Rosh Psychiatry Board Practice Exam

A young woman with excessive fear of embarrassment experiences physical symptoms such as sweating in social situations. Which additional finding suggests social anxiety disorder?

1. The fear causes clinically significant distress

2. The fear is due to the presence of people

3. The fear is not better explained by another medical condition

4. The fear is of being in public places where escape may be difficult

The correct answer is: The fear is due to the presence of people

The scenario presented indicates that the young woman experiences excessive fear of embarrassment and physical symptoms like sweating in social situations, which is consistent with social anxiety disorder. The additional finding that best suggests this disorder is linked to the fear being specifically due to the presence of people. In social anxiety disorder, the fear primarily revolves around social interactions or performance situations where the individual is concerned about being scrutinized or negatively evaluated by others. This direct link to the presence of others differentiates social anxiety disorder from other types of anxiety disorders, such as agoraphobia, where the concern is more about being in situations from which escape might be difficult. While clinical distress, the exclusion of medical explanations, and the fear of public places are important components in diagnosing various anxiety disorders, the defining feature of social anxiety disorder is the fear of social situations specifically due to the scrutiny from others. Therefore, the significant fear stemming from being around people aligns directly with the core characteristics of social anxiety disorder. By establishing this connection, it reinforces the diagnosis of social anxiety disorder.