RESUMEN
This study examines a large cohort of subjects with social phobia, as part of a larger naturalistic and longitudinal study of 711 subjects with anxiety disorders. We focused on 176 subjects who were in an episode of social phobia at intake. We were particularly interested in evaluating the diagnostic distinction between generalized and specific social phobia. We compared these two groups along demographic characteristics, comorbidities, psychosocial functioning (health, role functioning, social functioning, and emotional functioning) and global assessment scores. We found that generalized social phobics tended to have an earlier age of onset as compared to the specific group; however, this is not a statistically significant difference at this level of analysis. The two groups did not differ for the current comorbidities examined. We observed no differences in the treatment received by the two types of social phobia subjects, and the two groups functioned equally well in terms of health and fulfilling social roles. In addition, we examined adverse childhood events (i.e., death of a parent, childhood abuse) and found no evidence for any differential impact these events might have on the type of social phobia. Although we did observe significantly greater fear of public speaking among the specific compared to the generalized group, which may indicate a qualitative difference between the subtypes, our results suggest that for most parameters, generalized and specific social phobia represent a continuum of similar and overlapping entities.
Asunto(s)
Trastornos Fóbicos/diagnóstico , Adulto , Anciano , Agorafobia/clasificación , Agorafobia/diagnóstico , Agorafobia/epidemiología , Agorafobia/psicología , Trastornos de Ansiedad/clasificación , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Estudios de Cohortes , Comorbilidad , Diagnóstico Diferencial , Femenino , Humanos , Acontecimientos que Cambian la Vida , Estudios Longitudinales , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Trastorno de Pánico/clasificación , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/epidemiología , Trastorno de Pánico/psicología , Determinación de la Personalidad , Trastornos Fóbicos/clasificación , Trastornos Fóbicos/epidemiología , Trastornos Fóbicos/psicología , Estudios Prospectivos , Calidad de Vida , Factores de Riesgo , Ajuste SocialRESUMEN
The authors investigated the prevalence and characteristics of somatoform (SOM) disorders among 654 subjects with anxiety disorders who were part of the larger Harvard/Brown Anxiety Disorders Research Project. Thirty-six (5.5%) of the subjects had past or current SOM disorders. The subjects with SOM disorders were significantly more likely to have histories of posttraumatic stress disorder (22% vs. 8%, P = 0.01). The subjects with generalized anxiety disorder had significantly higher rates of SOM disorder (9.2% vs. 4.0%, P = 0.01). These results add support to the observation that SOM disorders are frequently comorbid with anxiety and depressive disorders.
Asunto(s)
Trastornos Somatomorfos/epidemiología , Trastornos de Ansiedad/complicaciones , Comorbilidad , Trastorno Depresivo/complicaciones , Femenino , Humanos , Incidencia , Masculino , Trastornos Fóbicos/complicaciones , Prevalencia , Trastornos Somatomorfos/complicaciones , Trastornos por Estrés Postraumático/psicologíaRESUMEN
OBJECTIVE: This analysis describes subjects who met rigorous criteria for DSM-III-R agoraphobia without a history of panic disorder and makes inferences from these data regarding relationships among agoraphobia without a history of panic disorder, panic disorder, and panic disorder with agoraphobia. METHOD: Twenty-six subjects (seven men and 19 women) with agoraphobia without a history of panic disorder were identified from among 711 subjects recruited for a multicenter, longitudinal anxiety disorder study. Narrative transcripts prepared by raters from study evaluations were coded for limited symptom attacks, situational panic, catastrophic cognitions, and possible precipitants and stressors, course, and somatic and psychosocial treatments received. RESULTS: Sixty-five percent of the subjects reported experiences consistent with situational panic attacks, and 57% had definite or probable limited symptom attacks; these attacks usually preceded or appeared at the same time as avoidance behavior. Eighty-one percent had catastrophic cognitions associated with agoraphobia. Twenty-six percent reported a likely precipitating factor for symptom onset, and 30% reported a definite or probable major life stressor within 6 months before symptom onset. Cognitive-behavioral treatments were relatively infrequently used. Course was relatively unchanged across the follow-up period. CONCLUSIONS: These data support a view of agoraphobia without a history of panic disorder on a continuum with uncomplicated panic disorder and with panic disorder and agoraphobia, rather than as a separate diagnosis.