204 Anxiety Disorders
ance can be extensive (e.g., not going to partie s, refusing school) or subtle (e.g., overpre-
paring the text of a speech, diverting at tention to others, limiting eye contact). 
The fear or anxiety is judged to be out of proportion to the actual risk of being nega-
tively evaluated or to the consequences of su ch negative evaluation  (Criterion E). Some-
times, the anxiety may not be judged to be excessive, because it is related to an actual
danger (e.g., being bullied or tormented by ot hers). However, individuals with social anx-
iety disorder often overestimate the negative  consequences of social situations, and thus
the judgment of being out of proportion is ma de by the clinician. The individual’s socio-
cultural context needs to be taken into account when this judgment is being made. For ex-
ample, in certain cultures, behavior that mi ght otherwise appear socially anxious may be
considered appropriate in social situations (e .g., might be seen as a sign of respect).
The duration of the disturbance is typically at least 6 months (Criterion F). This dura-
tion threshold helps distinguish the disorder from transient social fears that are com-
mon, particularly among children and in the community. However, th e duration criterion
should be used as a general guide, with allowance for some degree of flexibility. The fear,
anxiety, and avoidance must interfere significa ntly with the individual’s normal routine,
occupational or academic functioning, or social activities or relation ships, or must cause
clinically significant distress or impairment in social, occupational, or other important ar-
eas of functioning (Criterion G). For example, an individual who is afraid to speak in pub-
lic would not receive a diagnosis of social anxi ety disorder if this activity is not routinely