Shyness and Social Anxiety
15Although there is strong evidence that some of the DSM-IV-TR disorders (for 
example, schizophrenia, Alzheimer’s disease) are associated with a biological dysfunc -
tion, the evidence is much less clear for other disorders. The problems listed in the 
DSM-IV-TR range from severe mental illnesses to disorders that most people would 
consider “bad habits.” In fact, the DSM-IV-TR even includes such problems as nicotine 
dependence and impaired sleep resulting from jet lag or shift work.
If your anxiety symptoms meet the diagnostic criteria for social anxiety disorder, 
that does not mean that you are sick, have a disease, or are mentally ill. What it does 
mean is that you are experiencing social anxiety at a level that bothers you or interferes 
with aspects of your functioning. Remember that almost everyone experiences social 
anxiety, shyness, or performance anxiety from time to time. The social anxiety experi -
enced by people with social anxiety disorder is associated with the same types of anxious 
thoughts and behaviors that most people experience. The difference is that people with 
social anxiety disorder experience social anxiety at a more intense level, more frequently, 
and often in a wider range of situations than people without social anxiety disorder. 
Fortunately, social anxiety disorder responds extremely well to the types of treatment 
discussed throughout this book.
Diagnostic Criteria for Social Anxiety Disorder
A diagnosis of social anxiety disorder requires that a person have an intense and 
persistent fear of one or more social or performance situations. Typically, the fear is 
related to anxiety over being scrutinized by others or doing something embarrassing or 
humiliating. In addition, the fear must bother the individual or cause signiﬁcant interfer -
ence in his or her life. In other words, a person would not receive a diagnosis of social