Social anxiety is the fear of interaction with other people that brings on self-consciousness, feelings of being negatively judged and evaluated, and, as a result, leads to avoidance.
Diagnostic Criteria for Social Anxiety Disorder*
All criteria must be met for diagnosis.
- Marked fear or anxiety related to one or more social situations in which scrutiny by others is anticipated; examples include engaging in social interactions (e.g., having a conversation or meeting unfamiliar people), being observed (e.g., when eating or drinking), and performing in front of others (e.g., giving a speech)**
- Fear of acting in a way (e.g., showing symptoms of anxiety) that will be negatively evaluated by others (i.e., will be humiliating or embarrassing or will lead to causing offense or being rejected by others)
- Fear or anxiety is almost always provoked by social situations
- Social situations are avoided or endured with intense fear or anxiety
- Fear or anxiety is out of proportion to actual threat posed by social situation and to sociocultural context***
- Fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
- Fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- Fear, anxiety, or avoidance is not attributable to physiological effects of substance use (e.g., drug abuse or medication) or another medical condition
- Fear, anxiety, or avoidance is not better explained by symptoms of another mental disorder (e.g., panic disorder, body dysmorphic disorder, or autism spectrum disorder)
- If patient has another medical condition (e.g., Parkinson’s disease, obesity, or disfigurement from burns or injury), the patient’s fear, anxiety, or avoidance is clearly unrelated to that condition or is excessive
- If fear or anxiety is restricted to speaking or performing in public, social anxiety disorder should be specified as performance anxiety only.
* The diagnostic criteria listed are adapted from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).
** In children, the anxiety must occur in situations involving peers and not only during interactions with adults. The fear or anxiety may be expressed by crying, tantrums, “freezing” in place, clinging, or shrinking from or failing to speak in social situations.
*** The description of social anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-4-TR), has been changed from “the person recognizes that the fear is excessive or unreasonable” to “the fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context,” since the clinician may be able to better identify this behavior than a patient with social anxiety disorder.
References:
- Leichsenring F, Leweke F. Social Anxiety Disorder. N Engl J Med. 2017 Jun 8;376(23):2255-2264. [Medline]
- Gregory B, Peters L. Changes in the self during cognitive behavioural therapy for social anxiety disorder: A systematic review. Clin Psychol Rev. 2017 Mar;52:1-18. [Medline]
Created Jun 8, 2017.
