What is social anxiety disorder?

Social anxiety disorder diagnosis - infographic. Social anxiety symptoms.

Social anxiety facts – infographic

Social anxiety disorder (also know as social phobia) is characterized by a fear of social or performance situations in which a person is afraid to act in an embarrassing or humiliating way. Examples of social or performance situations are: meeting someone for the first time, attending a meeting, giving a presentation, a job interview, a first date or encounter with a stranger. This fear of social or performance situations alone is not enough for a social anxiety disorder diagnosis. Other criteria include the realization that the fear is unrealistic, and that the fearful event is avoided or endured with intense anxiety and distress. Sometimes, the distress and anxiety one experiences during a social event can cause a panic attack.
A proper social anxiety disorder diagnosis is important for several reasons:

  • An official diagnosis explains why someone experiences certain symptoms, and comes with a recommendation for further steps.
  • Some insurance companies require an official diagnosis in order to reimburse treatment.
  • An official social anxiety disorder diagnosis can help researchers develop more effective evidence based treatments and self-help strategies.

However, there are therapists who do not officially diagnose people, because they do not believe in the benefits of an official diagnosis. According to these therapists, an official diagnosis can ‘hunt’ people for a long time, and it doesn’t not change the treatment. It is up to the patient to decided whether on not an official diagnosis is preferable.

At Barends Psychology Practice social anxiety disorder treatment is offered (also online). Go to contact us to schedule a first, free of charge, first session. (Depending on your health insurance, treatment may be reimbursed).

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Social anxiety disorder diagnosis – differences between DSM IV and DSM V

In 2013 the Diagnostic and Statistical Manual of Mental Disorders (DSM) updated its previous DSM IV and named it the DSM V. Based on more recent research, some official criteria of certain mental disorders changed a little. For social anxiety disorder, one change was made as well: the duration. In the DSM IV, the official social anxiety disorder symptoms needed to be present for at least 6 months in people 18 years or younger. In the DSM V, however, the anxiety, fear, or avoidance is persistent, typically lasting for 6 or more months for anyone.
This seems to be a minor change, but it enables therapists to diagnose someone sooner, which is important if the person suffers from its symptoms a lot.

Social anxiety disorder diagnosis – DSM V

Here are the official social anxiety disorder diagnosis accompanied by an explanation and critical note when needed:

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g. giving a speech). Giving a speech in front of an (unknown) audience can be very stressful and produce physical symptoms, such as a dry mouth, trembling or shaking, sweating, numbness or tingling, feeling faint or dizzy, chest pain, shortness of breath, heart palpitation and accelerated heartbeat. Someone with social anxiety disorder usually is afraid that the audience will see these physical symptoms, which is embarrassing or humiliating for the person with social anxiety disorder.

B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others). These fears produce more physical symptoms and in turn increase the fears.

C. The social situations almost always provoke fear or anxiety. Experiencing some distress, worry and a few physical symptoms is normal on a first date or public speech. However, experiencing fear or anxiety every time an individual experiences something related to criterion A, is not healthy.

D. The social situations are avoided or endured with intense fear or anxiety. People do not like anxiety and try to avoid feared situations as much as possible. If they cannot avoid these situations, they usually endure the feared situation with intense anxiety and distress. Critical note: sometimes an individual has one or more safety behaviors or objects to reduce their anxiety levels. A safety behavior or object is a person or object or ritual one uses, performs or carries along that makes them more confident. An example could be taking a best friend to a meeting or keeping deodorant in a purse.

E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context. If someone responds out of proportion to the actual threat, it’s a sign someone has a problem with certain situations and that could lead to awkward situations. If responses are in line with the responses of others, it’s a clear sign that the individual can cope with the situation in a healthy way.

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or

G. The fear, anxiety, or avoidance causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning. Someone with social anxiety disorder may avoid parties and social gatherings and miss out on some things. It is also possible that an individual with social anxiety avoids speeches at work and consequently misses out on a promotion.

H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a
substance (e.g., a drug abuse, a medication) or another medical condition. Some drugs or medications produce side effects similar to those of social anxiety: trembling or shaking, heart palpitations, sweating, feeling more anxiety. In order to diagnose someone with social anxiety disorder, it is important to rule out side effects of drugs and medications.

I. The fear, anxiety, or avoidance is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder. Some mental disorders have overlapping symptoms. For instance, sleeping problems are common in depression, but also in PTSD. Ruling out other mental disorders is therefore important.

J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive. In other words: the social anxiety disorder symptoms cannot be (better) explained by another medical condition.