or drawing a "blank" are developed because of anxiety-produced interference between relevant responses and irrelevant responses generated from the person's anxious state. The difference in performance of a high-anxious test taker compared to a low-anxious test taker is largely due to the difference in their ability to focus on the tasks required.[33] A low-anxious test taker is able to focus greater attention on the tasks required of them while taking the test, while a high-anxious test taker is focused on their internal self, and the anxiety they are feeling. Anxious test takers do not perform adequately on the test as their attention is divided between themselves and the test. Therefore, students with high test anxiety are unable to focus their full attention on the test. Furthermore, anxiousness is evoked when a student believes that the evaluative situation, such as an assessment, exceeds his or her intellectual, motivational, and social capabilities.[21]

Psychologists Liebert and Morris (1967) analyzed the structure of test anxiety given on two distinct factors: Cognitive Test Anxiety and Emotionality.[7] Emotionality means that the individual shows high levels of several different symptoms related to test anxiety that can be seen through physiological responses experienced during situations where they are being evaluated; such as an exam.[7] Some of the physiological manifestations include: increased galvanic skin response and heart rate, dizziness, nausea, or feelings of panic.[7] There is evidence that emotionality is a distinct part of test anxiety; however, it can be seen that when an individual displays high emotionality it means that it is mostly associated with declining performance, but only when the individual is also experiencing high levels of worry.[7]

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