Social Anxiety Disorder (SAD): Symptoms, DSM-5 Criteria and Treatment

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Dr. Alexander Sidawi

Dr. Sidawi is an Orlando based, UF trained physician who is happy to be serving the community he grew up in by offering a combination of psychiatric medication management and psychodynamic psychotherapy.

Social Anxiety Disorder: Symptoms, DSM-5 Criteria, and Treatment

Social Anxiety Disorder (SAD), also known as social phobia, is a mental health condition characterized by an intense fear of social situations where one might be judged, leading to significant distress and impaired ability to function in daily life. This condition is more than just shyness; it’s a persistent fear that can be debilitating. In this article, we will explore the symptoms of Social Anxiety Disorder, delve into the DSM-5 diagnostic criteria, and discuss effective treatment options.

Signs and Symptoms of Social Anxiety Disorder

  • Intense Fear of Social Situations: Individuals with SAD experience a deep fear of being in social or performance situations where they feel they will be judged, embarrassed, or scrutinized. This often includes interactions with strangers, speaking in public, or being observed while doing something.

  • Avoidance of Social Interactions: People with this disorder tend to avoid social situations or endure them with intense fear or anxiety. This avoidance can significantly disrupt daily life, affecting work, school, and other activities. The anticipation of a social event can cause anxiety fear in advance of the event.

  • Physical Symptoms: Alongside emotional distress, SAD can manifest physically. Symptoms may include blushing, sweating, trembling, nausea, or difficulty speaking. These reactions further increase anxiety in social situations. Blushing is actually considered a hallmark response for social anxiety disorder.

  • Excessive Self-Consciousness: There is often an acute self-awareness or fear of acting in a way that will be embarrassing or humiliating.

  • Fear of Negative Evaluation: A pervasive worry about being negatively judged or rejected in social situations is common in those with SAD.

DSM-5 Criteria for Social Anxiety Disorder

The DSM-5 criteria to diagnose Social Anxiety Disorder are:

  1. 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, being observed, and performing in front of others.

  2. The individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluated (i.e. cause embarrassment or rejection).

  3. Social situations almost always provoke fear or anxiety.

  4. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

  5. The fear, anxiety, or avoidance is persistent, typically lasting for six months or more.

  6. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  7. The disturbance is not attributable to the physiological effects of a substance or another medical condition.

  8. The fear, anxiety, or avoidance is not better explained by another mental disorder, such as panic disorder, body dysmorphic disorder, or autism.

  9. If another medical medical condition is present, the fear, anxiety or avoidance is clearly unrelated or is excessive.

Performance Anxiety

The DSM-5 has a “performance only” specifier, which states that the social anxiety is strictly related to speaking or performing in public. This pertains to any situation where a person might feel judged by their performance, such as when giving a speech or playing a sport. Performance anxiety can often be seen in public speakers, athletes, musicians, and other careers that require performing in front of others.

Panic Attacks in Social Anxiety Disorder

The DSM-5 has a “panic attack” specifier, which states that patients with Social Anxiety Disorder may experience panic attacks related to the social phobia. These panic attacks are characterized as recurrent, unexpected periods of intense fear or discomfort that reach a peak within minutes and usually have symptoms such as sweating, shaking, dizziness, shortness of breath, and increased heart rate. These panic attacks usually subside within a 30 minutes to an hour of initiation.

Epidemiology of Social Anxiety Disorder

  • Prevalence: SAD is one of the more common anxiety disorders, with estimates suggesting that it affects approximately 7% of the population at some point in their lives.
  • Age of Onset: The disorder typically begins in the early to mid-teen years, and most have a history of social shyness in childhood.
  • Comorbidities: Up to 72% of individuals have another diagnosable psychiatric disorder. It is most commonly seen along with other anxiety disorders like generalized anxiety disorder.
  • Heritability: First degree relatives of individuals with social anxiety disorder have a two to six times higher chance of having social anxiety disorder

Treatment Options for Social Anxiety Disorder

  • Psychotherapy: Therapy treatments such as psychodynamic psychotherapy and Cognitive-Behavioral Therapy (CBT) are effective forms of treatment for SAD. CBT for SAD involves learning to identify and challenge negative thoughts about social situations and gradually facing feared social situations. Psychodynamic therapy for SAD involves analyzing your relationships, experiences and habits to better understand your anxiety, where it came from, and how you can change it.
  • Medications: Certain medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can be effective in treating SAD by taking the edge off of the level of anxiety experienced.
  • Combination Therapy: Often, a combination of therapy and medication is the most beneficial treatment approach.

Wrapping Up Social Anxiety Disorder

Understanding the nature of this disorder, its symptoms, and treatment options is crucial for those who suffer from it, as well as for their friends and families. If you think you or someone you know might have Social Anxiety Disorder, it’s important to seek professional help. Remember, SAD is treatable, and help is available.