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Depress Anxiety. 2015 Jul;32(7):502-8. doi: 10.1002/da.22361. Epub 2015 Apr 4.

CLINICAL CONSEQUENCES OF THE REVISED DSM-5 DEFINITION OF AGORAPHOBIA IN TREATMENT-SEEKING ANXIOUS YOUTH.

Author information

1
Department of Psychology, Mental Health Interventions and Technology (MINT) Program, Florida International University, Miami, Florida.
2
Weill Cornell College of Medicine, New York, New York.
3
Department of Psychology, Center for Anxiety and Related Disorders (CARD), Boston University, Boston, Massachusetts.

Abstract

BACKGROUND:

In DSM-5, the agoraphobia core symptom criterion has been revised to require fear about multiple situations from across at least two distinct domains in which escape might be difficult or panic-like symptoms might develop. The present study examined patterns and correlates of the recent change in a sample of anxious youth with symptom presentations consistent with the DSM-IV agoraphobia definition and/or specific phobia (SP) to consider how the recent diagnostic change impacts the prevalence and composition of agoraphobia in children and adolescents.

METHOD:

Analyses (N = 151) evaluated impairment and correlates of agoraphobic youth who no longer meet the DSM-5 agoraphobia criteria relative to agoraphobic youth who do meet the new DSM-5 criteria. Secondary analyses compared agoraphobic youth not meeting DSM-5 criteria to SP youth.

RESULTS:

One-quarter of youth with symptom presentations consistent with the DSM-IV agoraphobia definition no longer met criteria for DSM-5 agoraphobia, but showed comparable severity and impairment across most domains to youth who do meet criteria for DSM-5 agoraphobia. Further, these youth showed higher levels of anxiety sensitivity and internalizing psychopathology relative to youth with SP.

CONCLUSIONS:

A substantial proportion of impaired youth with considerable agoraphobic symptom presentations have been left without a specified anxiety diagnosis by the DSM-5, which may affect their ability to receive and/or get coverage for services and their representation in treatment evaluations. Future DSM iterations may do well to include a "circumscribed" agoraphobia specifier that would characterize presentations of fear or anxiety about multiple situations, but that do not span across at least two distinct situational domains.

KEYWORDS:

agoraphobia; anxiety; assessment; child/adolescent; diagnosis; phobias

PMID:
25845579
PMCID:
PMC5340313
DOI:
10.1002/da.22361
[Indexed for MEDLINE]
Free PMC Article

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