Antony M M, Brown T A, Barlow D H
Anxiety Disorders Clinic, Clarke Institute of Psychiatry, Toronto, Ontario, Canada.
Behav Res Ther. 1997 Dec;35(12):1089-100.
Recently, it has been suggested that situational specific phobias (e.g., phobias of driving, flying, enclosed places) are more closely related to agoraphobia than are other specific phobia types. The present study investigated this hypothesis by examining heterogeneity among the four main DSM-IV specific phobia types, particularly with respect to variables believed to be associated with agoraphobia. Using interviews and behavioral testing, 60 patients with specific phobias of animals, heights, blood/injections, or driving were compared with respect to etiology, age of onset, physiological response, predictability of panic attacks, and focus of apprehension. Fifteen patients suffering from panic disorder with agoraphobia served as a comparison group for some measures. Relative to the other specific phobias, driving phobias were most strongly associated with a later age of onset, similar to that of individuals with agoraphobia. Height phobias were also associated with a late age of onset as well as a more internal focus of apprehension, relative to other groups. Finally, individuals in the blood/injection phobia group reported a more internal focus of apprehension than those in other groups and were the only group to report a history of fainting in the phobic situation. Overall, the results did not support the hypothesis that situational phobias are a variant of agoraphobia. In fact, on several of the variables for which groups did differ, individuals with height phobias (a phobia from the natural environment type) showed a pattern most similar to individuals with agoraphobia. The implications of these results for the classification of specific phobias are discussed.
最近，有人提出情境特定恐惧症（如驾驶、飞行、封闭场所恐惧症）与广场恐惧症的关系比其他特定恐惧症类型更为密切。本研究通过考察《精神疾病诊断与统计手册》第四版中四种主要特定恐惧症类型之间的异质性来探究这一假设，尤其关注那些被认为与广场恐惧症相关的变量。通过访谈和行为测试，对60名患有动物、高处、血液/注射或驾驶特定恐惧症的患者在病因、发病年龄、生理反应、惊恐发作的可预测性以及担忧焦点等方面进行了比较。15名患有广场恐惧症的惊恐障碍患者作为部分测量指标的对照组。相对于其他特定恐惧症，驾驶恐惧症与较晚的发病年龄关联最为紧密，这与广场恐惧症患者相似。相对于其他组，高处恐惧症也与较晚的发病年龄以及更内在的担忧焦点相关。最后，血液/注射恐惧症组的个体报告的担忧焦点比其他组更内在，并且是唯一报告在恐惧情境中有昏厥史的组。总体而言，结果并不支持情境恐惧症是广场恐惧症变体的假设。事实上，在几组存在差异的变量中，患有高处恐惧症（一种自然环境类型的恐惧症）的个体在几种变量上呈现出与广场恐惧症患者最为相似的模式。本文讨论了这些结果对特定恐惧症分类的意义。
