The Diagnosis Of Social Phobia
تشخيص الرهاب الاجتماعي
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فيما يلي عرض تفصيلي لتشخيص اضطراب الرهاب الاجتماعي وفقاً للتصنيف العالمي للاضطرابات النفسية والسلوكية العاشر ( 1992 ) والدليل الأمريكي التشخيصي والإحصائي للاضطرابات النفسية الرابع ( 1994 ) .
ويلي ذلك شرح وتفاصيل عن عدد من المقاييس والاستبيانات المستعملة في دراسة هذا الاضطراب .
وأخيراً .. نقدم ترجمة بالعربية لمقياس قائمة الرهاب الاجتماعي [ SPIN ] تأليف كونور وآخرين ، وهو مقياس حديث ويفيد في الكشف عن حالات الرهاب الاجتماعي وفي استجابتها للعلاج .
|The two main classification systems for mental disorders, ICD-10 (1992; F40.1 Social Phobias) and DSM-IV (1994; Social Phobia [Social Anxiety Disorder), recognise social anxiety disorder/social phobia. Both describe the essential features to be a fear of scrutiny by other people in social situations, a fear of criticism or humiliation, and avoidance of feared situations. The condition may be diffuse/generalised, i.e. involving almost all social contacts, or discrete/non-generalised, i.e. restricted to specific social activities or performance situations. ICD-10
The ICD-10 Classification of Mental and Behavioural Disorders. World Health Organization, Geneva, 1992. F40.1 Social Phobias.
ICD-10 describes social phobia as centred around a fear of scrutiny by other people in comparatively small groups (as opposed to crowds), usually leading to avoidance of social situations. The fear may be discrete, i.e. restricted to particular situations such as eating or speaking in public and encounters with the opposite sex, or diffuse, i.e. involving almost all social situations outside the family circle.
1- The psychological, behavioural, or autonomic symptoms are primarily manifestations of anxiety and not secondary to other symptoms, such as delusions or obsessional thoughts
Social phobia may progress to panic attacks. Avoidance is often marked and in some cases may lead to complete social isolation.
Agarophobia and depressive disorders are often prominent and may contribute to the individual becoming 'housebound'. If the distinction between social phobia and agoraphobia is difficult, ICD-10 states that precedence should be given to agoraphobia. A depressive diagnosis should not be made unless a full depressive syndrome can be identified clearly.
Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, Washington, DC, American Psychiatric Association, 1994. 300.23 Social Phobia (Social Anxiety Disorder).
DSM-IV describes social phobia (social anxiety disorder) as a marked and persistent fear of one or more social or performance situations in which the individual is exposed to unfamiliar people or to possible scrutiny by others. The individual fears acting in a way (or showing anxiety symptoms) that will be humiliating or embarrassing.
1- Exposure to the feared situations provokes anxiety and sometimes a panic attack 2- The individual recognises that the fear is excessive or unreasonable
3- The feared situations are avoided or else endured with intense anxiety or distress 4- The avoidance, anxious anticipation, or distress interferes with the individual's normal routine, occupational functioning, or social activities or relationships, or there is marked distress about having the phobia
5- In individuals under the age of 18 years, the duration is at least six months
If the fears include most social situations, the social phobia is described as generalised.
In DSM-IV, for a diagnosis of social phobia, the fear or avoidance must not be due to the direct physiological effects of a substance or a general medical condition. In addition, they should not be better accounted for by another mental disorder such as panic disorder (with or without agoraphobia), separation anxiety disorder, body dysmorphic disorder, a pervasive developmental disorder, or schizoid personality disorder.
Although there is broad agreement between the ICD-10 and DSM-IV diagnostic criteria, the essential difference relates to the differential diagnosis of social anxiety disorder and agoraphobia.
A number of
Beidel DC, Borden JW, Turner SM, Jacob RG. The Social Phobia and Anxiety Inventory: concurrent validity with a clinic sample. Behav Res Ther 1989; 27: 573-576.
|Clinical severity||non-specific||Clinical Global Impression Scale for Severity of Illness||Clinician|
|non-specific||Clinical Global Improvement Scale||Clinician|
|non-specific||Hamilton Rating Scale for Anxiety||Clinician|
|non-specific||Hamilton Rating Scale for Depression||Clinician|
|specific||Liebowitz Social Anxiety Scale||Clinician|
|specific||Social Anxiety and Distress Scale||Clinician|
|specific||Fear of Negative Evaluation Scale||Patient|
|specific||Duke Brief Social Phobia Scale||Patient|
|specific||Social Phobia and Anxiety Inventory||Patient|
|specific||Social Phobia Inventory||Patient|
|specific||Social Performance Scale||Patient|
|specific||Social Interactional Anxiety scale||Patient|
|Functional disability||non-specific||Sheehan Disability Scale||Clinician|
|non-specific||Social and Occupational Functioning Assessment Scales||Clinician|
|non-specific||World Health Organization Disability Assessment Schedule 2||Clinician|
|non-specific||Global Assessment Functioning||Clinician|
|specific||Liebowitz Disability Self-rating Scale||Patient|
|specific||Reilly Work Productivity and Impairment Questionnaire||Patient|
|Quality of life||World Health Organization Quality of Life - 100||Patient|
|World Health Organization Quality of Life - BREF||Patient|
|Short Form - 36 items||Patient|
|Short Form - 12 items||Patient|
Scales in bold are the most widely applied
Liebowitz Social Anxiety Scale (LSAS)
- The LSAS has 24 items, of which 13 explore performance situations (P) and 11 examine social interaction situations (S).
|1.||Using a telephone in public||P|
|2.||Participating in a small group activity||P|
|3.||Eating in public places||P|
|4.||Drinking with others in public places||P|
|5.||Talking to people in authority||S|
|6.||Acting, performing, or giving a talk in front of an audience||P|
|7.||Going to a party||S|
|8.||Working while being observed||P|
|9.||Writing while being observed||P|
|10.||Calling someone you don't know very well||S|
|11.||Talking with people you don't know very well||S|
|13.||Urinating in a public bathroom||P|
|14.||Entering a room when others are already seated||P|
|15.||Being the centre of attention||S|
|16.||Speaking up at a meeting||P|
|17.||Taking a test||P|
|18.||Expressing disagreement or disapproval to someone you don't know very well||S|
|19.||Looking at people you don't know very well in the eyes||S|
|20.||Giving a report to a group||P|
|21.||Trying to pick up someone||P|
|22.||Returning goods to a store||S|
|width="3%">23.||Giving a party||S|
|24.||Resisting a high pressure salesperson||S|
- Clinicians ask patients how they do or would react if confronted with each situation and use numerical scales to rate their fear or anxiety and avoidance.
|Fear or anxiety||Avoidance|
|1 = none||1 = never (0%)|
|2 = mild||2 = occasionally (1-33%)|
|3 = moderate||3 = often (34-67%)|
|4 = severe||4 = usually (68-100%)|
Social Phobia Inventory (SPIN)