Social Anxiety Disorder

Question 1

What distinguishes SAD from normal anxiety?

Answer 1

SAD involves excessive, persistent fear of social situations, out of proportion to actual threat, causing distress or impairment.

Question 2

How is SAD different from shyness?

Answer 2

Shyness is a personality trait; SAD is a clinical disorder involving intense fear and avoidance that interferes with functioning.

Question 3

How is SAD different from Autism Spectrum Disorder?

Answer 3

• SAD: Fear of negative evaluation, desire to connect socially
• ASD: Deficits in social communication, restricted behaviours, diagnosed in early childhood

Question 4

What are the core DSM-5 criteria for SAD?

Answer 4

• Marked fear of social situations
• Fear of negative evaluation
• Situations provoke anxiety and are avoided or endured with distress
• Fear is out of proportion
• Lasts ≥6 months and causes significant impairment

Question 5

What is the “performance-only” specifier in SAD?

Answer 5

Fear is restricted to public speaking or performing, without broader social anxiety.

Question 6

What is the prevalence of SAD?

Answer 6

• ~8% in Australia
• Higher in women in general population
• Equal gender rates in clinical settings

Question 7

What is the course of SAD?

Answer 7

• Onset: 8–15 years
• Chronic without treatment; ~20-year delay in seeking help

Question 8

What are common comorbidities with SAD?

Answer 8

• Depression
• Other anxiety disorders
• Substance use
• Avoidant personality disorder

Question 9

What are the key components of the cognitive model of SAD?

Answer 9

1. Assumptions: High standards and negative beliefs about social performance
2. Perceived danger: Fear of negative scrutiny
3. Self-focused attention: Self-consciousness and misinterpretation of cues
4. Safety behaviours and somatic/cognitive symptoms
5. Pre-/Post-event processing: Anticipation and rumination

Question 10

What is the first-line treatment for SAD?

Answer 10

Cognitive Behaviour Therapy (CBT)

Question 11

What are key components of CBT for SAD?

Answer 11

• Psychoeducation
• Cognitive restructuring
• Behavioural experiments
• Attention training
• Video feedback
• Graded exposure hierarchy

Question 12

What are other treatment options for SAD?

Answer 12

• Psychodynamic therapy: Less effective
• Medication: SSRIs, SNRIs, beta-blockers, benzodiazepines (treat symptoms, not cause)