The structure of phobias in panic disorder

Article Abstract:

The Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), which contains criteria for diagnosing various psychiatric conditions, distinguishes between panic disorder (in which recurrent and spontaneous panic attacks occur, along with various phobias) and agoraphobia, which is generally defined as a fear of being in a public place because of the possibility of a panic attack. Unfortunately, according to current criteria, if fear of having a panic attack is present, the diagnosis must be agoraphobia. This is problematic, because social phobia (fear of social situations) may not be diagnosed as a type of panic disorder. As a first step toward reexamining the DSM-III hierarchical criteria, 1,168 patients who had experienced panic attacks in recent weeks were studied. The patients were obtained from 12 centers in Europe, and North and South America. Most (61 percent) were female, and the average age was 34. Rather than being diagnosed by means of DSM-III categories, the patients were instead assigned phobia scores on the basis of their own diary entries and responses to a phobia scale and other psychometric scales. Scores were then correlated with the number of panic attacks. The Marks-Sheehan Phobia Scale assessed items related to agoraphobia (e.g. fears of going far from home alone, traveling in buses, crowded places, open spaces), illness phobia (fears related to physical injury, illness, or reading about disease), and social phobia (e.g. fears of eating or writing in public, or being watched). The three factors distinguished by the scale were confirmed by analysis of the results. A surprising finding was a lack of significant correlation between panic attacks and agoraphobia. In addition, it was learned that most patients do not differentiate well between agoraphobic and social phobic issues. It is concluded that panic attacks can accompany agoraphobia, social phobia, or illness phobia. Though agoraphobia was the most common type of phobia, it was not found to have a special relationship to panic attacks. (Consumer Summary produced by Reliance Medical Information, Inc.)

Identification and classification, Panic disorders, Panic disorder, Agoraphobia, Panic attacks

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Koro: the genital retraction symptom after stroke

Article Abstract:

Koro is the name of a curious and rare complex in which a person believes that his penis (or breasts and labia, if a woman) is shrinking, that it is disappearing into his abdomen, and that he will consequently die. Because this complex in its complete form has only been seen in oriental (Chinese) patients, it has thus far been considered a culture-bound psychiatric problem. However, a case is described of a 73-year-old British man who developed the ''genital retraction symptom'' (as the author suggests it be called) following a stroke. He left visual field was gone, and his whole left side was partially paralyzed. The man continuously gripped his penis with his right hand, convinced that it was shrinking. The other effects of stroke subsided within three months, while the Koro symptom subsided within two weeks of admission. Evidence from existing literature is discussed in regard to the association between Koro and measurable psychomotor disturbances in other cases. It is pointed out that the temporoparietal and frontotemporal regions of the brain, which were damaged in other cases, are involved in maintenance of body image and sexual function. This case, involving as it does a non-Chinese elderly man, underscores the possibility of brain or nervous system pathology in cases of genital retraction syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Stroke (Disease), Stroke, Penis

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