Diagnosing And Treating Social Anxiety Disorder: DSM-5 Criteria And More

Reviewed by Dawn Brown, LPC, NCC

Published 01/08/2021

Along with generalized anxiety disorder, social anxiety disorder, or social phobia, is one of the most common anxiety disorders and is the most frequently diagnosed mental health concern. In this article, you will learn about what social anxiety entails by learning about its signs and symptoms, as described in the DSM-5, and what people can do to find relief for this issue and overcome social anxiety.

What Is Social Anxiety Disorder DSM 5?

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Social anxiety is just one of a handful of different anxiety disorders that people can face. Like the others, it can be severe and debilitating and significantly decrease a person’s quality of life due to the fear, distress, and physical symptoms typical of anxiety.

Unlike anxiety disorders like generalized anxiety disorder, social anxiety has a specific source; social situations. It’s typically due to a fear of humiliation, rejection, or other forms of judgment. This can include, but not limited to, meeting new people, attending job interviews, and public speaking.

These situations can create intense fear and anxiety in individuals, resulting in uncomfortable physical and emotional symptoms.

This contributes to the disorder's persistence because individuals will dread social situations and avoid them, so they don’t have to deal with the symptoms.

While this can provide some temporary relief, it ultimately reinforces the disorder and makes it stronger.

Because of this more focused component, social anxiety disorder is sometimes referred to as social phobia, much like the specific phobias that people can have, such as dogs, spiders, flying in airplanes, and much more.

Social anxiety is its condition in the DSM-5, and in the next section, you will learn about the indicators of social anxiety that help professionals diagnose it in individuals.

What Are Symptoms Of Social Anxiety Disorder? The DSM-5 Criteria

Social anxiety can be properly diagnosed with the DSM-5 (Diagnostic and Statistical Manual 5th edition) by the American Psychiatric Association. Below you will find the DSM-5 social anxiety guidelines to help people get diagnosed and start receiving treatment. [1]

a.  Marked fear or anxiety about one or more social situations in which the individual is exposed to others' possible scrutiny. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and 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. 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; it will lead to rejection or offend others).

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

Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

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c.  The fear or anxiety is out of proportion to the social situation’s actual threat and the socio-cultural context.

d.  The social situations are avoided or endured with intense fear or anxiety.

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

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

g. The fear, anxiety, or avoidance is not attributable to the physiological effects (e.g., a drug of abuse, a medication) or another medical condition.

h. 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.

If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is unrelated or is excessive.

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

“Why Do I Have Social Anxiety?”

Like most mental health disorders, the causes of social anxiety can be a combination of biological and environmental factors.

Anxiety disorders can run in families, and differences in brain structure or chemistry can also help develop them. For example, people who have a heightened fight-or-flight response because of an overactive amygdala may have an increased risk of anxiety disorder, including social anxiety. [2]

However, in many cases, social anxiety can be an issue that is learned and the behaviors associated with them, such as avoidance.

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People who have experienced humiliation or embarrassment at some point in their lives may be significantly affected by this negative and unpleasant situation and can impact their behavior towards social interaction.

Thus, social anxiety in children can be a significant problem that can last a lifetime and can start because of being the center of attention or being teased or bullied. Social anxiety in teens is also very common, and many individuals mention that their symptoms started during adolescence, which is the formative years, especially in regards to social development.

Social media and anxiety are especially problematic amongst these age groups because of peer-pressure and the desire to fit in.

Social Anxiety Vs. Shyness

Shyness and social anxiety are often confused for one another, especially by the general public; however, these two concepts are not synonymous and are different in many ways.

According to the Social Anxiety Institute, the main three reasons that separate social anxiety from shyness is that: [3]

  • Being shy is a personality trait or part of someone’s temperament.
  • Shy people don't have the negative and uncomfortable symptoms associated with social anxiety disorder
  • Not everyone with social anxiety is shy

While many people who develop social anxiety have shy personalities, it’s not unusual to be an extrovert with social anxiety, and there are celebrities with social anxiety as well.

For example, a celebrity might be a great actor, but  not enjoy going to award events or interacting with or meeting new people within that social circle, and thereby avoid going to parties and similar gatherings.

Shy people don't need to change their personalities. Still, those with social anxiety disorder should seek treatment as soon as possible because the condition generally gets worse over time and doesn’t sort itself out. 

Treating Social Anxiety

Like other anxiety disorders, even extreme social anxiety is very treatable, and people can regain control over their lives.

Therapy is highly recommended as a first-line treatment for it, and cognitive behavioral therapy (CBT), in particular, has shown to be very effective in helping people cope with the condition.

CBT for social anxiety works by addressing the negative and unhelpful thinking patterns associated with it, such as the fear of being embarrassed or being put on the spot. Since one of the hallmark symptoms of the condition is that this fear is out of proportion to the actual event, CBT can help patients think more rationally about the situations that currently bother them.

People can also benefit from social anxiety group therapy. This can be a place for you to relate to others going through the same issues as you in a nonjudgement atmosphere that encourages social interaction.

Breathing and relaxation techniques can also help manage the symptoms of the fight-or-flight response and promote calmness. Certain medications can be prescribed for this reason as well.

For example, beta-blockers can be prescribed by a doctor or psychiatrist to help social anxiety because it blocks the effects of norepinephrine on the body, and thus, reducing the physical symptoms of anxiety such as a rapid heartbeat, sweating, tremors, and blushing.

Overall, since social anxiety behaviors are learned, people can also unlearn them with effective coping strategies that can help them stay calm and rational when facing negative emotions.

How To Help Someone With Social Anxiety Disorder DSM 5 Criteria

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Social anxiety is a very persistent disorder that can make people alone. If you are a parent of someone you believe has a social anxiety disorder, or you have a friend or other family member who does, you want to try to provide support.

This means that you should avoid telling them simply to face their fear or get better with exposure since this is not how to fix social anxiety. Instead, try to point them in the right direction to a professional, experienced in providing structured and effective strategies designed for people with social anxiety.

By being aware of the condition and understanding their concerns, you can make a big difference in their improvement path.

If someone you care about hasn’t been diagnosed with social anxiety, and they have expressed their concerns to you, you can also show them this free social anxiety test for teenagers and adults.

By completing it, they might feel more compelled to start seeking out help, and with you in their corner, they will be less likely to give up.

Conclusion

Learning how to beat social anxiety isn't an easy task. Still, it can be done, and it all starts with understanding the condition and addressing the negative thought and behavior patterns associated with it. If you can realize and say, “I have social anxiety,” you have already taken the first step in identifying the issue, and you can start improving and eventually overcoming the disorder.

References

  1. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 16, DSM-IV to DSM-5 Social Phobia/Social Anxiety Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t12/
  2. Mayo Clinic Staff. (2017, August 29). Social anxiety disorder (social phobia). Retrieved from https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
  3. Social Anxiety Institute. (, 2020). Shyness... Or Social Anxiety Disorder? Retrieved from https://socialanxietyinstitute.org/shyness-or-social-anxiety-disorder