In the document entitled "Highlights of changes from DSM-IV-TR to DSM-5" it says for social anxiety disorder
"A more significant change is that the “generalized” specifier has been deleted and replaced with a “performance only” specifier. The DSM-IV generalized specifier was problematic in that “fears include most social situations” was difficult to operationalize. Individuals who fear only performance situations (i.e., speakingor performing in front of an audience) appear to represent a distinct subset of social anxiety disorder in terms of etiology, age at onset, physiological response, and treatment response."
First, does anyone know what makes these individuals a "distict subset of SAD" especially in terms of physiological response.
Second, does anyone know the empirical evidence that supports this distinction (especially for physiological response)?
Third, does "physiological response" refer to self-perceived bodily sensations and/or actual physiological parameters (central/peripheral)?
Thanks!
Really I totally agree from both clinical point of view and also no research support whether if difference actually exist.
Dear Patrick,
Some hints:
Dev Cogn Neurosci. 2015 Mar 23;13:21-31.
Forgetting the best when predicting the worst: Preliminary observations on neural circuit function in adolescent social anxiety.
Jarcho JM, Romer AL, Shechner T, Galvan A, Guyer AE, Leibenluft E, Pine DS, Nelson EE.
From the abstract: "Neural correlates of social evaluation prediction errors (PEs) were assessed by comparing engagement to expected and unexpected positive and negative feedback. For socially anxious adolescents, but not adults or healthy participants of either age group, PEs elicited heightened striatal activity and negative fronto-striatal functional connectivity. This occurred selectively to unexpected positive feedback from high-value peers and corresponded with impaired memory for social feedback. While impaired memory also occurred in socially-anxious adults, this impairment was unrelated to brain-based PE activity.social anxiety in adolescence may relate to altered neural correlates of PEs that contribute to impaired learning about social feedback. Small samples necessitate replication. Nevertheless, results suggest that the relationship between learning and fronto-striatal function may attenuate as development progresses."
I only attempt an answer to your first question: Social anxiety disorder is strongly based on unrealistic expectations about other people's faultfinding interest in your performance of even trivial tasks like pouring out a cup of coffee ("do they see that my hand is shaking? What will they think of me when they see my hand is shaking? etc.). It testifies of a strong uncertainty about oneself, probably fostered by a learning history with much criticism and rejection by one's parents or one's peer group. In public speaking the expectations of a critical audience and of the impact of making mistakes are much more realistic. And the risk of making mistakes is much greater, just because one's performance is under pressure. The task is not trivial and it needs much training to become skilled in it.
Whether there is a physiological difference between the reactions of a social phobic and a person who fears public speaking seems to me of subordinate interest.
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