Social Anxiety Disorder

Social Phobia

 Fear of social settings where others may watch, study or judge them 
 Fear they may offend others, embarrassed, negatively evaluated or humiliated 
 Fear of rejection or others will not like them 
 The individual is fearful or anxious about or avoidant of social interactions and situations that involve
the possibility of being scrutinized. These include social interactions such as:
o Meeting unfamiliar people
o Situations in which the individual may be observed eating or drinking, and
o Situations in which the individual performs in front of others.

Diagnostic Criteria
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to
possible scrutiny by others.
Examples:
 Social interactions (e.g., having a conversation, meeting unfamiliar people)
 Being observed (e.g., eating or drinking)
 Performing in front of others (e.g., giving a speech).
 Note: In children, the anxiety must occur in peer settings and not just during
interactions with adults.

B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively
evaluated (i.e., will be humiliating or embarrassing: will lead to rejection or offend others).
 blushing, trembling, sweating, stumbling over one’s words, or staring, that will be negatively
evaluated by others
 Among these physical responses, what do you think is hallmark physical response of social
anxiety disorder? BLUSHING
 paruresis, or “shy bladder syndrome” individuals who fear and avoid urinating in public
restrooms when other individuals are present

C. The social situations almost always provoke fear or anxiety.

 an individual who becomes anxious only occasionally in the social situation(s) would not be
diagnosed with social anxiety disorder. However, the degree and type of fear and anxiety may
vary (e.g., anticipatory anxiety, a panic attack) across different occasions.
 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
 Avoidance can be extensive (e.g., not going to parties, refusing school)
 or subtle (e.g., overpreparing the text of a speech, diverting attention to others, limiting eye
contact).
 E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the
sociocultural context.
 For example, in certain cultures, behavior that might otherwise appear socially anxious may be
considered appropriate in social situations (e.g., might be seen as a sign of respect).

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
 This duration threshold helps distinguish the disorder from transient social fears that are
common, particularly among children and in the community.

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

 The fear, anxiety, and avoidance must interfere significantly with the individual’s normal
routine, occupational or academic functioning, or social activities or relationships, or must
cause clinically significant distress
 For example, an individual who is afraid to speak in public would not receive a diagnosis of
social anxiety disorder if this activity is not routinely encountered on the job or in classroom
work, and if the individual is not significantly distressed about it. However, if the individual
avoids, or is passed over for, the job or education he or she really wants because of social
anxiety symptoms, Criterion G is met.

H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a
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 (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is
present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

Specifiers: Performance only: if the fear is restricted to speaking or performing in public.

 performance fears that are typically most impairing in their professional lives
 In roles that require regular public speaking.
 Performance fears may also manifest in work, school, or academic settings in which regular
public presentations are required.
 Individuals with performance only social anxiety disorder do not fear or avoid nonperformance
social situations.
Associated Features

 individuals may be shy or withdrawn, and they may be less open in conversations and disclose little
about themselves.
 may seek employment in jobs that do not require social contact, although this is not the case for
individuals with social anxiety disorder, performance only
 may live at home longer.
  Men may be delayed in marrying and having a family, whereas women who would want to work
outside the home may live a life without ever doing so.
 Self-medication with substances is common (e.g., drinking before going to a party).
 Social anxiety among older adults may also include exacerbation of symptoms of medical illnesses,
such as increased tremor.

What do you think is the difference between Social Phobia and Specific Phobia if both of them include and
happens at a certain situations?
What do you think is the difference between Social Anxiety Disorder and Specific Phobia?

Social Anxiety Disorder Specific Phobia

 Leads to impairment in functioning  Causes distress to the individual
 Prevents individual in doing their  Does not prevent them from
functions functioning but gives distress to the
person instead

Panic Disorder

 the individual experiences recurrent unexpected panic attacks and is persistently concerned or worried
about having more panic attacks or changes his or her behavior in maladaptive ways because of the
panic attacks (e.g., avoidance of exercise or of unfamiliar locations).
Types of Panic Attack
1. Cued or Situationally-bound-
o occur upon actual or anticipated exposure to certain situations.
o For example, a person who fears enclosed spaces may experience a panic attack when entering
or thinking about entering an elevator.

2. Uncued
o panic attacks occur without warning or “out of the blue.”
o No situational or environmental triggers are associated with the attack.
3. Situationally-Predisposed- occur in certain situations or triggers, but can also happen
unexpectedly.

4. Two characteristic types of panic attacks:

5. 1. expected- attacks for which there is an obvious cue or trigger, such as situations in which panic
attacks have typically occurred.
6. 2. unexpected- those for which there is no obvious cue or trigger at the time of occurrence (e.g.,
when relaxing or out of sleep [nocturnal panic attack]).

What do you think is the difference of Situationally-bound and Situationally-Predisposed Panic

attack?

Situationally-predisposed panic attacks Situationally-bound panic attacks

 higher likelihood of occurring in certain consistently and predictably occur in specific
situations, but they can also happen situations and are closely tied to the
unexpectedly in other contexts. presence of that particular trigger.

The main difference between situationally-predisposed panic attacks and situationally-bound panic
attacks lies in the predictability and specificity of the trigger.

Panic Attack

 may be expected, such as in response to a typically feared object or situation, or unexpected, meaning
that the panic attack occurs for no apparent reason.
 Sudden or unexpected. Intense fear reaction; At least 4 out of 13 symptoms: (also diagnostic criteria)
1. Palpitations
2. Sweating
3. Trembling
4. Shortness of breath
5. Feelings of choking
6. Chest pain
7. Nausea / Abdominal dizziness
8. Dizziness/unsteadiness/fainting
9. Chills/heat sensations
10. Paresthesia - (numbness or tingling sensations)
11. Derealization (feelings of unreality) (People and objects around you may
seem unreal.)
12. Fear of losing control
13. Fear of dying

11 of these 13 symptoms are physical(e.g., palpitations, sweating),

while 2 are cognitive (i.e., fear of losing control or going crazy, fear of dying).

A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort
that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur.
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing
control, having a heart attack, “going crazy”).
2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed
to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur
only in response to feared social situations, as in social anxiety disorder: in response to circumscribed phobic
objects or situations, as in specific phobia: in response to obsessions, as in obsessive-compulsive disorder: in
response to reminders of traumatic events, as in posttraumatic stress disorder: or in response to separation
from attachment figures, as in separation anxiety disorder).
Remember: Not everyone with a panic At least 6 months Attack will develop panic disorder.
Psychological Treatment for Social Anxiety Disorder

 Exposure also appears to be an effective treatment for social anxiety disorders such treatments often
begin with role playing or practicing with the therapist or in small therapy groups before undergoing
exposure in the more public social situations
 Social skills training, in which a therapist might provide extensive modeling behavior can help people
with social anxiety disorder who may not know what to do or say in social situations.
Psychological Treatment for Panic Disorder

 A psychodynamic treatment for panic disorder has been developed. The treatment involves 24
sessions focused on identifying the emotions and meanings surrounding panicattacks. 
 One well validated cognitive behavioral treatment approach called Panic Control Therapy (PCT) is
based on the tendency of people with panic disorder to overreact to the bodily sensations. In PCT , the
therapist uses exposure technique, that is he or she persuades the client to deliberately elicit the
sensations associated with panic

Panic Attack Specifier

o 11 of these 13 symptoms are physical(e.g., palpitations, sweating),
o while 2 are cognitive (i.e., fear of losing control or going crazy, fear of dying).

Symptoms are presented for the purpose of identifying a panic attack; however, panic attack is not a mental
disorder and cannot be coded. Panic attacks can occur in the context of any anxiety disorder as well as other
mental disorders
Limited-symptom attacks- Attacks that meet all other criteria but have fewer than four physical and/or
cognitive symptoms.
Two characteristic types of panic attacks:
1. expected- attacks for which there is an obvious cue or trigger, such as situations in which panic attacks have
typically occurred.
2. unexpected- those for which there is no obvious cue or trigger at the time of occurrence (e.g., when relaxing
or out of sleep [nocturnal panic attack]).

The determination of whether panic attacks are expected or unexpected is made by the clinician, who makes
this judgment based on a combination of careful questioning as to the sequence of events preceding or
leading up to the attack and the individual’s own judgment of whether the attack seemed to occur for no
apparent reason.
Panic attacks can occur in the context of any mental disorder (e.g., anxiety disorders, depressive disorders,
bipolar disorders, eating disorders, obsessive-compulsive and related disorders, personality disorders,
psychotic disorders, substance use disorders) and some medical conditions (e.g., cardiac, respiratory,
vestibular, gastrointestinal), with the majority of presentations never meeting criteria for panic disorder.
Recurrent unexpected panic attacks are required for a diagnosis of panic disorder.