title: Recognition of irrationality of fear and the diagnosis of social anxiety disorder and specific phobia in adults: implications for criteria revision in DSM-5.
abstract: BACKGROUND
  In DSM-IV, the diagnosis of social anxiety disorder (SAD) and specific phobia in adults requires that the person recognize that his or her fear of the phobic situation is excessive or unreasonable (criterion C). The DSM-5 Anxiety Disorders Work Group has proposed replacing this criterion because some patients with clinically significant phobic fears do not recognize the irrationality of their fears. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project we determined the number of individuals who were not diagnosed with SAD and specific phobia because they did not recognize the excessiveness or irrationality of their fear.
  
  
  METHODS
  We interviewed 3,000 psychiatric outpatients and 1,800 candidates for bariatric surgery with a modified version of the Structured Clinical Interview for DSM-IV. In the SAD and specific phobia modules we suspended the skip-out that curtails the modules if criterion C is not met. Patients who met all DSM-IV criteria for SAD or specific phobia except criterion C were considered to have "modified" SAD or specific phobia.
  
  
  RESULTS
  The lifetime rates of DSM-IV SAD and specific phobia were 30.5 and 11.8% in psychiatric patients and 11.7 and 10.2% in bariatric surgery candidates, respectively. Less than 1% of the patients in both samples were diagnosed with modified SAD or specific phobia.
  
  
  CONCLUSIONS
  Few patients were excluded from a phobia diagnosis because of criterion C. We suggest that in DSM-5 this criterion be eliminated from the SAD and specific phobia criteria sets.
authors.affiliation: The Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA. mzimmerman@lifespan.org
authors.forename: Mark
authors.initials: M
authors.lastname: Zimmerman
authors.forename: Kristy
authors.initials: K
authors.lastname: Dalrymple
authors.forename: Iwona
authors.initials: I
authors.lastname: Chelminski
authors.forename: Diane
authors.initials: D
authors.lastname: Young
authors.forename: Janine N
authors.initials: JN
authors.lastname: Galione
mesh_terms: D000328:Adult; D001364:Awareness; D050110:Bariatric Surgery / Q000523:psychology; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005239:Fear; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data; D010698:Phobic Disorders / Q000175:diagnosis* / Q000523:psychology*; D011594:Psychometrics / Q000706:statistics & numerical data; D011936:Reality Testing; D012016:Reference Values; D015203:Reproducibility of Results