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 Social Anxiety Disorder: Definition and Manifestations

  What is Social Anxiety Disorder or Social Phobia?  Definition, Diagnosis and Assessment

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What is Social Anxiety Disorder? It is a term often used for Social Phobia, which has been defined by psychologists, psychiatrists and other mental health professionals through DSM-IV (and soon to be DSM-V) criteria in the Diagnostic and Statistical Manual of the American Psychiatric Association. 
Social Anxiety Disorder or Social Phobia often first develops in mid teens or early adulthood, though sometimes children may develop the disorder.  Children or adolescents who become the subject of vicious teasing in middle school understandably can come to fear social situations with peers.  Critical parenting and other psychosocial factors may also predispose to the disorder.  Females tend to develop the disorder somewhat more than males.
Consistent with many other anxiety disorders, there appears to be some contribution of genetic risk.  There has been some evidence an exaggerated fear response stemming from over-activation in the brain’s amygdala, but there have been studies which have not always supported this. The lifetime course of the disorder varies in individuals.  Some may experience social anxiety during school or college years, others to some degree throughout adulthood, while others may have single episodes, and some may have episodes which recur under stress.
As with all classified psychiatric and mental disorders, it is important to differentiate between normal levels of being shy, introverted, or a little anxious speaking in front of people, and the more sever levels of anxiety which have some significant negative impact on social, occupational or health functioning.  Ruling out metabolic or medical factors which can manifest as heightened anxiety is often advised.
Psychological assessment can help minimize risk of mistaking Social Anxiety Disorder for a more complex personality disorder, or more critically early signs of a psychotic break, paranoid disorder, schizophrenia, depression, or bipolar disorder.  Psychological testing should be performed by a licensed psychologist and might include instruments such as the Minnesota Multiphasic Personality Inventory (MMPI-2), Personality Assessment Inventory (PAI), State-Trait Anxiety Scale, Clarke-Beck Obsessive-Compulsive Inventory, and versions of the Manifest Anxiety Scale that are available for children, adolescents, college students and adults.
 (Continued further below)


Diagnostic Criteria                                                                                Helpful Links

For a DSM-IV (APA, 1994) diagnosis of Social Phobia the following criteria must be met (paraphrased in some parts for simplicity):

A. A persistent fear of one or more social or 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 embarrassing and humiliating. 
B.  Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack. 
C.  The person recognizes that this fear is unreasonable or excessive.
D.  The feared situations are avoided or else are endured with intense anxiety and distress.
E.  The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress 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 direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.
H. Involves criteria that it is not primarily related to another disorder.
American Psychiatric Association, DSM-4 (1994)



Anxiety Disorders Association of America  Provides education and on-line information. 
Social Phobia – Information for teens with Social Anxiety Disorder.
Overcoming Social Anxiety – Website with a self-help focus provides strategies and suggestions for college students (University of Texas, Dallas)
PanicDisorderInfo.Com - Our own educational website on Panic Disorder.
Anxiety Disorders Foundation  Funds training for mental health providers and funds for treatment of Social Anxiety Disorder for those who cannot afford it.

Common Childhood Fears - Discussed common childhood phobias

CPANCF Articles and Archives - Articles about anxiety, stress, mood disorders, adolescent, children, and other topics. 

People who suffer social anxiety may experience overwhelming anxiety, a sense of panic, and/or excessive self-consciousness in many social situations. They may believe or fear that people are thinking negatively about them, that they are being judged or criticized, and often fear being embarrassed or humiliated. They may find speaking in front of groups difficult, fear intimate relationships or dating, and may even find speaking to unfamiliar individuals or in small groups difficult. They often fear being embarrassed or even humiliated. 

Individuals with social anxiety disorder or social phobia often experience physiological symptoms that are common in other anxiety disorders. This can include flushing, increased perspiration, tremulousness, GI complaints, clammy hands, racing heart beat, tunnel vision, and tightening of the vocal cords. These may cause further self-consciousness and anxiety.

The discomfort anxiety often leads to avoidance of social situations. This creates a classic pattern of reward in terms of anxiety relief when escaping or avoiding the social situation and tends to further reinforce the anxiety.

Often people with social anxiety or social phobia have some awareness of their difficult, and this may cause some co-existing dysphoria or depression. Other co-existing orders include other anxiety disorders, mood disorder, alcohol or substance abuse problems, avoidant personality disorder, and eating disorders such as Bulimia.

Discomfort in social situations can also cause difficulties in work environments or academic settings where there are high collaboration, leadership and communication demands. This often leads individuals to seek treatment. Generally, individuals with social anxiety disorder are somewhat distressed by their symptoms and desire better communication or closer relationships. This often differentiates the socially anxious individual from conditions such as Asperger’s or schizoid personality disorders.

Social Anxiety Disorder (Social Phobia) may have broad range impact or be more limited in terms of impact and focus of the phobia. Fear of public speaking is probably a common social phobia. Others may have more specific fears such as not feeling comfortable eating in front of others, changing at the gym, using public restrooms, may have a fear of talking to the opposite sex, or possibly speaking to authority figures. For others, fears may be multiple or occur in many situations. Fears may extend to how one sits, avoiding other’s eyes, and social interaction or events may cause anticipatory anxiety for days or even weeks.

There is help for Social Phobia or Social Anxiety Disorder. For more information about overcoming Social Anxiety Disorder click on “Overcoming Social Anxiety Disorder”.

Clinical  Psychology Associates of North Central Florida has offices in Gainesville and Ocala.  We offer comprehensive psychological and neuropsychological assessment services and offer psychotherapy for Social Anxiety Disoreder,  other anxiety disorders , mood disorders and other psychological conditions.   Colleen Cummings, Ph.D. provides assessment, psychotherapy and counseling services to children, adolescents, college students and adults suffering from social anxety disorder and provides counseling for self-esteem, body image, and career issues. Update 11/24/14: Colleen Cummings, Ph.D. now practices as a licensed psychologist in Rockville, Maryland. Her practice website link is: Melchor-Beaupre, Psy.D. offers assistance to children and adolescents suffering from childhood fears, childhood anxiety, chidhood depression,  and social anxiety disorder. 



See books below for more information.  Clinical Psychology Associates of North Central Florida does not make any representations, warranties or endorsement of any books below or any links from or to this site.  All decisions about your healthcare should be made in consultation with a licensed provider.






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