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Section 13
Detecting DSM-5 Social Anxiety Disorder

Question 13 | Test | Table of Contents

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In the last section, we discussed Interventions for Agoraphobia.  Interventions for agoraphobia include cognitive strategies, methods to choose acceptance, and action strategies. 

In this section, we will discuss social phobias.  We will discuss the DSM Identification of social phobias, the fear of being evaluated, and features of social phobias. 

♦ #1  DSM Identification
Social phobias are concerned with one’s exaggerated fear of being the focus of attention and devaluation by another person or persons.  According to the DSM, the essential feature of social phobia is ‘a persistent irrational fear of, and compelling desire to avoid, a situation in which the individual is exposed to possible scrutiny by others.’  Many therapists find this definition too broad, in that it encompasses a large proportion of the population as well as a significant number of clients who have been accurately diagnosed as having a generalized anxiety disorder. 

In contrast to the definition of social phobia, the official definition of agoraphobia specifies that ‘normal activities are increasingly constricted as the fears or avoidance behavior dominate the individual’s life.’  Would you agree that this restrictive criterion might well serve the definition of social phobia as well? 

The DSM also includes examples of social phobias such as, ‘fears of speaking or performing in public, using public lavatories, eating in public, and writing in the presence of others.’  Should the fear of speaking in public be included?  Could a more restrictive definition of social phobia cause only a small percentage of clients with social anxiety to be considered social phobics?

Unlike other phobias we have discussed, a major feature of the social anxieties is that the actual fear prior to entering a situation appears plausible and indeed seems to have a reasonable probability of being realized.  For example, a client with a fear of heights, bridges, or elevators runs a minimal risk of falling or suffocating.  However, clients like Sal could reasonably expect his fear to materialize. 

Sal, age 32, lived in fear that he would become tongue tied and unable to carry on conversations.  Sal often feared that his mind would go blank during social interactions.  Sal stated, "Not only am I afraid that I won’t be able to perform socially, many times I really can’t!"  Would you agree that, for clients like Sal, actually having the fear seems to bring on the undesirable consequence? 

Sal stated, "It’s like a vicious cycle.  I anticipate clamming up and that makes me more fearful and inhibited."  Would you agree that clients who do not experience the fear of inept social performance tend to be less likely to respond ineptly?

♦ #2  The Fear of Being Evaluated
Next, let’s discuss the fear of being evaluated.  In therapy, I found that Sal’s central fear was that of negative evaluation by another person or persons.  Sal stated, "What scares me the most is being the center of attention."  Think of your Sal.  Is he afraid of having his weaknesses exposed, and consequently of being judged adversely by one or more people?  Sal stated, "People look at everything.  They judge your performance, fluency, self assurance.  Everything." 

♦ #3  15 Features of Social Phobias
In addition to the DSM identification and the fear of being evaluated, let’s discuss features of social phobias.  Clinical studies by K.A. Nichol revealed 15 distinct features of social phobias. 
1. The first two features involve disapproval or critical regard by others. 
2 . Does your social phobic perceive and/or expect disapproval? 
3 Third is a strong tendency to perceive and respond to nonexistent criticism. 
4. A fourth feature of social phobia is a feeling of being less capable and less powerful than others.  Think of your Sal.  How might you evaluate your client’s level of self esteem? 
5. Does your client have rigid ideas of appropriate social behavior without the ability to vary behavior? 
6. Clearly, a sixth feature of social phobia is negative fantasies which produce anticipatory anxiety. 
7. Seventh, as described earlier in this section by Sal, is the heightened awareness and fear of being evaluated and judged by others. 
8. Also, social phobics may experience a sense of being watched. 
9. A ninth features of social phobias is discrimination and fear of situations from which sudden withdrawal would be unexpected and likely to attract attention. 
10 . Next, social phobics often have a sense of being trapped or confined in social situations.  Sal stated, "The worst is when I’m around people and I realize I’m going to lose it and not have a way out." 
11. Eleventh, an exaggerated interpretation of the sensory feedback relates to tension or embarrassment. 
12. Twelfth, social phobics detect bodily sensations within social situations.  For example, Sal reported feeling ‘shaky and weak.’ 
13. Another feature of social phobias is a fear of being seen to be ‘ill’ or losing control. 
14. Next is the experience of a progressive build-up of the discomfort. 
15. Finally, social phobics have to live with the unpredictability of the phobic response. 

In this section, we have discussed social phobias.  We will discuss the DSM Identification of social phobias, the fear of being evaluated, and features of social phobias. 

In the next section, we will continue to discuss causes of social phobias.  Two causes of social phobia that we will examine are shame and social image and fear of loss of love or abandonment.

- Dubenetzky, Salome. Differential Diagnosis of Anxiety Disorders. Annals of Psychotherapy & Integrative Health. Summer2013, Vol. 16 Issue 2, p40-46. 7p.

- Jensen, Vicki L.; Hougaard, Esben; Fishman, Daniel B. Sara, A Social Phobia Client with Sudden Change After Exposure Exercises in Intensive Cognitive-Behavior Group Therapy: A Case-Based Analysis of Mechanisms of Change. PCSP: Pragmatic Case Studies in Psychotherapy. 2013, Vol. 9 Issue 3.

Update
Social Anxiety Disorder: Associated
Conditions and Therapeutic Approaches

- Alomari, N. A., Bedaiwi, S. K., Ghasib, A. M., Kabbarah, A. J., Alnefaie, S. A., Hariri, N., Altammar, M. A., Fadhel, A. M., & Altowairqi, F. M. (2022). Social Anxiety Disorder: Associated Conditions and Therapeutic Approaches. Cureus, 14(12), e32687.

Peer-Reviewed Journal Article References:
Garcia-Lopez, L.-J., Beidel, D., Muela-Martinez, J.-A., & Espinosa-Fernandez, L. (2018). Optimal cut-off score of Social Phobia and Anxiety Inventory-Brief Form: Detecting DSM-5 social anxiety disorder and performance-only specifier. European Journal of Psychological Assessment, 34(4), 278–282.

Hutsebaut, J., Kamphuis, J. H., Feenstra, D. J., Weekers, L. C., & De Saeger, H. (2017). Assessing DSM–5-oriented level of personality functioning: Development and psychometric evaluation of the Semi-Structured Interview for Personality Functioning DSM–5 (STiP-5.1). Personality Disorders: Theory, Research, and Treatment, 8(1), 94–101.

Keesman, M., Aarts, H., Häfner, M., & Papies, E. K. (2020). The decentering component of mindfulness reduces reactions to mental imagery. Motivation Science, 6(1), 34–42.

Querstret, D., Morison, L., Dickinson, S., Cropley, M., & John, M. (2020). Mindfulness-based stress reduction and mindfulness-based cognitive therapy for psychological health and well-being in nonclinical samples: A systematic review and meta-analysis. International Journal of Stress Management. Advance online publication.

Rosellini, A. J., & Brown, T. A. (2014). Initial interpretation and evaluation of a profile-based classification system for the anxiety and mood disorders: Incremental validity compared to DSM-IV categories. Psychological Assessment, 26(4), 1212–1224.

QUESTION 13
What are three aspects of social phobias? To select and enter your answer go to Test.

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