Social Anxiety Disorder (Social Phobia) DSM-5 300.23 (F40.10)

Social Anxiety Disorder (Social Phobia) DSM-5 300.23 (F40.10)

DSM-5 Category: Anxiety Disorders


Social anxiety disorder, also known as social phobia, is an anxiety disorder involving discomfort around social interaction, and concern about being embarrassed and judged by others (NIH, 2014) . This discomfort will be experienced as fear and anxiety, and will be accompanied by autonomic arousal, including diaphoreses, apnea, tremors, tachycardia, and nausea ( ADAA, 2014). It can range in severity to a discomfort which can be circumvented and adapted to, to a virtually disabling fear with infiltration into multiple areas of life (American Psychiatric Association, 2013). The discomfort that people with Social Anxiety Disorder experience can generalize to routine activities such as eating in front of others, or using a public bathroom. People with social phobia desire social contacts and want to participate in social situations, but their anxiety can become unbearable (NIMH, 2014).Social anxiety can lead to isolation, and either absence of development or stagnation of social skills, which can intensify existing social anxiety.

Symptoms of Social Anxiety Disorder

According to the DSM-5, (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), there are a total of ten diagnostic criteria for Social Anxiety disorder :

  1. fear or anxiety specific to social settings, in which a person feels noticed, observed, or scrutinized. In a adult, this could include a first date, a job interview, meeting someone for the first time, delivering an oral presentation, or speaking in a class or meeting. In children, the phobic/avoidant behaviors must occur in settings with peers, rather than adult interactions, and will be expressed in terms of age appropriate distress, such as cringing, crying, or otherwise displaying obvious fear or discomfort.
  2. typically the individual will fear that they will display their anxiety and experience social rejection,
  3. social interaction will consistently provoke distress,
  4. social interactions are either avoided, or painfully and reluctantly endured,
  5. the fear and anxiety will be grossly disproportionate to the actual situation,
  6. the fear, anxiety or other distress around social situations will persist for six months or longer and
  7. cause personal distress and impairment of functioning in one or more domains, such as interpersonal or occupational functioning,
  8. the fear or anxiety cannot be attributed to a medical disorder, substance use, or adverse medication effects or
  9. another mental disorder, and
  10. if another medical condition is present which may cause the individual to be excessively self conscious- e.g., prominent facial scar, the fear and anxiety are either unrelated, or disproportionate. The clinician may also include the specifier that the social anxiety is performance situation specific - e.g., oral presentations (American Psychiatric Association, 2013).


According to the DSM-5, the median age of onset of social anxiety disorder in the US is age 13, with 75% of those with social anxiety disorder experiencing the onset at a range of ages 8-15. The onset can either be insidious, or sudden onset triggered by a specific event. (American Psychiatric Association, 2013).


The DSM-5 cites the annual prevalence of social anxiety disorder as 7%, in both children and adults in the United States (American Psychiatric Association, 2013).

Risk Factors

The DSM-5 notes that temperamental qualities of fear of poor social evaluation and inhibition are risk factors for the development for social phobia, Child maltreatment, including peer abuse is a correlational risk factor for social phobia, but causality cannot be verified. There appears to be a genetic basis, though it could be speculated that social anxiety is also a learned behavior. (American Psychiatric Association, 2013).Obesity has been identified as a risk factor in teens, (ADAA, 2013) as teens who are obese may experience peer rejection and develop social anxiety as a learned behavior.


Comorbidity occurs with other anxiety disorders, depression and substance abuse disorders according to the DSM- 5 (American Psychiatric Association, 2013). Other anxiety disorders can accompany Social anxiety, and social anxiety can lead to depression, due to loneliness, isolation, and inability to make social contacts. People may use drugs or alcohol in an effort to reduce their anxiety in social situations (NIMH,2014).

Treatment for Social Anxiety Disorder

CBT (Cognitive Behavioral Therapy) with an emphasis on exposure can reduce symptoms of social phobia. Exposure therapy involves gradually placing oneself in anxiety provoking situations, and associating the feared stimulus with a response of relaxation or indifference. This is also known as systematic desensitization , and is a very effective evidence based treatment of phobia, including social phobia. (NIMH, 2014).

Impact on Functioning

The impact on functioning can be substantial. The DSM-5 notes that overall quality of life can be effected due to social withdrawal and isolation (American Psychiatric Association, 2013).

Differential Diagnosis

There are a number of rule-outs that the clinician must consider to arrive at an accurate diagnosis. Shyness and introversion are within normal limits personality characteristics which may be misconstrued as Social phobia. Shyness is an endearing quality, which people may find attractive, especially those who are less socially confident. A shy person does not represent a threat and may be easier to approach. Introversion is a choice and preference for solitary activities, deep thinking and contemplation, quiet solitude, and the company of a small number of meaningful social contacts, rather than a large quantity of shallow contacts. Agoraphobia involves a fear of leaving a perceived safe area, and has a different etiology, involving a conditioned response to a specific place, which had generalized to other places. panic disorder Is an acute activation of the sympathetic nervous system in the absence of a clear threatening stimuli. GAD (General Anxiety Disorder) is global anxiety about multiple stimuli. PTSD (Post-traumatic Stress Disorder) is not specifically noted in the DSM-5 as a co-morbid diagnosis, but one could speculate that the social isolation and withdrawal component of PTSD could be misdiagnosed as social anxiety disorder. There is a qualitative difference between PTSD and social phobia, in that people with PTSD feel fundamentally unsafe in the world, and isolation is an effort to shrink the world around them and make their life more manageable. Other specific phobias may be misconstrued as social phobia, but are actually a response to another objective event in the environment, e.g., fear of the dark prohibits people from going to a theatre. Depression can be the result of social phobia, but it is a discrete disorder. The Social withdrawal and isolation which often accompanies depression can look like features of social phobia. BDD (Body Dysmorphic Disorder) can result in social withdrawal and avoidance, but the causal factor is discomfort with a perceived physical flaw . A delusional disorder-can manifest with social withdrawal, if the individual's delusional content revolves around not leaving the home, or avoiding others. Autism spectrum disorder can produce an indifference to social contacts, or inability to form social contacts, A personalty disorder can lead to a withdrawal from social activity, but the defining belief will be that others are at fault, and this is the culmination of repeated social awkwardness, or dramatic social confrontations where others have rejected the individual with the personality disorder. Medical conditions may also make the individual self-conscious and limit their volition to pursue social contacts.


ADAA.(2014) Social Anxiety Disorder. ADAA. Retrieved February 28, 2014 from

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.

NIH. ( 2014) What is Social Phobia ( Social Anxiety Disorder) NIH. Retrieved February 28, 2014 from

NIMH.(2014) Social Anxiety Disorder. NIMH Retrieved February 28, 2014, from

Nordqvist, C. (2010, January 22). What Is Social Anxiety Disorder? What Causes Social Anxiety Disorder?. Medical News Today. Retrieved March 1, 2014, from

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