Social anxiety, which is also referred to as social anxiety disorder or social phobia, is a mental illness in which a person has a fear of or worry concerning social situations that does not go away. This anxiety may be accompanied by mutism, which is the inability or unwillingness to speak in certain situations.
Social anxiety is more commonly seen in children and middle-aged women, with 9% of youth and 12% of adults being affected by social anxiety. However, this condition may remain unrecognized for a very long period.
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Before the term “anxiety” was defined, this condition was generally expressed as “stress” or “nerves disorder.” The understanding of this disorder was very poor in common people and even by health professionals. For this reason, very few people got effective treatment.
The recognition of social anxiety happened slowly over several hundreds of years and was based on the diagnosis of the condition in several cases.
The historical developments in the field can be described in three stages including the pre-developmental period, initial developmental period, and recent developments.
Social anxiety was first described by Hippocrates as “shyness” in early 400 B.C. People who “love darkness as life” and "thinks every man observes him" fell into this category.
The term “phobia” for fear or terror was coined by the Greeks long ago. In fact, the Greeks used the word phobia with a Latin or Greek prefix to convey different kinds of fear. Some of the social anxieties included scopophobia, which is the fear of being observed, xenophobia, which is defined as a fear of strangers, and anthropophobia, which is a fear of people.
During the eighteenth century, European psychiatrists, psychologists, and authors started examining the topic. This raised a considerable amount of questions and viewpoints. It also brought to light many manifestations of social anxiety. However, the idea of providing recognition to the study of social anxiety as a discipline did not arise until the 20th century.
Initial developmental period
Casper was the first person to study ereutophobia. In 1846, he described it in his report as “a serious social anxiety affecting a young man.” Pitres and Regis conducted studies in 1807 and 1902 on this phobia. A comprehensive review on this topic was published by Claparede during the same period.
Social phobia was first included by Janet as a separate section in her reference to the classification of phobias in 1903. In 1910, Hartenberg described many forms of social anxiety under the generic name of shyness, such as performance anxiety, timidity, and personality disorder.
The term “social neurosis” was used to describe the condition of extremely shy patients in 1938 by Schilder, a psychiatrist. Joseph Wolpe, a South African psychiatrist, determined a path for the improvement of behavioral therapy for the treatment of phobias in 1950 by developing a technique called systematic desensitization. This led to an increased involvement of researchers in behavioral therapy of phobias.
Apart from these, there were no landmark developments until the 1960s, although people like Morita (Japan, 1930s) showed interest in the area. Many terms and names like ‘Kontaktneurosen’ or ‘social neurosis’ were duly mentioned in the literature of Britain and Germany.
The idea of classifying social phobias as a separate category from other normal phobias was first put forward by a British psychiatrist named Isaac Marks in 1960. In the second edition of “Diagnostic and Statistical Manual of Mental Disorders (DSM-II)” published by the American Psychiatric Association (APA) in 1968, a narrow definition was provided for social anxiety. To this end, it is “a specific phobia of social situations or an excessive fear of being observed or scrutinized by others.”
Since the existing definition was a narrow one, in 1980, the APA officially added social phobia as a psychiatric diagnosis in their third edition of DSM. In this edition, social phobia is described as “a fear of performance situations," and did not include fears of less formal situations such as casual conversations. According to DSM-III, it was difficult to diagnose a patient with both social anxiety and avoidant personality disorder.
A research on social anxiety was initiated in 1985 by Michael Liebowitz (a psychiatrist) and Richard Heimberg (a clinical psychologist). Prior to this, the condition was considered to be a "neglected anxiety disorder” due to the lack of studies on the topic.
In 1987, the APA made a revision to the DSM-III in which they included changes in the diagnostic criteria. Instead of considering “significant distress" symptoms alone for diagnosis, they also added “interference or marked distress” symptoms. It allowed the diagnosis of social phobia and avoidant personality disorder in the same patient. They moved one step ahead and introduced a term called “generalized social phobia” for referring to more intense and distributive forms of the disorder.
In the DSM-IV, which was published in 1994, the term social phobia was replaced by “social anxiety disorder (SAD).” SAD described the depth of the disorder as “marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others.” There were also some small modifications to the diagnostic criteria.
In the latest revision of DSM, which is DSM-V, further changes in the diagnosis of social anxiety disorder were updated and published in 2013.
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