DSM-5: Here are the Changes We'd Like to See

The DSM-5 definition of social anxiety disorder is the most clearly produced to date; however, there are several problems with this definition that should be addressed.

The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) currently defines social anxiety disorder in the following way. 

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.  In individuals under age 18 years, the duration is at least 6 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...

Copyright 2012-13, The American Psychiatric Association (abridged)

Problems with the DSM-5 Definition of Social Anxiety

While this definition is clearly the most precise official definition produced so far, "social anxiety disorder" has only been officially recognized since 1980, and the problem was not adequately explained until the 1987 version of the DSM.  Thus, the definition of social anxiety disorder has become clearer and more precise with each edition.  

Here is where the current DSM needs to be revised:

1.  The descriptive language is generally good, but could be more direct and precise.  For example:

2.  The reference in "B" to a situationally bound or situationally pre-disposed Panic Attack is confusing, and for the most part, inaccurate.  The use of the term "Panic Attack", which is the name of a separate anxiety disorder, is confusing and can prevent a proper diagnosis from being made.  

See our article on the differences between Panic Disorder (with and without agoraphobia) and Social Anxiety Disorder for further details.

3.  People with social anxiety disorder may experience "anxiety" attacks that are situationally bound, but they do not experience "panic" attacks, which, by definition, initially precipitate feelings of a medical emergency (i.e., fear of losing control, heart attack, and dying, to name a few).  

There needs to be a clear distinction between these terms, as many people are misdiagnosed as a result of the current language in the DSM-5.  

4.  Demographic and epidemiological studies show correlations between many mental health care disorders.  However, these associations do NOT usually rise to the level of diagnostic "labeling".  That is, people can exhibit symptoms of a disorder, but not experience the number of symptoms necessary to be clinically diagnosed with the disorder.  Confusion exists in the psychiatric/psychological community about this.

5.  It is possible for people to have "clinical cases" of both panic disorder and social anxiety disorder, as defined by the DSM-5.  In these cases, which are not common, it is typically the panic disorder that is most bothersome initially, and should be treated first.