DSM-5 Diagnostic Criteria
A. Fear or intense anxiety in one or more social situations in which the individual is exposed to possible examination by other people. Examples include social interactions (e.g., having a conversation, meeting strangers), being watched (e.g., eating or drinking), and performing in front of other people (e.g., giving a talk). .
Note: In children, anxiety can occur in meetings with individuals of the same age and not only in interaction with adults.
B. The individual is afraid of acting in a certain way or showing symptoms of anxiety that are negatively valued (i.e., humiliated or embarrassed, resulting in rejection, or offending other people).
C. Social situations almost always provoke fear or anxiety.
Note: In children, fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failure to speak in social situations.
D. Social situations are avoided or resisted with fear or intense anxiety.
E. The fear or anxiety is disproportionate to the actual threat posed by the social situation and sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting six or more months.
G. Fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. Fear, anxiety, or avoidance cannot be attributed to the physiological effects of a substance (e.g., drug, 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 an autism spectrum disorder.
J. If another medical condition exists (e.g., Parkinson’s disease, obesity, disfigurement due to burns or injuries) the fear, anxiety, or avoidance is clearly unrelated or excessive.
Specify if:
Performance only: If the fear is limited to speaking or acting in public.
Social phobia is characterized by the fear of suffering embarrassment or humiliation in social situations. As a consequence of this fear, situations where one must “perform” and submit to the scrutiny of others are avoided. In a sense, social phobia is an extreme form of “performance anxiety.” For some people, just thinking about feared situations can cause serious anxiety and even panic attacks.
Mild forms of social phobia are very common. Fear of public speaking, sometimes referred to as “stage fright” by actors and musicians, is probably the most common social phobia. Other common forms include difficulty using public bathrooms, fear of writing one’s name or signing in the presence of others, difficulty eating or drinking in public, and fear of blushing.
Avoidance of Social Situations
The social phobic shows great anxiety and tends to avoid situations in which he or she comes into contact with other people, especially those mentioned above, such as speaking in public, being watched while eating, drinking or writing in front of others, or talking to people of similar importance. greater authority. The reasons include being seen by others as insecure or clumsy, blushing, or the feeling of true terror at the possibility of being ridiculed or disapproved of by others.
There are a large number of social situations in which many people can suffer from nerves, such as when doing a job interview or speaking in public, without there being any anxiety disorder. Furthermore, the level of anxiety that people suffer will depend proportionally on the importance that the situation has for them, such as the first date with someone they like or asking for a raise, causing that once that behavior is repeated , anxiety is reduced. Most social fears that are common in adolescence tend to disappear in adulthood as the person gains experience.
However, the anxiety level of a person with social phobia is disproportionate to the actual threat and does not reduce with experience. Anxiety tends to persist, generating a high degree of discomfort in the individual and difficulties in adapting to social contexts, with the consequent avoidance that ends up perpetuating anxiety. People with social phobia show an inhibited communication style characterized by averting their gaze, blushing and, ultimately, passive behavior; which results in other people showing little interest in him or even disapproval, which increases the problem, increasing the level of anxiety and feelings of insecurity.
Importance of Cognitive Distortions
Thoughts play a very relevant role in the development of social phobia, producing errors of interpretation or assessment and failures in memory or attention. Among the most notable cognitive factors are:
- undervaluing oneself, undervaluing one’s own capabilities in certain social situations.
- Focus attention on the negative aspects, attributing them to one’s own behavior.
- being excessively aware of the opinions of others, fearing disapproval or rejection and interpreting any gesture as a symbol of this.
- continually remembering negative experiences of social relationships and maximizing them while undervaluing positive ones.
- focusing on oneself excessively.
- overestimating the possibility of negative events occurring and anticipating negative consequences in relationships with others.
These types of thoughts can be so important and generate such a high level of anxiety that they prevent the person from behaving successfully in social situations, despite knowing the repertoire of behaviors well.
Types of Social Phobia
We can distinguish between two types of social phobia:
- Specific social anxiety. Referring to very specific situations or stimuli. The most common fear is of speaking in public, and other behaviors may occur such as urinating in public bathrooms, eating in the company of others, being watched while writing, etc. The only one that may be more common than generalized social phobia is public speaking.
- Generalized social anxiety. It occurs in the face of a high number of situations and stimuli without referring to any in particular, such as fear of having conversations or starting them, talking to people of authority or of the other sex, going on dates, etc. The individual with this type of social fears tends to restrict their social life by avoiding numerous situations.
Limitations Produced by Social Anxiety
This type of phobia generates serious limitations in numerous daily life situations, and anticipatory anxiety also appears long before the person has to face the situation. Sometimes, a vicious circle occurs in which anticipatory anxiety generates a large number of bodily symptoms and distorted thoughts that limit performance in the real situation and, in turn, increase anticipatory anxiety,…
Social phobia can lead to other more serious anxiety disorders such as agoraphobia; in cases of depression, which account for 50% of cases of social phobia; as well as in alcoholism (between 40% and 50%) given the tendency of social phobia to use alcohol to face feared situations.