رابطه بین اضطراب جدایی و اختلال

The goal of this study was to characterize the contemporaneous and prognostic relationship between symptoms of separation anxiety disorder (SAD) and associated functional impairment. The sample comprised n = 2067 8–16-year-old twins from a community-based registry. Juvenile subjects and their parents completed a personal interview on two occasions, separated by an average follow-up period of 18 months, about the subject's current history of SAD and associated functional impairment. Results showed that SAD symptoms typically caused very little impairment but demonstrated significant continuity over time. Older youth had significantly more persistent symptoms than younger children. Prior symptom level independently predicted future symptom level and diagnostic symptom threshold, with and without impairment. Neither diagnostic threshold nor severity of impairment independently predicted outcomes after taking account of prior symptom levels. The results indicate that impairment may index current treatment need but symptom levels provide the best information about severity and prognosis.

Clinically significant impairment or distress was added to the diagnostic criteria for many psychiatric disorders in the DSM-IV (American Psychiatric Association - 1994) - This criterion was introduced to help “establish the threshold for the diagnosis of a disorder in those situations in which the symptomatic presentation by itself (particularly in its milder forms) is not inherently pathological and may be encountered in individuals for whom a diagnosis of “mental disorder” would be inappropriate” (American Psychiatric Association - 1994 - p - 7 Use of the Manual) - Despite the widespread adoption of these criteria - especially the impairment criterion - rather little is known about the relationship between impairment and juvenile anxiety disorders in community settings - There is a substantial reduction in the estimated rate of individual or aggregate juvenile anxiety disorders when impairment is required for a diagnosis (Canino et al - - 2004 - Costello - Egger - & Angold - 2004 - Essau - Conradt - & Peterman - 2000 - Romano - Tremblay - Viaro - Zoccolillo - & Pagani - 2001 - Simonoff et al - - 1997) - consistent with expectations (Wakefield & Spitzer - 2002) - The utility of diagnostic thresholds for identifying impaired youth in need of services cannot - however - be inferred from these data - Youth with sub-threshold symptoms or NOS disorders may also be significantly impaired (Angold - Costello - Farmer - Burns - & Erkanli - 1999) - The severity of impairing childhood emotional disorder (anxiety or depression) was prognostic for adolescent disorder (Costello - Angold - & Keeler - 1999) but does not clarify whether impairment ratings capture prognostic information independent of symptom or syndrome severity or if there is any heterogeneity in the symptom-impairment relationship within the emotional disorders - Pickles et al - (2001) found that juvenile depression and oppositional-defiant disorder symptoms were highly impairing whereas conduct disorder symptoms were not - Impairment related to conduct and oppositional symptoms predicted future symptoms and impairment independent of symptom load but impairment related to depression did not - This led to the suggestion (Pickles et al - - 2001) that impairment may be an epiphenomenon of depression symptoms - Do results for juvenile depression generalize to all juvenile emotional disorders or do anxiety disorders have a distinct symptom-impairment relationship? The aim of this study was to characterize the relationship between a common juvenile anxiety disorder - separation anxiety disorder - and associated functional impairment in a large community based sample of youth aged between 8 and 16 years - We report the temporal and prognostic relationship between separation anxiety disorder symptom levels - diagnostic symptom threshold - and functional impairment - by age and sex -