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A Brief History of Social Anxiety Disorder

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Updated July 07, 2012

The history of social anxiety disorder (SAD) is best described as a series of events leading to the diagnosis we know today. Although it may seem like SAD has not been a recognized diagnosis for very long, the idea of social anxiety dates back to the early part of the 20th century. Below you will find an historical timeline highlighting major turning points in the history of SAD.

  • 400 B.C.: The concept of social fear dates back as early as 400 B.C. During this time, Hippocrates described the overly shy person as someone who "loves darkness as life" and "thinks every man observes him."

  • Early 1900s: In the early part of the 20th century, psychiatrists used terms such as social phobia and social neurosis to refer to extremely shy patients.

  • 1950s: South African psychiatrist Joseph Wolpe paved the way for later advances in behavioral therapy for phobias through his work developing systematic desensitization techniques.

  • 1960s: British psychiatrist Isaac Marks proposed that social phobias be considered a distinct category separate from other simple phobias.

  • 1968: In the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II), published by the American Psychiatric Association, social fears were described as a specific phobia of social situations or an excessive fear of being observed or scrutinized by others. At this point in history, the definition of social phobia was very narrow.

  • 1980: In the third edition of the DSM (DSM-III), social phobia was included as an official psychiatric diagnosis. In this edition, social phobia was described as a fear of performance situations, and did not include fears of less formal situations such as casual conversations. People with such broad fears were more likely to be diagnosed with avoidant personality disorder (which could not be diagnosed at the same time as social phobia).

  • 1985: Psychiatrist Michael Liebowitz and clinical psychologist Richard Heimberg initiated a call to action for research on social phobia. Up to this point, research on the disorder had been lacking � leading some to refer to it as the "neglected anxiety disorder."

  • 1987: A revision to the DSM-III leads to changes in some of the diagnostic criteria. A diagnosis now requires that the symptoms cause "interference or marked distress" rather than simply "significant distress." It was also now possible to diagnose social phobia and avoidant personality disorder in the same patient. Finally, the term "generalized social anxiety disorder," referring to a more severe and pervasive form of the disorder, was introduced.

  • 1994: The DSM-IV is published and the term social anxiety disorder (SAD) replaces social phobia. This new term is used to refer to how broad and generalized fears are in the disorder. In this new edition, the disorder is defined as a "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." The diagnostic criteria are only slightly modified from the DSM-III-R.

  • 1995 to present: Since the publication of the DSM-IV, an enormous amount of research attention has been focused on SAD. Cognitive-behavioral therapy techniques are developed and supported by evidence from scientific investigations. At the same time, four medications (Paxil, Zoloft, Effexor, and Luvox) are approved for treating SAD. With the increased attention, many people who may have previously been misdiagnosed or not diagnosed at all are receiving the help that they need.

Sources:

Weiner IB, Freeheim DK. Handbook of psychology. New York: John Wiley & Sons; 2004.

Furmark T. Social phobia: From epidemiology to brain function [dissertation]. Uppsala, Sweden: Department of Psychology, Uppsala University; 2000.

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