4 - The emergence of social anxiety disorder as a major medical condition  pp. 40-49

The emergence of social anxiety disorder as a major medical condition

By Michael R. Liebowitz

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Development of the modern concept of social anxiety disorder

To properly understand the current concept of social anxiety disorder, previously termed social phobia, it is necessary to recall the situation surrounding this condition in the early to mid 1980s, after the publication of DSM-III (American Psychiatric Association 1980) but before the revised version, DSM-III-R, was available (American Psychiatric Association 1987).

Background

In DSM-III, the prevailing diagnostic guide when I began my research career, social phobia was considered a subdivision of phobic disorders along with agoraphobia and the specific phobias. This classification reflected the work of investigators like Isaac Marks (Marks & Gelder 1966), whose classic studies of phobias in the 1960s and 1970s made a powerful empirical case – based on symptomatic presentation, course of illness, and family history – for reducing a laundry list of individual phobias into these three major categories. The distinct category of social phobia was found by Marks to include “fears of eating, drinking, shaking, blushing, speaking, writing, or vomiting in the presence of other people,” with the core feature being fear of appearing foolish to others, leading to marked avoidance.

Marks's original concept of social phobia was not far from our current thinking about this condition, but the very influential DSM-III classification did not adopt his concept in full.

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