Stein M B, Baird A, Walker J R
Department of Psychiatry, St. Boniface General Hospital, University of Manitoba, Winnipeg.
Am J Psychiatry. 1996 Feb;153(2):278-80. doi: 10.1176/ajp.153.2.278.
The authors evaluated features of social anxiety in a group of adult stutterers to explore the soundness of the DSM-IV requirement that social phobia not be diagnosed in patients who stutter if their phobia relates to their stuttering.
They conducted diagnostic interviews and verbal fluency assessments with 16 consecutive adults seeking speech therapy for stuttering. Patients also completed scales measuring social phobia symptoms and associated disability.
When DSM-IV criteria were modified to permit a diagnosis of social phobia if phobic symptoms were clearly excessive in relation to the severity of stuttering, seven of the 16 patients were given a diagnosis of social phobia. All seven identified social anxiety as an important source of role impairment. Three of the seven patients entered cognitive-behavioral group therapy and benefited from this intervention.
Many adults seeking treatment for stuttering have salient difficulties with social anxiety that may prove amenable to cognitive-behavioral interventions. By precluding a diagnosis of social phobia in these patients, DSM-IV may hinder the identification of social anxiety as a source of disability and may limit access to treatment.
作者评估了一组成年口吃者的社交焦虑特征，以探究《精神疾病诊断与统计手册》第四版（DSM-IV）中规定的合理性，即如果口吃患者的恐惧与口吃相关，则不得诊断为社交恐惧症。
他们对连续16名寻求口吃言语治疗的成年人进行了诊断访谈和言语流畅性评估。患者还完成了测量社交恐惧症症状及相关残疾程度的量表。
当按照DSM-IV标准进行修改，允许在恐惧症状明显超出口吃严重程度时诊断为社交恐惧症时，16名患者中有7名被诊断为社交恐惧症。所有7名患者均认为社交焦虑是导致角色功能受损的重要原因。7名患者中有3名参加了认知行为团体治疗并从中受益。
许多寻求口吃治疗的成年人存在明显的社交焦虑问题，这些问题可能适合采用认知行为干预方法。由于DSM-IV排除了对这些患者社交恐惧症的诊断，可能会阻碍将社交焦虑识别为导致残疾的原因，还可能限制治疗的可及性。
