judgement (34043230_s)Social anxiety disorder aka SAD aka social phobia is one of those diagnoses, like OCD or PTSD, that many people use casually to describe non-clinical symptoms (eg, "I really don't want to go to that party, my social phobia's kicking in.") But having some anxiety about party-going or spending time in groups of people isn't a disorder. It's just, for many, life--normal, non-clinical worry. Take a look at these (abridged) criteria for SAD:

A. Fear of scrutiny in social situations.

B. Fear of anxiety showing and being negatively evaluated.

C. The social situations almost always provoke anxiety.

D. The social situations are avoided and endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual threat posed.

F. Symptoms are persistent, lasting for 6 months or more.

G. Symptoms cause clinically significant distress or impairment.

H Symptoms are not attributable to the effects of a substance or

I. ...another disorder or...

J. ...a medical condition.

The focus in social anxiety disorder is a fear of scrutiny and negative evaluation. What will people say about me? On the social work licensing exam, look for phrases like that. As soon as you see,  people think I'm a loser, start thinking social anxiety disorder. Then look for the six month duration, intensity, impairment, lack of exceptions, and the absence of other explanations, and you've got your dx!

SAD was by far the most popular choice for the last free practice question. And why not? "A social worker sees a client, an MSW student, who reports feeling anxious in social situations, especially in classes. She says she gets clammy hands, shortness of breath, and can't bring herself to speak at all when called upon." That sounds a lot like social anxiety disorder. The trick there was the client's inability to speak. That's not a SAD symptom. That's selective mutism. Selective mutism was the best primary diagnosis in that case. The client in the vignette may qualify for both diagnoses. So it's sort of a trick question--the kind that will probably not be used for scoring--a tester which will be discarded before appearing as a scored item on the ASWB exam.

Hope this clears things up some. For additional reading about social anxiety disorder, try these:

For more questions about social anxiety disorder, anxiety disorders in general, and lots more, sign up now for SWTP's full-length practice exams.


[Post by Will Baum, LCSW]

April 2, 2016
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