Which of the following phobias is characterized by persistent fear of social situations where the individual may be scrutinized or embarrassed by others?

Explanation

## Social Anxiety Disorder (Social Phobia) **Key Point:** Social anxiety disorder (social phobia) is defined by persistent, intense fear of social or performance situations where embarrassment, scrutiny, or negative evaluation by others may occur. ### Diagnostic Criteria for Social Anxiety Disorder **High-Yield:** The core feature distinguishing social phobia from other anxiety disorders is the **fear of negative evaluation by others** in social contexts, not fear of panic symptoms or separation. ### Key Diagnostic Features (DSM-5) | Feature | Characteristic | |---------|----------------| | **Feared situation** | Social/performance situations involving potential scrutiny | | **Core anxiety** | Fear of negative evaluation, embarrassment, humiliation | | **Duration** | ≥6 months | | **Onset** | Often in adolescence (mean age 13 years) | | **Prevalence** | ~7% lifetime prevalence in general population | | **Gender ratio** | Slightly higher in females | ### Common Feared Situations - Public speaking or performing - Eating or drinking in public - Writing in front of others - Using public restrooms - Attending social gatherings - Making phone calls - Initiating conversations **Clinical Pearl:** Individuals with social anxiety disorder often experience anticipatory anxiety (worry before the event) and rumination afterward (reviewing perceived failures), which perpetuates the disorder. ### Differential Diagnosis from Other Phobias ```mermaid flowchart TD A["Patient with anxiety in specific situation"]:::outcome --> B{"What triggers the fear?"}:::decision B -->|"Fear of panic symptoms or being trapped"| C["Agoraphobia"]:::outcome B -->|"Fear of negative evaluation by others"| D["Social Anxiety Disorder"]:::outcome B -->|"Fear of specific object/animal/situation"| E["Specific Phobia"]:::outcome B -->|"Fear of separation from attachment figure"| F["Separation Anxiety Disorder"]:::outcome ``` **Mnemonic:** **SANE** for Social Anxiety Disorder features: - **S**ocial/performance situations - **A**nxiety about negative evaluation - **N**eed to avoid or endure with distress - **E**xcessive fear (out of proportion to actual threat) [cite:DSM-5 pp. 202–208]