SOCIAL ANXIETY DISORDER - 02/09/11
Résumé |
Social anxiety disorder, also called social phobia in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), now is recognized as an anxiety disorder with significant prevalence, substantial comorbidities, and serious consequences. It is the third most prevalent disabling psychiatric disorder, exceeded only by substance abuse and major depressive disorder.61 This disorder has been described as far back as Hippocrates77 as erythrophobia, which is a fear of blushing in front of others,91 and as a disorder distinct from other phobias by Marks and Gelder.77 In the first two versions of DSM, the disorder that was called exclusively social phobia was not conceptualized as a separate diagnosis. Social phobia, as a distinct Axis I diagnostic category, first made its appearance in DSM-III. In DSM-III, the symptoms of social phobia overlapped with those of the Axis II diagnosis avoidant personality disorder. Avoidant personality disorder took precedence if the person's fear of scrutiny was intense, involved multiple social situations, was debilitating, and had an early age of onset. In DSM-III, it was not possible to assign both diagnoses in the same individual. This situation had implications for the conceptualization of the disorder and the type of treatment that might be used.
In DSM-III-R, which removed the hierarchical rules that existed in DSM-III, social phobia could be diagnosed in the presence of multiple social fears and other comorbid conditions, such as avoidant personality disorder. To differentiate individuals with multiple performance and interaction fears from individuals with only one or two circumscribed performance fears, such as public speaking, the concept of a generalized subtype was introduced in DSM-III-R. DSM-III-R continued to restrict children with symptoms of social anxiety to a diagnosis of avoidant personality disorder or overanxious disorder, however.
With the advent of DSM-IV, the condition was allocated two official names, social phobia and social anxiety disorder. The names were interchangeable and synonymous, and either name for the diagnosis could be assigned. In view of evidence that it is difficult to distinguish between avoidant personality disorder, overanxious disorder, and social phobia in children,8, 36 DSM-IV eliminated the diagnoses of avoidant personality disorder and overanxious disorder, and the diagnosis of social phobia (social anxiety disorder) was extended to include children.
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| Address reprint requests to B. Ashok Raj, MD, Department of Psychiatry, University of South Florida College of Medicine, 3515 East Fletcher Avenue, Tampa, FL 33613 |
Vol 85 - N° 3
P. 711-733 - mai 2001 Retour au numéro
Article précédent
- GENERALIZED ANXIETY DISORDER : An Important Clinical Concern
- Rosario B. Hidalgo, Jonathan R.T. Davidson
- OBSESSIVE-COMPULSIVE DISORDER AND TIC SYNDROMES
- Neal R. Swerdlow
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