A 16-year-old girl refuses to attend school, avoids eating in the cafeteria, and will not participate in class presentations due to intense fear of embarrassment and negative evaluation by peers. She feels physically ill before any social event. These symptoms have been present for over a year and are significantly impairing her academics and friendships. She has no mood disorder or psychosis. What is the most likely diagnosis?
- A Separation anxiety disorder
- B Specific phobia, situational type
- C Social anxiety disorder (social phobia) ✓
- D Agoraphobia
Correct answer: C. Social anxiety disorder (social phobia)
Explanation
Social anxiety disorder is characterized by marked, persistent fear or anxiety about social situations involving possible scrutiny or negative evaluation by others, leading to avoidance or endurance with intense distress. The fear is of acting in a way that will be humiliating or embarrassing, which distinguishes it from agoraphobia (fear of being unable to escape or get help). When symptoms are limited specifically to performance contexts, a 'performance only' specifier is applied. Duration of at least 6 months and functional impairment are required for diagnosis.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.