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KMID : 0654219920010000145
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Journal of Asan Welfare Foundation Haesung General Hospital
1992 Volume.1 No. 0 p.145 ~ p.155
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An Attempt to Subclassify Social Phobia
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Abstract
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As one looks into the clinical pictures of social phobia in Korea, it is not as simple as is described in DSM-III(R).
In the previous reports the authors have indicated that DSM-III(R) criteriae of social l phobia is not applicable in explaining all of the social phobic cases in Korea.
In order to get a more clear picture, the authors previously suggested to subclassity so-´ cial phobia into three subgroups according to the severity of cognitive distortion : simple, delusional and borderline. .
Despite its practical usefulness, the ward "delusional" has given much misunderstanding to Western colleague.
It is for this reason that we are to present the new subclassifcation system.
It is subcassified according to the clinical menifestations either there is any noticeable physical signs or any cognitive distortion : (1) Physical type (2) Cognitive type (3) Mixed type (physical and cognitive)
1. Some clinical characteristics of each type are as follows
1) Physical type : There are noticeable physical signs, e.g. blushing, shaky voice, stiff facial expression etc, and the suffering is limited only to patient him/her self.
2) Cognitive type : It shows no noticeable physical signs, but only cognitive distortion : e. g. difficult eye contact, emitting odors, being stared at etc.
3) Mixed type : It has both elements, physical & cognitive.
2. Out of the 160 social phobia cases seen of Koryo General Hospital during the period of five years, some clinical findings of subtypes are as follows :
1) Fifty two cases(32.5 % ) were classified as physical type, forty cases(25.0 % ) as cognitive type and sixty eight cases(42.5%) as mixed type.
2) With the applicability of diagnostic crieteria of DSM-111 (R) on social phobia, 74 cases (46.3%) out of 160 cases may be included. All the physical type may be included in DSMIII(R) criteria, but only a part of the cognitive and mixed type may be included.
3) The age of symptom onset was earlier in the cognitive type(17.8 year-old) than in the physical type(19.5 year-old) and the age of initial hospital visit was later in the physical type(30.1 year-old).
4) Physical type shows higher educational level and better social adjustment.
5) In physical type, symptoms tend to occur to acquaintances and in cognitive type, to anyone.
6) Group therapy was more effective for the physical or cognitive type than
for the mixed type. The most effective therapeutic technique in the physical type was paradoxical intention, and in the cognitive type, therapist´s lecture.
The clinical usefulness of this new proposal to subclassification system has been discussed and we suggest the need for a better way of subclassifying saocial phobia in the future.
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