Phobias Mario Maj (2)

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.Curtis G.C., Magee W.J., Eaton W.W., Wittchen H.U., Kessler R.C.(1998) Specific fears and phobias: epidemiology and classification.Br.J.Psychiatry, 173: 212–217.5.Magee W.J., Eaton W.W., Wittchen H.U., McGonagle K.A., Kessler R.C.(1996)Agoraphobia, simple phobia, and social phobia in the National ComorbiditySurvey.Arch.Gen.Psychiatry, 53: 159–168.6.Himle J.A., McPhee K., Cameron O.G., Curtis G.C.(1989) Simple phobia:evidence for heterogeneity.Psychiatry Res., 28: 25–30.7.Bourdon K.H., Boyd J.H., Rae D.S., Burns B.J., Thompson J.W., Locke B.Z.(1988) Gender differences in phobias: results of the ECA community study.J.Anxiety Disord., 2: 227–241.1.8Comorbidity in Social Phobia: Nosological ImplicationsConstantin R.Soldatos and Thomas J.Paparrigopoulos1The introduction of operational diagnostic criteria for psychiatric disorders has stimulated interest in comorbidity, which is generally defined as the co-occurrence of two or more disorders over a specified period of time.Thestudy of comorbidity has important implications for both clinical researchand practice.It may contribute to the delineation of different disorders and, therefore, validate proposed diagnostic categories.Moreover, given thatcomorbidity of psychiatric disorders is a very frequent occurrence,confounding symptoms may frequently intrude and blur a prototypalclinical picture.Consequently, reference to comorbidity issues is deemednecessary for an adequate description and improved understanding of thephenomenology of a specific disorder.This applies in particular to anxiety disorders, with as many as 50% of patients having a specific anxietydisorder which may meet diagnostic criteria for another anxiety disorder [1].Based on clinical studies as well as on general population surveys, socialphobia is strongly associated with other anxiety disorders (about 50%),affective disorders (20%) and substance abuse (15%).On average, 80% ofpatients with social phobia meet diagnostic criteria for another lifetimecondition, which is indicative that comorbidity tends to be the rule rather than the exception [2,3].According to the US National Comorbidity Survey[4], the vast majority of individuals with any phobia in general (83.4%), and primary social phobia specifically (81%), meet the criteria for at least one other lifetime DSM-III-R diagnosed psychiatric disorder.In most cases(76.8%), social phobia precedes the comorbid disorder [3].In the presence of 1 University Mental Health Research Institute, Eginition Hospital, 72 Vasilissis Sophias Avenue, Athens GR-11528, GreeceDIAGNOSIS AND CLASSIFICATION OF PHOBIAS: COMMENTARIES ____________ 51the diagnosis of social phobia, the odds ratio for other disorders are found to be 7.75 for simple phobia, 7.06 for agoraphobia, 4.83 for panic disorder, 3.77 for generalized anxiety disorder, 3.69 for major depression, 3.15 fordysthymia, 2.69 for post-traumatic stress disorder and 2.01 for substanceabuse [4].Generalized anxiety disorder (GAD) and social phobia frequently co-occur in clinical samples [1] as well as in the general population [4].It has been reported that GAD may be the most common additional diagnosisamong patients with social phobia in clinical populations; conversely, social phobia is most frequently diagnosed in patients with GAD (up to 59% ofthe cases) [1].Comorbid social phobia and GAD may merely indicate ashortcoming of our taxonomic systems.In this context, it has beensuggested that the ‘‘mixed’’ social phobia/GAD group may represent adistinct subgroup of individuals who are characterized by a fear of negative evaluation as well as chronic worry, both resulting in a greater degree offunctional impairment [5].As far as the comorbidity of social phobia and panic disorder isconcerned, it has been reported to be as high as 50% [3].These twopurportedly distinct conditions present with quite similar and overlappingsymptoms and at times they are difficult to distinguish on clinical grounds, e.g.when a person experiences a panic attack while giving a speech andafterwards develops social phobia.The differentiation commonly offeredby clinicians is that, in contrast to what a patient with social phobiapresents, a patient with panic disorder does not fear scrutiny itself but the physical sensations associated with a feeling of being in danger andtrapped, yet this distinction is not always easy to make.Finally, attention should be given to the demarcation of the boundaries ofsocial phobia with avoidant personality disorder and with temperamentalmake-ups such as shyness.In studies comparing avoidant personalitydisorder with non-focused social phobia (generalized social phobia),comorbidity rates vary from approximately 25% up to 89%; thus, theability to diagnose one disorder in the absence of the other is questioned [6].Comparison of the characteristics of avoidant personality disorder andgeneralized social phobia has yielded few qualitative differences, although some investigators have shown that avoidant personality disorder mayrepresent a more severe form of generalized social phobia with respect tointensity of symptoms, fear of negative evaluation, anxiety, avoidance anddepression; others have concluded that the co-occurrence of generalizedsocial phobia and avoidant personality disorder pertains to persons withthe most severe symptoms of social phobia and poorest functioning [7].Furthermore, personality dimensions such as shyness have been found tobe strongly associated with both avoidant personality disorder andgeneralized social phobia, and there is evidence that individuals suffering52 ____________________________________________________________________________________________ PHOBIASfrom phobicness in social settings also exhibit fears and avoidance across a variety of non-social domains.Indeed, research supports the position thatgeneralized social phobia and avoidant personality disorder belong to anosological continuum that is artificially divided between axes II and I of the DSM classification system.In conclusion, based on the above comorbidity features of social phobia,which are based on clinical and epidemiological studies, future refinementof criteria pertaining to the diagnosis of social phobia should be seriously considered.REFERENCES1.Sanderson W.C., Di Nardo P.A., Rapee R.M., Barlow D.H.(1990) Syndromecomorbidity in patients diagnosed with a DSM-III-R anxiety disorder.J.Abnorm.Psychol., 99: 308–312.2.Merikangas K.R., Angst J.(1995) Comorbidity and social phobia: evidence from clinical, epidemiologic, and genetic studies.Eur.Arch.Psychiatry Clin.Neurosci., 244: 297–303.3.Schneier F.R., Johnson J., Hornig C.D., Liebowitz M.R., Weissman M.M.(1992) Social phobia: comorbidity and morbidity in an epidemiological sample.Arch.Gen.Psychiatry, 49: 282–288.4.Magee W.J., Eaton W.W., Wittchen H.U., McGonagle K.A., Kessler R.C.(1996)Agoraphobia, simple phobia, and social phobia in the National ComorbiditySurvey.Arch.Gen.Psychiatry, 53: 159–168.5.Mennin D.S., Heimberg R.G., Jack M.S [ Pobierz całość w formacie PDF ]

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