Beyond DSM-5: An alternative approach to assessing Social Anxiety Disorder

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Highlights

  • Many changes to the diagnostic criteria of SAD over several DSM editions.

  • Further revision of DSMs SAD diagnostic criteria is necessary.

  • The changes made to the DSM-5 diagnostic criteria for SAD do not all seem to be completely in line with research so should be amended to more accurately reflect the research literature.

  • A proposed set of diagnostic criteria that address several concerns is presented here.

  • The proposed criteria reflect a hybrid categorical–dimensional system of classification.

Abstract

This article focuses on the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification of Social Anxiety Disorder (SAD). The article details the diagnostic criteria for SAD that have evolved in the various editions and demonstrates that whilst there have been some positive steps taken to more comprehensively define the disorder, further revision is necessary. It will be argued that the DSM-5 (APA, 2013) has made some changes to the diagnostic criteria of SAD that do not seem to be completely in line with theory and research and do not describe SAD effectively in terms of both diversity and presentation. This article concludes with the presentation of a proposed set of diagnostic criteria that address the concerns raised in the article. The proposed criteria reflect a hybrid categorical–dimensional system of classification.

Section snippets

Beyond DSM-5: an alternative approach to assessing Social Anxiety Disorder

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013) has recently been released. There are several notable changes to the diagnostic criteria for several disorders but this article details the diagnostic criteria for Social Anxiety Disorder (SAD) that have evolved over the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM); namely DSM-III (APA, 1980), DSM-III-R (APA, 1987), DSM-IV (

DSM III to DSM-IV-TR

Social Anxiety Disorder/Social Phobia first appeared as a diagnostic category in the DSM-III (APA, 1980). Originally, the DSM used the term ‘Social Phobia’ to describe ‘Social Anxiety Disorder’ but DSM-IV adopted the term ‘Social Anxiety Disorder’. The terms ‘Social Phobia’ and ‘Social Anxiety Disorder’ (SAD) have been used interchangeably in the past. There have been significant changes to the diagnostic criteria for SAD since this time. These changes are outlined next.

First, Criterion C of

Future directions for classifying Social Anxiety Disorder: a new proposed set of diagnostic criteria using a dimensional approach

SAD is one of the most common disorders and yet it remains ill defined in the DSM. The difficulties with particular symptoms that are listed in the diagnostic criteria have been outlined above. In addition to the stated deficiencies with the current list of symptoms, the continued use of a categorical system primarily based on the medical model of classifying disease is more generally problematic due to the variable nature of social anxiety as it is represented in individuals in clinical

Proposed new criteria

This section presents alternative diagnostic criteria to SAD that may be used to understand social anxiety in terms of both interpersonal functioning and symptom severity. The proposed diagnostic criteria are presented in Table 1. As can be seen in Table 1, several evidence-based criteria from the existing DSM-5 SAD diagnostic criteria remain. In addition to these criteria, factors that have been determined to maintain social anxiety have been included, along with a scale for impairment in

Clinical utility

Whilst the inclusion of these new proposed criteria presented here and exclusion of others appears relatively straightforward and evidence based, the direct application of a dimensional system of classification is much more complex and fraught with difficulty. Hence, we have determined that a hybrid categorical–dimensional system of classification is a most suitable way of incorporating the strengths of both approaches.

Categorical descriptions such as DSM-5 are a convenient way to classify

Conclusion

This article reviewed the changes that have been made to the DSM diagnostic criteria of SAD. Some of the most notable changes found within DSM-5 (APA, 2013) have been evaluated in relation to the literature. Specifically, the following have been outlined: the removal of wording that highlights the fear is persistent; the removal of performance fears in the general diagnostic criteria and inclusion of a performance fear specifier; the specific emphasis on the fear of negative evaluation, rather

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