فراتر از DSM-5: یک روش جایگزین برای ارزیابی اختلال اضطراب اجتماعی

Abstract This article focuses on the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification of Social Anxiety Disorder (SAD). The article details the diagnostic criteria for SAD that have evolved in the various editions and demonstrates that whilst there have been some positive steps taken to more comprehensively define the disorder, further revision is necessary. It will be argued that the DSM-5 (APA, 2013) has made some changes to the diagnostic criteria of SAD that do not seem to be completely in line with theory and research and do not describe SAD effectively in terms of both diversity and presentation. This article concludes with the presentation of a proposed set of diagnostic criteria that address the concerns raised in the article. The proposed criteria reflect a hybrid categorical–dimensional system of classification.

Conclusion This article reviewed the changes that have been made to the DSM diagnostic criteria of SAD. Some of the most notable changes found within DSM-5 (APA, 2013) have been evaluated in relation to the literature. Specifically, the following have been outlined: the removal of wording that highlights the fear is persistent; the removal of performance fears in the general diagnostic criteria and inclusion of a performance fear specifier; the specific emphasis on the fear of negativeevaluation, rather than evaluation or scrutiny in general; and changes to the criterion that indicate a lack of insight into the unreasonable nature of the fear that is experienced. DSM specifiers, past and present were also discussed and evaluated for their usefulness and accuracy. The article concluded by proposing a new set of criteria within a dimensional approach to describing the disorder. This proposed criteria set (seen in Table 1) incorporates the evidence-based aspects of the DSM-5 (APA, 2013) criteria and proposes several other changes. The following changes have been proposed. First, Criterion A has been revised to include all three feared situations (i.e., social interaction fears, being observed and performance). This approach removes the need for specifiers altogether and is a more comprehensive and empirically supported way to describe an individual with SAD. Second, Criterion B has been divided into fear of negative evaluation and fear of positive evaluation in line with theory and research. Third, Criterion C has been revised to highlight that the fear persists while the individual is within the social situation in line with theory and research. Fourth, Criterion D includes safety behaviours (as subtle avoidance behaviour) as well as overt avoidance behavior and rates them along similar lines. Fifth, Criterion G includes impairment in functioning along the spectrum of interpersonal functioning. The DSM-5 diagnostic criteria set were not a part of the field trials conducted to evaluate the validity and reliability of the new criteria for several disorders. The proposed SAD criteria presented here would need to be trialled in comparison to the DSM-5 diagnostic criteria for SAD. A field trial would enable the comparison of the two diagnostic criteria sets and assess the clinical utility of the proposed criteria.