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Diagnostic Criteria for Social Anxiety Disorder (Social Phobia)
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Jan 3, 2023
Let's walk you through the diagnostic criteria for social anxiety disorder. We outline how clinicians, such as psychiatrists and clinical psychologists, make their diagnostic decision when treating socially anxious patients. There are three commonly used diagnostic manuals: The DSM-5, the ICD-11, and the OPD-2. While the DSM-5 and the ICD-11 are most widely used and their diagnostic criteria for social anxiety disorder are very similar in nature, the OPD-2 takes a fundamentally different approach. If you think you suffer from social phobia, we recommend you watch our video about the most common symptoms of the disorder. Refrain from self-diagnosis and talk to a qualified professional if you struggle with emotional or psychological difficulties. #socialanxiety #mentalhealth #diagnosis
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Feeling somewhat insecure in the presence of others or being a little anxious in certain social situations is completely normal
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However, once these fears exceed a certain threshold, a person might qualify for a diagnosis of social anxiety disorder, often also called social phobia
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In this video, we will take a closer look at the diagnostic criteria for this disorder
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First, a very important disclaimer. Although I am a psychologist, this video is for educational purposes only
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it is vitally important to refrain from self-diagnosis. If you believe you are affected by psychological or emotional difficulties, see your doctor
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psychiatrist or other qualified mental health professional. Now with that being said, it is important to understand that there are different diagnostic
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manuals that help physicians such as psychiatrists and clinical psychologists identify and determine
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whether a patient is affected by a particular mental health disorder. Diagnostic criteria can be considered a type of checklist. They are based on scientific studies
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and generalize the typical signs and symptoms of a particular condition. The diagnostic manual used by the
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the clinician depends on your country of residence and often also on your physician's preferences
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There are two main manuals that are most commonly used. First, we have the diagnostic and statistical
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manual of mental disorders, which is currently in use in its fifth edition, and you may have heard
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of it as the DSM-5. And then there's the international classification of diseases, whose 11th version
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went into effect in January 2022 and is now known as the ICD-11. In the United States, the DSM-5 is
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primarily used as the most common manual. Outside of the United States, the ICD-11 is generally used as the standard manual
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However, there are many clinicians within the US who may use the ICD-11, just as there are many
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outside the US who may use the DSM-5. So let's first talk about the diagnostic criteria of these two manuals, since your clinician
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will most likely use one of them. Let's start with the DSM-5. While the DSM used to refer to this
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condition as social phobia, in its fifth and current version, it adjusted the name to social
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anxiety disorder. To qualify for a diagnosis of social anxiety disorder, the following conditions
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must be met. Condition A, a marked fear or anxiety about one or more social situations in which
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the individual is exposed to possible scrutiny by others. Examples include social interactions
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being observed and performing in front of others. In children, the anxiety must occur in peer settings
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and not just during interactions with adults. Condition B, the individual fears that he or she
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will act in a way or show anxiety symptoms that will be negatively evaluated For example they will be humiliating or embarrassing They will lead to rejection or offend others Condition C the social situations almost
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always provoke fear or anxiety. In children, the fear or anxiety may be expressed by crying
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tantrums, freezing, clinging, shrinking or failing to speak in social situations. Condition D
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the social situations are either avoided or endured with intense fear or anxiety. Condition
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E, the fear or anxiety is out of proportion to the action. threat posed by the social situation and to the sociocultural context
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Condition F, the fear, anxiety or avoidance is persistent, typically lasting for six months or more
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Condition G, the fear, anxiety or avoidance causes clinically significant distress or impairment
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in social, occupational or other important areas of functioning. Condition H, the fear, anxiety or avoidance is not attributable to the physiological effects
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of a substance, for example, a drug of abuse or a medical, or another medical condition. Condition I, the fear, anxiety or avoidance is not better
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explained by the symptoms of another mental disorder such as panic disorder, body dysmorphic
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disorder or autism spectrum disorder. And condition J, if another medical condition such as Parkinson's
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disease, obesity or disfigurement from bumps or injury is present, the fear, anxiety or avoidance is
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clearly unrelated to these conditions or is excessive. So these are all the conditions that must be
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met in order to receive a diagnosis. In addition, the DSM-5 includes a so-called performance-only
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specifier, which means that the clinician may decide to diagnose social anxiety disorder while specifying
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that the social anxiety is limited to public speaking or performing in public. For example, people
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with public speaking anxiety may fall into this category, given that they do not have social
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anxiety in non-performance situations. Okay, that's it for the DSM-5. Next, let's look at how the ICD-11
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defines social anxiety disorder. As a quick note, While the ICD continued to refer to the condition as social phobia until its 10th version
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it has now been adjusted to social anxiety disorder. So don't be surprised if you still hear a lot of
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people talking about social phobia as it is still used as a synonym for social anxiety disorder
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Okay, in order to receive a diagnosis of social anxiety disorder, according to the ICD 11
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the following six conditions must be met. Number one, a marked and excessive fear or anxiety
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that occurs consistently in one or more social situations such as social interaction such as having a conversation doing something while feeling observed such as eating or drinking in the presence of others or performing in front of others such as giving a speech Number two the individual is concerned that he or she will act in a way or show anxiety symptoms
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that will be negatively evaluated by others. For example, they will be humiliating, embarrassing, lead to rejection or be offensive
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Number three, relevant social situations are consistently avoided or only endured with intense fear or anxiety
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Number 4. The symptoms are not transient. That is, they persist for an extended period of time
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For example, at least several months. Number 5. The symptoms are not better accounted for by another mental disorder, such as agoraphobia
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body dysmorphic disorder, olfactory reference disorder, and so on. And number 6, the symptoms result in significant distress about experiencing persistent anxiety
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symptoms or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. If the functioning is maintained
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it is only through significant additional effort. So these are the essential requirements for a
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diagnosis according to the ICD-11. As you can see, they are very similar to those of the DSM-5
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However, the ICD-11 defines some additional features that may be present and affected individuals
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and that may help clinicians in making their diagnostic decision. Let's take a quick look at them
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First, individuals with social anxiety disorder may report concerns about physical symptoms such as blushing, sweating or trembling rather than initially endorsing fears of negative
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evaluation. Second, social anxiety disorder frequently co-occurs with other anxiety or fear-related
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disorders as well as depressive disorders. Third, individuals with social anxiety disorder are at
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higher risk for developing disorders due to substance use, which may arise subsequent to use for the
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purposes of attenuating anxiety symptoms in social situations. And fourth, individuals with social anxiety
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disorder may not view their fear or anxiety in response to social situations as excessive
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As such, clinical judgment should be applied to determine whether the reported fear, anxiety
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or avoidance behavior is disproportionate to what the social situation warrants, taking into
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consideration both accepted cultural norms and the specific environmental circumstances to which
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that the individual is subjected. For example, fear of interacting with peers may be appropriate
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if the individual is being bullied. And yet another important feature that is specifically noted in the
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ICD 11 is the following. Many individuals experience fear in social situations
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For example it is very common for individuals to experience anxiety about speaking in public or they manifest the normal personality trait of shyness Social anxiety disorder should only be considered in cases in which the individual reports
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social fear, anxiety and avoidance that are clearly in excess of what is normative for the
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specific cultural context and result in significant distress or impairment. This means that it is essential to understand that some form of insecurity and anxiety
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is normal in certain social situations, and that there's no need to worry or to be concerned
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concerned if that's the case for you. What counts is the excess of anxiety in those situations
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For example, being so nervous when speaking in front of an audience that you are unable to get your words out may indicate a social anxiety disorder, whereas a reasonable degree of nervousness is entirely normal in such situations
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So, as I mentioned earlier, these two manuals are the ones most commonly used by clinicians. However, there's a third option, sometimes used by therapists who have a psychodynamic approach to psychopathology
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Psychodynamic therapists look at internal conflicts as well as emotional and motivational forces
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which are usually unconscious, and attempt to reduce symptoms such as social anxiety disorder
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by making them conscious. A therapist with this approach may use the operationalized
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psychodynamic diagnosis or the OPD2 as a diagnostic manual. This manual is based on the principles
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of depth psychology that I just mentioned. It is significantly different from the two previous
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manuals and that it focuses primarily on the patient's subjective experiences rather than on objective
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checklists. If you work with a psychodynamic therapist, they will most likely conduct an
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extensive interview with you in which they will examine different axes as they are called. For example
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they might explore your relationship axis, your conflict axis and your structure axis. I won't go into
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details here because it would take too much time, but we will certainly do a video on this topic
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in the future. It is important for you to understand here that your subjective experiences play a
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crucial role in the diagnostic process when the OPD 2 is used. At the same time, your
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therapist will most likely use the ICD 11, the manual we just talked about, to corroborate
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his or her diagnostic decision. All right, that's it. You should now have a good idea of the
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diagnostic criteria for social anxiety disorder. If you think you are affected, we invite you to
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watch our video on the most common symptoms of social anxiety, which will further clarify your
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doubts and questions. And once again, refrain from self-diagnosis and talk to qualified professional
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if you think you are affected. We at Conquer Social Anxiety wish you all the best and thank you for your attention
#Anxiety & Stress
#Mental Health
#Psychology