Social Anxiety Disorder (SAD)

Social anxiety disorder is characterized as an intense fear of social situations. A person suffering from social anxiety disorder will often find themselves very uncomfortable around other people to the point that they begin avoiding social situations all together. In the presence of other people they cannot stop thinking about how the other people or person is viewing them.

Criteria for the Diagnosis of Social Phobia

The Diagnostic and Statistical Manual, fourth edition (DSM-IV) sets criteria for diagnosing social phobia. These criteria are listed A through H below:

(A) A marked and persistent fear of one or more social and 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 humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.

(B) Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

(C) The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.

(D) The feared social or performance situation are avoided or else are endured with intense anxiety or 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 the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).

(H) If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of Stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa.

The origins of social anxiety disorder

Whether social anxiety arose in nature as a defense mechanism is unclear. All social animals benefit from knowing their place in the pack, so it’s easy to see how a small amount of anxiety in a group situation can be beneficial from an evolutionary standpoint. Further support for an evolutionary link comes from studies that have found close relatives of social anxiety sufferers to be 2 to 3 times more likely to develop social anxiety than the general population. One argument to an evolutionary adaptation is that if social anxiety is programmed into us by evolution, it should manifest earlier in development than it does. Social anxiety disorder typically arises in adolescence or early adulthood, after the individual has already had a few social experiences; thus leading one to conclude that their previous experiences may have played at least some part in their social anxiety. That being said, it is likely that social anxiety arises partially from our genes and partially from the experiences we have, both socially and non-socially.

It is important to know that there are actually two subtypes of social anxiety disorder, generalized social anxiety disorder and nongeneralized or discrete social anxiety disorder. Most patients who seek treatment for social anxiety disorder have the generalized form where any social interaction causes distress. With discrete social anxiety disorder only a few situations are likely to cause distress.