Dalrymple Kristy L, Walsh Emily, Rosenstein Lia, Chelminski Iwona, Zimmerman Mark
Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, United States.
Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States.
J Affect Disord. 2017 Mar 1;210:230-236. doi: 10.1016/j.jad.2016.12.055. Epub 2017 Jan 3.
The DSM 5 modified the medical exclusion criterion from DSM-IV, which now allows for a diagnosis of social anxiety disorder (SAD) to be given if the fears are related only to the medical condition (e.g., obesity) yet cause significant impairment or distress.
To examine this modification, the current study compared bariatric surgery candidates with DSM-IV SAD (n=135), modified SAD (clinically significant social fears related to obesity only; n=40), and no history of Axis I disorders (n=616) on variables related to pre-surgical problematic eating behaviors, body image dissatisfaction, functional impairment, and other characteristics related to bariatric surgery. Participants were referred by their surgeon for a psychiatric evaluation as part of the clearance process, and completed a comprehensive, semi-structured diagnostic interview and self-report measures.
There were several differences between those with DSM-IV SAD and modified SAD compared to those with no disorder (e.g., on binge and emotional eating), but the two SAD groups did not differ from each other on any of the comparisons.
Results may not generalize to individuals suffering from obesity in the general population or those seeking other types of weight loss treatment. Because they were seeking psychiatric clearance, they also may have underreported symptoms/problems for fear that they would not get cleared.
Overall, the modified SAD group more closely resembled the DSM-IV SAD group rather than the no disorder group, providing further support for diagnosing SAD even when the social fears are related to obesity only.
《精神疾病诊断与统计手册》第5版（DSM - 5）修改了DSM - IV中的医学排除标准，现在如果恐惧仅与医学状况（如肥胖）相关，但会导致严重损害或痛苦，则允许诊断为社交焦虑障碍（SAD）。
为检验这一修改，本研究比较了接受减肥手术的候选者中，患有DSM - IV社交焦虑障碍的患者（n = 135）、修改版社交焦虑障碍患者（仅与肥胖相关的具有临床意义的社交恐惧；n = 40）以及无轴I障碍病史的患者（n = 616）在与术前问题饮食行为、身体形象不满、功能损害以及其他与减肥手术相关特征方面的差异。参与者由其外科医生转介进行精神科评估，作为审批流程的一部分，并完成了全面的半结构化诊断访谈和自我报告测量。
与无障碍者相比，患有DSM - IV社交焦虑障碍和修改版社交焦虑障碍的患者之间存在一些差异（例如在暴饮暴食和情绪化进食方面），但两个社交焦虑障碍组在任何比较中彼此之间均无差异。
结果可能不适用于一般人群中的肥胖个体或寻求其他类型减肥治疗的个体。由于他们正在寻求精神科审批，他们也可能因担心无法获批而少报症状/问题。
总体而言，修改版社交焦虑障碍组与DSM - IV社交焦虑障碍组更为相似，而非与无障碍组相似，这为即使社交恐惧仅与肥胖相关时诊断社交焦虑障碍提供了进一步支持。
