Diagnostic and symptoms

social anxiety disorder criteriaCriteria

According to the DSM-IV-TR[8], to be diagnosed with Social Phobia all these criteria (A-H) must be met:

A. A marked and persistent fear of one or more social performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.

The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.

Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.

B. Exposure to the social or performance situation almost invariably provokes an immediate anxiety response.

This response may take the form of a situationally bound or situationally people predisposed Panic Attack.

Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

C. The person recognizes that their fear is excessive or unreasonable.

Note: In children, this feature may be absent.

D. The social or performance situation is avoided, although it is sometimes endured with dread (intense anxiety or distress).

E. The avoidance, anxious anticipation of, or distress in, the feared social or performance situation interferes significantly with the person’s normal routine, occupational (academic) functioning, social life, or if the person is markedly distressed about having the phobia.

F. In individuals under age 18 years, the duration is at least 6 months.

G. The fear or avoidance is not due to the direct physiological effects of a substance or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).

H. If a general medical condition or another mental disorder is present, the fear in Criterion A or the avoidance in Criterion D, is unrelated to it (e.g., the fear is not of Stuttering, trembling in Parkinson’s disease, or exhibiting abnormal eating behavior in Anorexia Nervosa).

Specify if:
Generalized: if the fears include most social situations (also consider the additional diagnosis of Avoidant Personality Disorder).


Cognitive aspects

In cognitive models of Social Anxiety Disorder, social phobics experience dread over how they will be presented to others.

They may be overly self-conscious, pay high self-attention after the activity, or have high performance standards for themselves.

According to the social psychology theory of self-presentation, a sufferer attempts to create a well-mannered impression on others but believes he or she is unable to do so.

Many times, prior to the potentially anxiety-provoking social situation, sufferers may deliberately go over what could go wrong and how to deal with each unexpected case. After the event, they may have the perception they performed unsatisfactorily. Consequently, they will review anything that may have possibly been abnormal or embarrassing.

These thoughts do not just terminate soon after the encounter, but may extend for weeks or longer.

Those with social phobia tend to interpret neutral or ambiguous conversations with a negative outlook and many studies suggest that socially anxious individuals remember more negative memories than those less distressed.

An example of an instance may be that of an employee presenting to his co-workers.

During the presentation, the person may stutter a word upon which he or she may worry that other people significantly noticed and think that he or she is a terrible presenter.

This cognitive thought propels further anxiety which may lead to further stuttering, sweating and a possible panic attack.


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