Social Anxiety Disorder

Social Anxiety Disorder is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • Social anxiety disorder, also known as social phobia, is a psychological condition with developmental and genetic underpinnings. The disorder is characterized by marked and persistent fear of social situations in which the person is exposed to unfamiliar people or possible scrutiny by others.
  • DSM-5 criteria:
    • Marked fear or anxiety of one or more social situations in which the individual is exposed to possible scrutiny by others (in children: anxiety must occur in peer situations, not just in interactions with adults)
    • The individual fears that he/she will act in a way or show anxiety symptoms that will be negatively evaluated.
    • The social situations almost always provoke fear or anxiety and are avoided or endured with intense fear or anxiety.
    • The fear/anxiety is out of proportion to the actual threat posed by the situation/context and is persistent, typically lasting 6 months or more.
    • The fear/anxiety or avoidance causes significant distress or impairment in social, occupational, or other areas of functioning.
    • The fear/anxiety is not attributable to psychological effects of substances, a medical condition, or by another psychiatric diagnosis.

Epidemiology

Approximately 7% of youths suffer from social anxiety disorder. The prevalence is somewhat higher in girls than in boys. Subclinical social anxiety symptoms are much more common and are distinguished by the degree of functional impairment and cultural context.

Risk Factors

  • Preexisting shyness or social inhibition
  • Avoidant temperament
  • Behavioral inhibition
  • Family history: 1st-degree relatives have 2 to 6 times greater chance of having the disorder.
  • Moderate genetic component based on twin studies

Commonly Associated Conditions

  • Anxiety disorders
    • Generalized anxiety disorder
    • Specific phobia
    • Selective mutism
    • Obsessive-compulsive disorder
    • Panic disorder
  • Attention deficit hyperactivity disorder (ADHD)
  • Depression

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