Social phobia criteria
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Diagnostic Criteria for Social Phobia
Core Features of Social Phobia
Social phobia, also known as social anxiety disorder (SAD), is characterized by a marked and persistent fear of social situations where the individual is exposed to possible scrutiny by others. The primary concern is the fear of embarrassment, humiliation, or rejection due to perceived negative evaluation1 4. This fear often leads to anticipatory anxiety and avoidance behaviors in situations such as public speaking, eating in public, or using public restrooms1.
Diagnostic Criteria and History
The diagnosis of social phobia is primarily based on the patient's history and self-reported experiences. The onset typically occurs around puberty, and the condition often follows a chronic course. Common comorbidities include depression and substance abuse, which individuals may use in an attempt to alleviate their anxiety symptoms1. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has evolved in its criteria for social phobia, with significant changes in DSM-5, which broadened the criteria to include fears of acting in a way that might offend others or lead to rejection4.
Assessment Tools
Several tools have been developed to assess social phobia, including the Social Phobia and Anxiety Inventory (SPAI) and the Social Phobia Scale (SPS). These instruments measure cognitive, somatic, and behavioral dimensions of social fear and have been validated for their reliability and ability to differentiate social phobia from other anxiety disorders2 5. The SPAI, for instance, uses a Likert-scale format to assess the severity of symptoms across various social situations2.
Prevalence and Sociodemographic Factors
Social phobia is a prevalent condition, affecting a significant portion of the general population. A study in Sweden estimated the point prevalence at 15.6%, with variations depending on the level of distress and impairment6. Social phobia is more commonly associated with female gender, lower educational attainment, psychiatric medication use, and lack of social support6.
Subtypes and Comorbidities
The DSM has recognized subtypes of social phobia, including generalized and performance-only specifiers. Generalized social phobia involves fear in most social situations, while performance-only social phobia is limited to specific activities like public speaking4 9. Children with social phobia often present with higher levels of fearfulness, loneliness, and depression compared to those with simple phobias, and they are more likely to have comorbid avoidant and overanxious diagnoses3.
Clinical Features and Treatment
Patients with social phobia often exhibit physical signs of anxiety, such as moist hands, averted gaze, and blushing during examination1. Treatment options include cognitive therapy, which has been shown to be more effective than medication like fluoxetine in reducing social phobia symptoms and maintaining improvements over time10.
Conclusion
Social phobia is a complex and multifaceted anxiety disorder with significant implications for individuals' social and occupational functioning. Accurate diagnosis and effective assessment tools are crucial for identifying and treating this condition. Understanding the core features, prevalence, and subtypes of social phobia can aid in developing targeted interventions to improve the quality of life for those affected.
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Most relevant research papers on this topic
The diagnosis of social phobia.
Social phobia is characterized by persistent fear of embarrassment in social situations, often accompanied by depression and substance abuse.
Highly CitedAn empirically derived inventory to measure social fears and anxiety: The Social Phobia and Anxiety Inventory.
The Social Phobia and Anxiety Inventory (SPAI) is a reliable and sensitive instrument for assessing social phobia, allowing for better treatment planning and assessing severity levels.
Highly CitedSocial and simple phobias in children
Social phobic children are older, have higher fearfulness, loneliness, and depression, and are more likely to have comorbid avoidant and overanxious diagnoses than simple phobic children.
Observational StudyHighly CitedSocial Anxiety Disorder
Social anxiety disorder (SAD) is characterized by excessive fear of embarrassment, humiliation, or rejection in public performances or social interactions.
Highly CitedDevelopment and validation of measures of social phobia scrutiny fear and social interaction anxiety.
The Social Phobia Scale (SPS) and Social Interaction Anxiety Scale (SIAS) are valid, useful, and easily scored measures for assessing social phobia, improving upon existing measures.
Observational StudyHighly CitedSocial phobia in the general population: prevalence and sociodemographic profile
Social phobia is a prevalent and distressing issue in the Swedish general population, with public speaking being the most common fear, and is associated with female gender, low education, psychiatric medication use, and lack of social support.
Observational StudyHighly CitedSocial phobia features across the DSM-III-R anxiety disorders
Social phobia is more prevalent in generalized anxiety disorder than in simple phobia, with generalized anxiety disorder being associated with the greatest degree of social anxiety.
Observational StudyHighly CitedSocial phobia syndrome in Japan.
In Japan, social phobia syndrome is considered a complex symptom complex with obsessive and delusional features, not just a mere phobic anxiety disorder as described in DSM-III and ICD-10.
Highly CitedThe issue of subtypes in the diagnosis of social phobia
This paper reviews the literature on subtyping social phobia, examining demographic differences, clinical features, treatment response, and overlap with avoidant personality disorder, and considers options for subtyping in the DSM-IV.
Literature ReviewHighly CitedCognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial.
Cognitive therapy (CT) is superior to fluoxetine plus self-exposure (FLU + SE) and placebo plus self-exposure (PLA + SE) in treating generalized social phobia, with long-term benefits.
RCTHighly Cited