According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the basic feature of social anxiety disorder is the feeling of intense fear of social situations where an individual may be negatively analyzed by others. In children, this fear must not only occur in interactions with adults but also with their peers.
Diagnostic Criteria for Social Anxiety Disorder DSM-5 300.23 (F40.10)
The following are used to make a correct diagnosis of social anxiety disorder, as outlined by the DSM-5:
- An intense fear about social situations that may involve the individual being scrutinized by others (e.g., meeting new people, having a simple conversation) or being observed by others (e.g., eating in a public place).
- The individual fears his or her anxiety symptoms will be noticed and scrutinized; he or she worries this may lead to rejection or will even offend others.
- Social situations almost always incite fear in the individual; children may express this fear by crying, clinging, or having tantrums.
- These social situations are avoided at all costs.
- The fear is excessive as compared to the actual threat of the social situation or in the minds of others.
- The fear or avoidance is persistent, usually lasting for at least 6 months or longer.
- The fear or avoidance causes clinically concerned stress or impairment in important areas of life, such as social or occupational.
- The fear or avoidance cannot be attributed to the physiological effects of a different medical condition or a substance, such as a drug or medication.
- The fear or avoidance cannot be attributed to another mental disorder (e.g., panic disorder).
- When another medical condition is present, the fear or avoidance is either excessive or not connected.
It should also be noted if the symptoms are performance only: the fear or avoidance only occurs when an individual has to speak or perform in public. These performance fears may occur in work or school settings, where regular public presentations transpire. Individuals with performance only social anxiety disorder do not have issue with other, nonperformance social situations.
Who Is at Risk of Developing Social Anxiety Disorder DSM-5 300.23 (F40.10)?
According to U.S. as well as European studies, social anxiety disorder sometimes occurs in individuals with a childhood history of shyness. Onset may also follow a traumatic or embarrassing life event or life-altering decision (e.g., starting a new job, getting married). The disorder can wane if an individual conquers a specific fear, but can return if the individual is challenged yet again.
Patterns in the disorder differ among age groups: older adults experience social anxiety at a lesser level but fear a greater multitude of situations, while younger ones report greater levels of social anxiety but in very specific scenarios. Also, adolescents more consistently experience fear and avoidance than do younger children.
There are a few additional factors that may affect susceptibility to developing social anxiety disorder. While they don’t guarantee development, these factors do raise concern and possibly your risk level:
- The individual has a history of fearing the scrutiny of others.
- The individual had a neglectful childhood.
- The disorder runs in the individual’s family.
Is There Treatment for Social Anxiety Disorder?
Many individuals that suffer with anxiety disorders do not seek treatment due to shame or feeling as if they can deal with it on their own. However, treatment should and can be sought. Here are a couple treatment options:
- Counseling: Working through an individual’s fears with a therapist can be effective, as it’s important to identify one’s fears and figure out what may provoke them.
- Medicines: There are many anxiety-reducing medications out there such as antidepressants, benzodiazepines, and beta-blockers.
Social Anxiety on the Big Screen
Charlie Kelmeckis, the main character in The Perks of Being a Wallflower, so easily steals our hearts in the novel as well as the film with his charisma and innocence. And it may not occur to you that he could have social anxiety disorder, due to moments of boldness, but with careful evaluation one can conclude that it’s a possibility. Let’s take a look:
- Overview: Charlie is a young teenager, one that is simply trying to maneuver through his first years of high school despite past and current struggles. This is not so easy, as he is still very much dealing with his best friend’s recent suicide and a long-endured childhood of sexual abuse committed by his aunt.
- Diagnosis: Although it is not exclusively discussed in the novel or film, it appears that Charlie may suffer from a few disorders. He has recurrent flashbacks related to his abuse, which clearly cause him emotional distress—this characterizes PTSD and also triggers an apparent state of depression. Charlie also has trouble navigating normal social interactions; he grew up shy and sheltered and fears the scrutiny of his peers. While Charlie certainly doesn’t allow any of these factors to get in his way when it matters most, they could point to mild social anxiety.
- Conclusion: Charlie has many of the risk factors for social anxiety disorder and shows possible symptoms. But remember, one cannot make a sure diagnosis unless the individual meets all the criteria outlined in the DSM-5.