What Are the Criteria for Diagnosing Social Anxiety Disorder?

Getting a diagnosis of SAD can be difficult.
The DSM-5 outlines the criteria for a diagnosis of SAD.. Ned Frisk / Getty Images

A diagnosis of social anxiety disorder (SAD) requires that a number of specific criteria are met.

DSM-5 Diagnosis

Mental health professionals use a handbook called the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-V) when making diagnoses. A mental health professional will ask questions to determine whether you meet each of the following criteria when making a diagnosis:

  • You have significant and persistent fear of social or performance situations in which embarrassment, rejection or scrutiny are possible.
  • You almost always experience the physical symptoms of anxiety when in the feared social situation(s).
  • You recognize that the fear is unreasonable but are unable to do anything about it.
  • You either avoid the feared situations or endure them with intense anxiety or distress.
  • Your symptoms have persisted for 6 months or longer.

In order to be diagnosed with SAD, the fear and avoidance must be so severe that they significantly interfere with your daily functioning, school, work, or relationships or you are in significant distress about having the phobia.

mental health professional will also rule out possible alternative causes of symptoms such as drug or medication use, or a medical condition, before making a diagnosis of SAD.

Finally, the fear must not be only about the symptoms of a medical condition or another mental disorder.

For example, the fear is not just of shaking in Parkinson's disease or panic attacks in panic disorder.

In cases where you fear only one or a few social situations (such as public speaking), the diagnosis is specific SAD. In contrast, if you are afraid of and avoid most social situations, you would be diagnosed with generalized SAD.

DSM-5 Criteria 

The following are the actual criteria listed in the DSM-5 for social anxiety disorder.

A. A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.

B. Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed panic attack.  

C. The person recognizes that this fear is unreasonable or excessive.

D. The feared situations are avoided or else are endured with intense anxiety and distress.

E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F. The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.

G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder...

ICD-10 Diagnosis

The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) is a medical classification system published by the World Health Organization (WHO).

According to the ICD-10, social phobia (diagnosis code F40.10) is an anxiety disorder that involves intense fear of one or more social or performance situations in which scrutiny from others is possible. This fear is recognized as being unreasonable or excessive. 

Screening Instruments

A step below diagnosis, screening for social anxiety disorder involves the use of instruments that can be used with the general population or those suspected of having SAD, to identify the need for further investigation or diagnosis. Examples of screening instruments include the Liebowitz Social Anxiety Scale and the Social Phobia Inventory.

These instruments are also often used as part of research studies to measure the severity of social anxiety and how it may change before and after different treatments.

Do I Need a Diagnosis?

You may still be wondering—how do I get a diagnosis (or do I need one?) The best first step is to make an appointment with your family practitioner if you are concerned about symptoms of social anxiety. From there you can be referred to a mental health specialist for further evaluation.

Though the thought of being diagnosed with a mental disorder may seem scary, there are many advantages to a diagnosis, such as receiving appropriate treatment, being able to request accommodations at work or school, and even being an advocate for others who may be in search of answers for problems similar to the ones you have been experiencing.

Sources:

American Psychiatric Association, DSM-5 Task Force. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.; 2013. Accessed May 24, 2016.

American Psychiatric Association, DSM-5 Task Force. Social Anxiety Disorder.; 2013. Available at: http://www.dsm5.org/Documents/Social%20Anxiety%20Disorder%20Fact%20Sheet.pdf. Accessed May 24, 2016.  

Heimberg RG, Hofmann SG, Liebowitz MR, et al. Social Anxiety Disorder in DSM-5. Depression and Anxiety. 2014;31(6):472-479. doi:10.1002/da.22231.

World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research.; 1992. Accessed May 24, 2016.

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