A Brief History of Social Anxiety Disorder

The history of SAD spans many decades.
Learn more about the history of SAD. Heritage Images / Getty Images

The history of social anxiety disorder (SAD) is best described as a series of events leading to the diagnosis we know today. Although it may seem like SAD has not been a recognized diagnosis for very long, the idea of social anxiety dates back to the early part of the 20th century.

Below you will find an historical timeline highlighting major turning points in the history of SAD as well as some interesting tidbits that happened along the way.

The Early Years

  • 400 B.C.: The concept of social fear dates back as early as 400 B.C. During this time, Hippocrates described the overly shy person as someone who "loves darkness as life" and "thinks every man observes him."
  • Early 1900s: In the early part of the 20th century, psychiatrists used terms such as social phobia and social neurosis to refer to extremely shy patients.

Mid-Century

  • 1950s: South African psychiatrist Joseph Wolpe paved the way for later advances in behavioral therapy for phobias through his work developing systematic desensitization techniques.
  • 1960s: British psychiatrist Isaac Marks proposed that social phobias be considered a distinct category separate from other simple phobias.
  • 1967: Barbra Streisand forgot the lyrics to a song while singing in Central Park, which she attributed to anxiety that she later received treatment for.
  • 1968: In the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II), published by the American Psychiatric Association, social fears were described as a specific phobia of social situations or an excessive fear of being observed or scrutinized by others. At this point in history, the definition of social phobia was very narrow.

    Approaching the Millenium

    • 1980: In the third edition of the DSM (DSM-III), social phobia was included as an official psychiatric diagnosis. In this edition, social phobia was described as a fear of performance situations and did not include fears of less formal situations such as casual conversations. People with such broad fears were more likely to be diagnosed with avoidant personality disorder (which could not be diagnosed at the same time as social phobia).
    • 1985: Psychiatrist Michael Liebowitz and clinical psychologist Richard Heimberg initiated a call to action for research on social phobia. Up to this point, research on the disorder had been lacking, leading some to refer to it as the "neglected anxiety disorder."
    • 1987: A revision to the DSM-III lead to changes in some of the diagnostic criteria. A diagnosis now required that the symptoms cause "interference or marked distress" rather than simply "significant distress." It was also now possible to diagnose social phobia and avoidant personality disorder in the same patient. Finally, the term "generalized social phobia," referring to a more severe and pervasive form of the disorder, was introduced.
    • 1990s: Donny Osmond suffered with severe stage fright while performing in Joseph and the Amazing Technicolor Dreamcoat.
    • 1994: The DSM-IV was published and the term social anxiety disorder (SAD) replaced social phobia. This new term was used to refer to how broad and generalized fears are in the disorder. In this new edition, 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." The diagnostic criteria were only slightly modified from the DSM-III-R.

      The New Millenium

      • 2006: Baseball player Zack Greinke is diagnosed with social anxiety disorder.
      • 2007: Verywell.com began its first pages about social anxiety disorder. This library of resources has grown to hundreds or articles on the topic and a corresponding Facebook page (About Social Anxiety Disorder) was started to provide a place for people with SAD to gather.
      • 2012: Susan Cain published the tangentially related book "Quiet," which promoted the positive aspects of introverts. This cause some confusion, and possibly added to the perception of social anxiety disorder not being a "real disorder."
      • 2013: The DSM-V was published, with little change to the diagnosis of social anxiety disorder other than wording of the time frame for diagnosis.

      A Word From Verywell

      Understanding the evolution of the diagnosis of social anxiety disorder is helpful in learning more about your symptoms and how they will be treated. Moving forward, it is likely that new methods of treating SAD will be identified—particularly in the area of technology and therapy delivery. As we move forward with genetic testing, it is also likely that we will gain a better understanding of the underlying causes of the disorder.

      Sources:

      Furmark T. Social phobia: From epidemiology to brain function (dissertation). Uppsala, Sweden: Department of Psychology, Uppsala University; 2000.

      Social Anxiety Institute. DSM-V definition of social anxiety disorder

      Weiner IB, Freeheim DK. Handbook of psychology. New York: John Wiley & Sons; 2004.

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