Social Anxiety Disorder: Social Phobia
The Diagnostic and Statistical Manual of Mental Disorders defines social anxiety disorder as a marked and persistent fear of social or performance situations in which embarrassment may occur (DSM). Exposure to these situations provokes an immediate anxiety response such as a panic attack (DSM). In order to be diagnosed, fear or avoidance of these situations must interfere significantly with the person’s normal routines, occupational or academic functioning, social activities or relationships, or a person must experience marked distress about having the phobia (DSM). In 400 B.C., Hippocrates described a young man that displayed the symptoms of a social anxiety disorder. “He dare not come in company for fear he should be misused, disgraced, overshoot himself in gesture or speeches, or be sick; he thinks every man observes him” (Burton 2009). Throughout the 20th century, psychiatrists described extremely shy patients as having social phobia and social neurosis. British psychiatrists Isaac Marks and Michael Gelder proposed that social phobias be considered a distinct category separate from other simple phobias (Hope, Heimberg, Juster, & Turk 2005). In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders introduced social phobia as an official psychiatric diagnosis. Social phobia was described as a fear of performance situations, but did not include fears of informal situations such as casual conversations or social situations. Patients with broad fears were likely to be diagnosed with avoidant personality disorder, which could not be diagnosed in conjunction with social phobia (Weiner, Freedheim, Freedheim, Reynolds, Miller, Gallagher, Nelson, Gallagher, Nelson, Gallagher, & Nelson 2003). In 1985, psychiatrist Michael Liebowitz and psychologist Richard Heimberg initiated a call to action for research on social phobia (Weiner, Freedheim, Freedheim, Reynolds, Miller, Gallagher, Nelson, Gallagher, Nelson, Gallagher, & Nelson 2003). Due to the lack of research on social anxiety disorder, the disorder came to be known by many as the “neglected anxiety disorder” (Weiner, Freedheim, Freedheim, Reynolds, Miller, Gallagher, Nelson, Gallagher, Nelson, Gallagher, & Nelson 2003). In 1987, the DSM-III-R introduces changes in some of the diagnostic criteria. To diagnosis social anxiety disorder the symptoms must cause "interference or marked distress" rather than simply "significant distress." It also became possible to diagnose social phobia and avoidant personality disorder in the same patient (Weiner, Freedheim, Freedheim, Reynolds, Miller, Gallagher, Nelson, Gallagher, Nelson, Gallagher, & Nelson 2003). In 1994, the DSM-IV was released, and the disorder was defined as a "marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others" (Weiner, Freedheim, Freedheim, Reynolds, Miller, Gallagher, Nelson, Gallagher, Nelson, Gallagher, & Nelson 2003). The etiology of social anxiety disorder is largely attributed to genetics, and environmental factors. Family studies of individuals with social anxiety disorder show a higher incidence of the disorder than that found in the general population, and a twin study found a concordance rate of 15.3% in dizygotes and a 24.4% concordance in monozygotes (Kedler, Neale, Kessler, Heath & Eaves 1992.). Of course, there is very little evidence that the genetic factors attributed to social anxiety disorder extend beyond the link between environmental factors since there is very little evidence of neurobiological factors. Other than the fact that selective serotonin reuptake inhibitors (SSRIs) are effective treatments for social anxiety disorder, there is little evidence to implicate dysfunction of the serotonergic system (Jefferson 2001.). The lack of empirical data identifying neurobiological factors in causing the onset of social anxiety...
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