Child Development and Education, University of Amsterdam, 1018VZ Amsterdam, The Netherlands.
Depress Anxiety. 2010 Feb;27(2):168-89. doi: 10.1002/da.20670.
This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues.
A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V.
RESULTS/CONCLUSIONS: Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a "predominantly performance" variety of SAD. A specifier based on "fear of showing anxiety symptoms" (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options.
本综述评估了 DSM-IV 社交焦虑障碍（SAD）的标准，重点关注广泛性特定标准和替代特定标准、SAD 和回避型人格障碍的 DSM-IV 诊断标准之间的大量重叠，以及发展问题。
采用 DSM-V 谱研究组提供的有效验证器进行文献回顾。本综述提出了一些可供 DSM-V 考虑的选择和初步建议。
结果/结论：目前的特定标准，即广泛性 SAD，几乎没有支持证据。相反，SAD 患者的症状似乎根据恐惧的数量沿着严重程度的连续体分布。现有证据表明，指示“主要表现”形式的 SAD 的特定标准具有实用性。考虑了基于“表现出焦虑症状的恐惧”（例如脸红）的特定标准。然而，表现出焦虑症状的倾向是 SAD 的核心恐惧之一，类似于以某种方式行动或表现。在考虑根据核心恐惧对 SAD 进行亚型分类之前，需要进行更多的研究。SAD 在儿童和青少年中是一种有效的诊断。选择性缄默症可以部分视为儿童对社交恐惧的回避反应。广泛性考试焦虑不仅可能属于 SAD，也可能属于广泛性焦虑障碍。关于是否将回避型人格障碍简单地视为 SAD 的严重形式，数据存在争议。需要进行二次数据分析、现场试验和有效性测试，以调查这些建议和选择。
