DSM-5 Criteria For Social Anxiety Disorder

Social anxiety disorder (SAD) is a type of anxiety disorder that’s estimated to affect around 7% of U.S. adults. Social anxiety manifests within a sociocultural context, where individuals experience symptoms of intense self-consciousness and fear of social scrutiny in social situations. People with SAD may avoid social interactions altogether or endure them with marked fear or anxiety. Their daily lives can be significantly impacted as a result since anxiety symptoms may make work, school, and maintaining social relationships difficult.

Only a qualified healthcare provider can properly diagnose social anxiety disorder; however, understanding the diagnostic and statistical criteria listed in the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders), may help individuals to understand whether it might be time to seek support for symptoms of social anxiety.

Diagnostic criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guide to mental illnesses that’s published by the American Psychiatric Association. The first edition of the guide was published in the 1950s, and its content has been updated several times since then as new research and understandings of mental health have emerged. (For example, social anxiety disorder was once referred to as “social phobia,” but that term is now outdated.) The most recent edition is the DSM-5, released in 2013. It lists specific criteria for all currently recognized clinical mental health disorders. Mental health professionals can use this updated diagnostic and statistical manual to assess and treat their clients. 

Some of the key criteria for diagnosing SAD as outlined in the DSM-5 include:

• Intense fear of being judged and/or embarrassed in social situations
• Physical symptoms such as blushing, shaking, sweating, and a racing heart when facing social situations
• Avoiding eye contact, speaking softly, or limiting gestures in social situations
• Fear or anxiety that can be considered out of proportion to the situation at hand
• Excessive self-consciousness and self-criticism
• Low self-esteem or self-image
• Difficulty forming and maintaining relationships as a result of anxiety
• Avoidance even of social situations that may be essential to one’s life goals, such as important work, school, or family events
• Worrying about social situations for days or weeks beforehand

The manual also notes that, in order to potentially qualify as social anxiety disorder, these symptoms must persist — typically for six months or more. They must not be explainable by another physical or mental health condition; they must interfere with daily functioning; and they must not be limited only to situations where the person has to speak or perform in front of an audience.

Again, only a qualified healthcare professional can provide an accurate diagnosis of any mental health condition, but comparing their symptoms to the criteria above may help an individual decide to seek treatment for suspected anxiety disorders. With the proper support, social anxiety disorder is generally considered to be treatable.

Risk factors

Who is at risk for developing social anxiety disorder? As with many mental health conditions, the causes of social anxiety disorder are not yet fully understood but are thought to be complex. Several factors may play a role, including:

• Genetics. According to research on the topic, heritability for social anxiety disorder is considered to be “significant,” meaning that if you have a biological relative with the disorder, or a related medical condition, you could be more likely to develop it as well
• Brain chemistry. Abnormalities in an individual’s levels of certain neurotransmitters, or chemical messengers in the brain, may also contribute to the development of SAD
• Life experiences. Having experienced traumatic or otherwise difficult life experiences, such as childhood bullying, substance abuse, or relationship difficulties could increase an individual’s risk of developing social anxiety disorder
• Temperament. People who are naturally introverted or shy may be more prone to developing anxiety disorders, especially those related to social phobia
• Personality. Individuals with perfectionist or self-critical tendencies might be more at risk of developing SAD, as it may make them inclined to judge themselves harshly for every detail of their social interactions
• Environmental factors. Chronic stress, which may be caused by financial difficulties or relationship problems, for example, may also contribute to the development of SAD or any number of other mental health conditions

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Treatment options

It’s worth repeating that social anxiety disorder is considered to be a treatable condition. The recommended treatment method may vary based on an individual’s specific circumstances, including the severity of their symptoms and any other co-occurring mental or physical health conditions. That said, some form of psychotherapy is typically a key tenet of treatment, sometimes in combination with medication. The American Psyhciatric Assocciation is the largest psychiatric organization in the U.S. and they provide numerous services to support the health and well-being of people with social anxiety disorders. Through the pyshiatric association, many therapists are trained to offer specialized care, whether an individual is seeking exposure therapy for social phobia, or CBT for a panic disorder.

Exposure therapy is one type of therapy that’s commonly recommended for those with SAD. It usually involves teaching the client relaxation techniques and then gradually exposing them to the object of their fear until it no longer triggers symptoms. For example, depending on the specific source of a client’s social anxiety, a therapist might encourage them to work their way up to attending social functions by commenting on a social media post to start a conversation with a stranger, posting a video of them speaking, complimenting someone they don’t know, or calling a restaurant to order food.

Cognitive behavioral therapy (CBT) is a common type of talk therapy that relies on helping an individual learn to recognize and then reframe distorted patterns of thinking. For example, a therapist might help a client question the validity or likelihood of the thought that everyone will laugh at them if they stumble over their words when introducing themselves and replace this thought with a more realistic, optimistic alternative.

Getting support for social anxiety per the DSM-5

Since social anxiety disorder can have such a significant impact on a person’s daily functioning and well-being, seeking treatment can be important. That said, some people may find it difficult or impossible to meet with a therapist for a traditional in-person appointment due to their symptoms. In cases like these, online therapy can represent a viable alternative. With a virtual therapy platform like BetterHelp, you can get matched with a licensed therapist who you can speak with via phone, video call, or even in-app messaging to address the challenges you may be facing. One study suggests “a strong efficacy” of online cognitive therapy treatment for social anxiety disorder, so this format can represent a more comfortable but equally effective option for addressing symptoms of SAD in those who prefer it. Usually, these professionals are licensed to diagnose and treat individuals via the American Psyhciatric Association.