Cornacchio Danielle, Chou Tommy, Sacks Hayley, Pincus Donna, Comer Jonathan
Department of Psychology, Mental Health Interventions and Technology (MINT) Program, Florida International University, Miami, Florida.
Weill Cornell College of Medicine, New York, New York.
Depress Anxiety. 2015 Jul;32(7):502-8. doi: 10.1002/da.22361. Epub 2015 Apr 4.
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.
在《精神疾病诊断与统计手册》第5版（DSM - 5）中，广场恐惧症的核心症状标准已被修订，要求对至少两个不同领域中的多种情况感到恐惧，在这些情况下可能难以逃脱或可能出现惊恐样症状。本研究调查了一组有焦虑症状的青少年样本中近期变化的模式及相关因素，这些青少年的症状表现符合DSM - IV广场恐惧症的定义和/或特定恐惧症（SP），以探讨近期的诊断变化如何影响儿童和青少年广场恐惧症的患病率及构成。
分析（N = 151）评估了不再符合DSM - 5广场恐惧症标准的广场恐惧症青少年与符合新DSM - 5标准的广场恐惧症青少年的损害情况及相关因素。二级分析将不符合DSM - 5标准的广场恐惧症青少年与特定恐惧症青少年进行了比较。
四分之一有符合DSM - IV广场恐惧症定义症状表现的青少年不再符合DSM - 5广场恐惧症的标准，但在大多数领域的严重程度和损害程度与符合DSM - 5广场恐惧症标准的青少年相当。此外，相对于特定恐惧症青少年，这些青少年表现出更高水平的焦虑敏感性和内化性精神病理学症状。
相当一部分有明显广场恐惧症症状表现且受损的青少年未被DSM - 5明确诊断为焦虑症，这可能会影响他们获得服务及/或保险覆盖的能力，以及他们在治疗评估中的代表性。未来的DSM版本不妨纳入一个“局限性”广场恐惧症说明符，用于描述对多种情况的恐惧或焦虑表现，但这些情况不跨越至少两个不同的情境领域。
