AssessmentsSocial anxiety disorder
Social anxiety disorder
USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 25-year-old woman comes to the physician due to concerns about being socially withdrawn. The patient tells the physician she has been avoiding any social events at her job. She adds that although she likes to go out and meet new people at her work, she fears that she will be embarrassed and they will judge her negatively. She also declined a promotion at this job 6 months ago because she thought she would have to talk to more people in both virtual and in-person meetings; she was concerned that she would feel embarrassed if she “said the wrong thing.” She is able to sleep 8 hours every night and has no trouble falling asleep. She has no history of alcohol or substance dependence. Past medical history is noncontributory. Which of the following is the most likely diagnosis?
Content Reviewers:Rishi Desai, MD, MPH
Say it’s your first day at a new job. Maybe you’re nervous or jittery. You want to make a good impression.
Those feelings are pretty normal, and may actually help you be more alert and careful.
But after a few weeks, once you’re used to the job, and you know your coworkers, that nervousness usually diminishes, right?
Well, for some people that initial anxiety is really high, and stays really high over time.
For those people, the fear of being judged negatively by new people might be so daunting that it affects their ability to do their job well.
In fact, the idea of having to be somewhere where they may be scrutinized by others might make them not want the job or avoid looking for work in the first place.
This describes social anxiety disorder.
It’s unclear what causes social anxiety disorder, but it’s thought to be a combination of genetic and environmental factors; first degree relatives of people with anxiety disorders have between two and six times the risk of having some form of social anxiety, and people who have experienced neglect or abuse are also more likely to develop social anxiety.
The DSM-5 defines social anxiety disorder as the fear of acting in a certain way that could be negatively evaluated by others.
Social anxiety disorder causes intense distress that significantly interferes with someone’s normal routine, occupational or academic functioning, or with their social activities and relationships.
What’s more is that this fear or anxiety is persistent, lasting for 6 or more months.
The main cause for distress in individuals with social anxiety disorder is the fear that their behavior will be judged negatively by others.
For example, one person might get really anxious while making small talk with acquaintances, or meeting new people.
Another person might get performance anxiety, and not feel able to give a presentation, or give a toast at a friend’s wedding.
With the exception of some cases in which the individual is below a certain age or intellectual level, social anxiety disorder is usually considered an ego-dystonic condition, meaning people who have the disorder usually understand that their anxiety is unwarranted.
Unfortunately, that awareness sometimes just causes even more anxiety, because they’ll fear others will be able to tell how anxious they are, and that they’ll judge them for it.