CLINICAL CONSEQUENCES OF THE REVISED DSM-5 DEFINITION OF AGORAPHOBIA IN TREATMENT-SEEKING ANXIOUS YOUTH.
CLINICAL CONSEQUENCES OF THE REVISED DSM-5 DEFINITION OF AGORAPHOBIA IN TREATMENT-SEEKING ANXIOUS YOUTH.
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DOI：
10.1002/da.22361
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发表时间：
2015-07
影响因子：
7.4
通讯作者：
Comer J
中科院分区：
文献类型：
--
作者：
Cornacchio D;Chou T;Sacks H;Pincus D;Comer J
在DSM-5中，广场恐怖症的核心症状标准已被修订，要求对来自至少两个不同领域的多种情况感到恐惧，这些情况可能难以逃脱或可能出现恐慌样症状。本研究探讨了模式和相关的焦虑青年的样本最近的变化与DSM-IV广场恐怖症的定义和/或特定的恐惧症（SP）的症状表现一致，考虑如何最近的诊断变化影响儿童和青少年广场恐怖症的患病率和组成。分析（N=151）评估减值和相关的广场恐怖青年不再满足DSM-5广场恐怖症的标准相对于广场恐怖青年谁满足新的DSM-5标准。次要分析比较了不符合DSM-5标准的广场恐怖青年与SP青年。四分之一的症状表现符合DSM-IV广场恐怖症定义的青年不再符合DSM-5广场恐怖症的标准，但在大多数领域表现出与符合DSM-5广场恐怖症标准的青年相当的严重程度和损害。此外，这些青年表现出更高水平的焦虑敏感性和内化的精神病理学相对于青年SP。相当大比例的受损青年与相当大的广场恐惧症症状的介绍已经离开了没有指定的焦虑诊断DSM-5，这可能会影响他们的能力，接受和/或获得覆盖面的服务和他们的代表性在治疗评价。未来的DSM迭代可能会很好地包括一个“限制”广场恐怖症说明符，它将表征对多种情况的恐惧或焦虑的表现，但不会跨越至少两个不同的情景域。
In DSM-5, the agoraphobia core symptom criterion has been revised to require fear about multiple situations from across at least two distinct domains in which escape might be difficult or panic-like symptoms might develop. The present study examined patterns and correlates of the recent change in a sample of anxious youth with symptom presentations consistent with the DSM-IV agoraphobia definition and/or specific phobia (SP) to consider how the recent diagnostic change impacts the prevalence and composition of agoraphobia in children and adolescents. Analyses (N=151) evaluated impairment and correlates of agoraphobic youth who no longer meet the DSM-5 agoraphobia criteria relative to agoraphobic youth who do meet the new DSM-5 criteria. Secondary analyses compared agoraphobic youth not meeting DSM-5 criteria to SP youth. One-quarter of youth with symptom presentations consistent with the DSM-IV agoraphobia definition no longer met criteria for DSM-5 agoraphobia, but showed comparable severity and impairment across most domains to youth who do meet criteria for DSM-5 agoraphobia. Further, these youth showed higher levels of anxiety sensitivity and internalizing psychopathology relative to youth with SP. A substantial proportion of impaired youth with considerable agoraphobic symptom presentations have been left without a specified anxiety diagnosis by the DSM-5, which may affect their ability to receive and/or get coverage for services and their representation in treatment evaluations. Future DSM iterations may do well to include a “circumscribed” agoraphobia specifier that would characterize presentations of fear or anxiety about multiple situations, but that do not span across at least two distinct situational domains.