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.<sup>61 Kessler R.C., McGonagle K.A., Zhao S. , e al. Lifetime and 12 month prevalence of DSM III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey Arch Gen Psychiatry 1994 ;  51 : 8-19

Cliccare qui per andare alla sezione Riferimenti</sup> This disorder has been described as far back as Hippocrates<sup>77 Marks I.M., Gelder M.G. Different ages of onset in varieties of phobia Am J Psychiatry 1966 ;  123 : 218-221

Cliccare qui per andare alla sezione Riferimenti</sup> as erythrophobia, which is a fear of blushing in front of others,<sup>91 Pelissolo A., Lepine J.P. Social phobia: Historical and conceptual perspectives Encephale 1995 ;  21 : 15-24

Cliccare qui per andare alla sezione Riferimenti</sup> and as a disorder distinct from other phobias by Marks and Gelder.<sup>77 Marks I.M., Gelder M.G. Different ages of onset in varieties of phobia Am J Psychiatry 1966 ;  123 : 218-221

Cliccare qui per andare alla sezione Riferimenti</sup> 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,<sup>8 Beidel D.C. Social phobia and overanxious disorder in school age children J Am Acad Child Adolesc Psychiatry 1991 ;  30 : 545-552  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 36 Francis G., Last C.G., Stauss C.C. Avoidant disorder and social phobia in children and adolescents J Am Acad Child Adolesc Psychiatry 1992 ;  31 : 1086-1089  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> 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.