Social Anxiety Disorder and the DSM-5
Social phobia was first classified as a mental disorder in the DSM-III. More recently it has been reclassified in the DSM-5 (Diagnostic And Statistical Manual of Mental Disorders-Fifth edition) as social anxiety disorder. It is one of the most common anxiety disorders with some researchers believing that it has a lifetime prevalence rate of a little more than 10%. Most people are diagnosed with social anxiety disorder in childhood or in the earlier adolescent years. This anxiety disorder is frequently comorbid with other mental health disorders such as major depressive disorder, substance use disorders and other anxiety disorders.
Main Characteristics of Social Anxiety Disorder:
Some of the key features of social anxiety disorder include an ongoing fear and worry of social situations. If you have social anxiety disorder, you may have a fear of negative evaluation by others, performance anxieties or fear of being observed in various social circumstances. The DSM-5 also included a performance only specifier which needs to be experienced for a minimum of six months. Children and adolescents also share the same minimum duration as adults.
While both genders seem to share the same intense fears and worries, women tend to be diagnosed with social anxiety disorder more often than men. An interesting anecdote is that people with social anxiety disorder tend to never marry or have children. This anxiety disorder is highest among Caucasian and Native Americans, and studies have found it to also be high among Latino and Caucasian youth.
Some people may believe shyness to be a social anxiety disorder, but it is not. Shyness is not pathological and does not result in the severe impairment that you would see in someone who has social anxiety disorder. Also, when comparing social anxiety disorder to specific phobias, phobic individuals typically do not worry about being judged in social situations. Individuals with social anxiety disorder seem to have a capacity for age-appropriate interactions as well as social relationships, although they sometimes avoid them and may experience significant personal distress at times. Individuals diagnosed with social anxiety disorder often have significant insight into the disproportionate fear and anxiety they experience in social situations.
Social Anxiety and Public Speaking:
The most common and most easily recognizable social anxiety disorder is fear of public speaking. This disorder is experienced by approximately three out of four or about 75% of the overall population. Most people have some anxiety about speaking in public, while individuals with this performance related social anxiety disorder may have very intense almost disabling ability to speak in front of other people.
Social Anxiety Disorder Treatments:
Some of the treatments available for social anxiety disorder include both psychological treatments and medication. Psychological treatments include cognitive behavioral therapy, relaxation therapy and the use of exposure treatment. Medications treatments include the use of depression medications such as the SSRIs, and anxiety medication such as Xanax and Klonopin.
Social Anxiety Disorder Coding and Specifiers:
Social anxiety disorder has only one diagnostic code: 300.23 (F40.10). However, a performance only specifier may also be included with this disorder if it is specifically related to speaking or performing in public. In most cases these individuals do not avoid social situations and fear evaluation or scrutiny except for when public speaking or performing in front of others. If people experience panic attacks in conjunction with social anxiety disorder, they may also be given the specifier with panic attacks, which should be added to the actual diagnosis.
The specific symptoms of social anxiety disorder follow below.
Social Anxiety Disorder (Social Phobia) diagnostic criteria 300.23 (F40.10):
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 such as having a conversation, meeting unfamiliar people, being observed eating or drinking, and performing in front of others such as giving a speech.
B. Individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated such as feeling humiliated or embarrassed or will lead to rejection or offend others.
C. The social situations almost always provoke fear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for six months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance such as drug of abuse, a medication or another medical condition.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
J. If another medical condition such as Parkinson’s disease, obesity, disfigurement from burns or injury is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Performance only: If the fear is restricted to speaking or performing in public.
Diagnostic Information and Criterion adaptedfrom the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist
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