Beyond DSM-5: An alternative approach to assessing Social Anxiety Disorder
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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Fear of negative and positive evaluation and reactivity to social-evaluative videos in social anxiety disorder
2019, Behaviour Research and TherapyCitation Excerpt :Recently, classical cognitive-behavioral models of SAD that highlighted FNE as the main fear domain in SAD (e.g., Clark & Wells, 1995; Rapee & Heimberg, 1997) have been updated by including the second fear domain (FPE; Heimberg et al., 2010; Weeks & Howell, 2012). Still, FPE was not incorporated into the revised diagnostic criteria of SAD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), despite according suggestions (Skocic, Jackson, & Hulbert, 2015). The present results indicate important implications for fear of evaluation models and treatment protocols of SAD.
Identifying sub-categories of social fears using an alternative factor analytic structure of the Social Phobia and Anxiety Inventory
2017, Psychiatry ResearchCitation Excerpt :Instead, the specifier of “performance situations only” was set to characterize the subset of patients who present with only a specific fear of public performance, most commonly public speaking. According to Kessler and Stein (1998), this subtype is much less prevalent and impairing and therefore the focus of prevention and treatment should be on the majority of individuals who present with multiple social fears, as number of social fears seems to correlate with severity (Skocic et al., 2015). The SPAI, given the large breadth of situations it addresses, may be a valuable tool in determining the range of such social fears.
Social anxiety and trustworthiness judgments of dynamic facial expressions of emotion
2016, Journal of Behavior Therapy and Experimental PsychiatryCitation Excerpt :Social anxiety and social phobia (or social anxiety disorder, SAD) are characterized by persistent and excessive fear and avoidance of situations involving scrutiny and possible negative evaluation by other people (American Psychiatric Association, 2013; Heimberg, Brozovich, & Rapee, 2014; Skocic, Jackson, & Hulbert, 2015).