PCN 605 Grand Canyon University Anxiety Disorder Treatment Essay: Social Science Answers 2021
PCN 605 Grand Canyon University Anxiety Disorder Treatment Essay
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1. Read Chapter 11 in DSM-5 in Action. Read pages 507-521 in DSM-5 in Action.
Dziegielewski, S. F. (2014). DSM-5 in action (3rd ed.). John Wiley & Sons.
2. Read pages 31-86 and 156-160 in the DSM-5.
Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). (2013). American
3. Read “Erikson’s General and Adult Developmental Revisions of Freudian Thought: ‘Outward,
Forward, Upward,'” by Hoare, from the Journal of Adult Development (2005).
4. Read “The Past Achievements and Future Promises of Developmental Psychopathology: The
Coming of Age of a Discipline”, by Cicchetti & Toth, from the Journal of Child Psychology &
5. Review the “Child and Adolescent Mental Health” section of the National Institute of Mental
6. Read “Responding to the Crisis in Children’s Mental Health: Potential Roles for the Counseling
Profession” by Mellin, E. A. from the Journal of Counseling & Development, (2009).
7. Read “The Concept of Development in Developmental Psychopathology” by Sroufe, from Child
8. Read ” A Developmental Psychopathology Perspective on Adolescence” by Cicchetti & Rogosch,
from Journal of Consulting and Clinical Psychology (2002).
9. Read “Annual Research Review: Current Limitations and Future Directions in MRI Studies of
Child- and Adult-Onset Developmental Psychopathologies” by Horga, Kaur, & Peterson, from
Journal of Child Psychology & Psychiatry (2014).
10. Read “Focusing on the Positive: A Review of the Role of Child Positive Affect in Developmental
Psychopathology,” by Davis, & Suveg, from Clinical Child and Family Psychology Review (2014).
11. Read “Developmental Level and Psychopathology: Comparing Children With Developmental
Delays to Chronological and Mental Age Matched Controls” by Caplan, Neece, & Baker, from
Research in Developmental Disabilities (2015). https://www-sciencedirectcom.lopes.idm.oclc.org/science/article/pii/S0891422214004594?via%3Dihub
12. Read “Can Psychopathology at Age 7 Be Predicted from Clinical Observation at One Year?
Evidence from the ALSPAC Cohort” by Allely, Doolin, Gillberg Gillberg, Puckering, Smillie, &
Wilson, from Research in Developmental Disabilities (2012). https://www-sciencedirectcom.lopes.idm.oclc.org/science/article/pii/S089142221200176X?via%3Dihub
13. Read the “Developmental Milestones” section of the Centers for Disease Control and Prevention
14. Read “Interdisciplinary Critical Inquiry: Teaching About the Social Construction of Madness” by
Connor-Greene, from Teaching of Psychology (2006).
15. Read “Biological Conceptualizations of Mental Disorders Among Affected Individuals: A Review
of Correlates and Consequences” by Lebowitz, from Clinical Psychology: Science and Practice
16. Read “Diagnosis – The Limiting Focus of Taxonomy,” by Sturmberg and Martin, from Journal of
Evaluation in Clinical Practice (2016).
Journal of Anxiety Disorders 30 (2015) 8–15
Contents lists available at ScienceDirect
Journal of Anxiety Disorders
Beyond DSM-5: An alternative approach to assessing Social Anxiety
Sonja Skocic ∗ , Henry Jackson, Carol Hulbert ∗
Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
a r t i c l e
i n f o
Received 5 March 2014
Received in revised form
25 November 2014
Accepted 8 December 2014
Available online 25 December 2014
Social Anxiety Disorder
a b s t r a c t
This article focuses on the Diagnostic and Statistical Manual of Mental Disorders (DSM) classiﬁcation
of Social Anxiety Disorder (SAD). The article details the diagnostic criteria for SAD that have evolved in
the various editions and demonstrates that whilst there have been some positive steps taken to more
comprehensively deﬁne the disorder, further revision is necessary. It will be argued that the DSM-5 (APA,
2013) has made some changes to the diagnostic criteria of SAD that do not seem to be completely in line
with theory and research and do not describe SAD effectively in terms of both diversity and presentation.
This article concludes with the presentation of a proposed set of diagnostic criteria that address the
concerns raised in the article. The proposed criteria reﬂect a hybrid categorical–dimensional system of
© 2014 Elsevier Ltd. All rights reserved.
1. Beyond DSM-5: an alternative approach to assessing
Social Anxiety Disorder
2. History of Social Anxiety Disorder in the DSM
2.1. DSM III to DSM-IV-TR
The latest edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5; American Psychiatric Association [APA],
2013) has recently been released. There are several notable changes
to the diagnostic criteria for several disorders but this article details
the diagnostic criteria for Social Anxiety Disorder (SAD) that have
evolved over the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM); namely DSM-III (APA,
1980), DSM-III-R (APA, 1987), DSM-IV (APA, 1994), DSM-IV-TR
(APA, 2000) and DSM-5 (APA, 2013). We argue that despite the
efforts taken to improve the diagnostic criteria for SAD, there exist
several deﬁciencies in the latest approach to DSM from clinical,
research and theoretical perspectives.
In order to contextualise our arguments, we begin by examining the historical changes in the DSM diagnostic criteria of SAD. A
critical review of the diagnostic criteria as recorded in the DSM-5 is
then presented. Next, a proposed set of diagnostic criteria for SAD
is discussed. The proposed criteria add some key features to the
existing criteria and remove others. Overall, the proposed changes
are arguably more theoretically sound and grounded in evidence.
∗ Corresponding authors at: Melbourne School of Psychological Sciences, Redmond Barry Building, University of Melbourne, Parkville, Victoria 3010, Australia.
Tel.: +61 38326 4774; fax: +61 38326 7616.
E-mail addresses: email@example.com (S. Skocic), firstname.lastname@example.org
0887-6185/© 2014 Elsevier Ltd. All rights reserved.
Social Anxiety Disorder/Social Phobia ﬁrst appeared as a diagnostic category in the DSM-III (APA, 1980). Originally, the DSM
used the term ‘Social Phobia’ to describe ‘Social Anxiety Disorder’
but DSM-IV adopted the term ‘Social Anxiety Disorder’. The terms
‘Social Phobia’ and ‘Social Anxiety Disorder’ (SAD) have been used
interchangeably in the past. There have been signiﬁcant changes to
the diagnostic criteria for SAD since this time. These changes are
First, Criterion C of the DSM-III (APA, 1980) indicated that if
the symptoms were due to another disorder (e.g., Avoidant Personality Disorder [AvPD]), a diagnosis of SAD would be excluded.
This exclusion was later supported by information gathered from
studies that indicated qualitative differences in relation to social
skills between those individuals with AvPD and those with SAD
(e.g., Turner, Beidel, Dancu, & Keys, 1986). However, the exclusion clause was removed in subsequent editions of the DSM. This
change was supported by literature indicating that there are minimal to no differences between those individuals with comorbid
AvPD and SAD compared to those individuals with SAD only (e.g.,
Herbert, Hope, & Bellack, 1992). These changes to DSM reﬂect the
considerable level of discussion and research undertaken in order to
better understand the similarities and differences of SAD and AvPD.
What continues to fuel the interest is that high levels of comorbidity
between SAD and AvPD are reported (e.g., ranges from 31% to 86%;
Grant et al., 2005; Ralevski et al., 2005; Tillfors, Furmark, Ekselius,
S. Skocic et al. / Journal of Anxiety Disorders 30 (2015) 8–15
& Fredrikson, 2004; Zimmerman, Rothschild, & Chelminski, 2005).
These results conclude that whilst there is considerable overlap or
co-morbidity between these two disorders, it is possible to have
SAD without a diagnosis of AvPD and vice versa.
Second, the articulation of where the fear is experienced
changed from fear in a situation (DSM-III; APA, 1980), to “one or
more situations” (DSM-III-R; APA, 1987, p. 243) and then to “one or
more social or performance situations” (DSM-IV; APA, 1994, p. 416;
DSM-IV-TR; APA, 2000, p. 456). It appears that these changes were
graded attempts to address the diversity that was being recorded in
the SAD population in terms of the types of feared situations. These
changes have, at least partially, addressed this type of variability,
but other types of diversity (such as the presence or absence of
broader interpersonal functional impairment, or the diverse nature
of avoidance behaviour, where some people with SAD largely avoid
the situations they fear, but others endure them with distress)
Third, the DSM-IV-TR introduced a speciﬁcation that anxiety
may be present when the individual “is exposed to unfamiliar
people” and referred to a person’s fear of “show(ing) anxiety symptoms” (APA, 2000, p. 456). This addition addressed the increasingly
reported symptom of self-consciousness, such as when people with
SAD have a great fear of blushing or shaking in public situations, or a
fear of unfamiliar people. Finally, a reference to the possibility that
the anxiety “may take the form of a situationally bound or situationally predisposed Panic Attack” was added in the DSM-IV (APA,
1994, p. 456).
The changes outlined above went some way to including symptoms that were being seen in clinical practice settings and reported
in research. However, several problems remained. The next section
critically reviews the changes to the most recent edition of the DSM
diagnostic criteria for SAD as it appears in DSM-5.
2.2. Social Anxiety Disorder in the DSM-5 (APA, 2013)
The DSM-5 diagnostic criteria for Social Anxiety Disorder (SAD)
include some minor changes (e.g., the removal of the words “act
in a way” from Criterion A in DSM-IV-TR (APA, 2000, p. 456), to
Criterion B in DSM-5). There have also been several other notable
changes to the diagnostic criteria with the publication of the DSM-5
(APA, 2013). These notable changes are outlined next.
First, Criterion A of the DSM-5 no longer refers to a “marked and
persistent fear” as it did in the DSM-IV-TR. The removal of the words
“and persistent” from Criterion A indicates that an individual with
SAD may have a marked fear of one or more social situations, but
that this fear does not necessarily persist within the social situation.
Although the DSM-5 Criterion F acknowledges the persistence of the
disorder over time (i.e., “typically lasting 6 months or more”), there
is now no longer an acknowledgement of the more proximal nature
of persistent anxiety during the social situation. Instead, the changes
to Criterion A in DSM-5 indicate that the fear may somehow come
and go over the course of the social situation or when thinking
about the social situation.
This particular change is problematic as it is inconsistent with
evidence-based cognitive models of social anxiety (e.g., Clark
& Wells, 1995; Heimberg, Brozovich, & Rapee, 2010; Rapee &
Heimberg, 1997) that indicate a number of key variables that
contribute to the persistent nature of the fear about or within
social situations. For instance, the Clark and Wells’ (1995) cognitive
model of social anxiety refers to pre- and post-event processing
that is a type of social situation-speciﬁc rumination. This rumination often leads to persistent fear in the individual leading
up to, during and after the social situation. Clark and Wells’
(1995) model also references self-focus attention bias, where the
individual focuses on their performance and anxiety symptoms,
instead of the task at hand. Such a focus often causes increased
anxiety in the social situation (McManus, Sacadura, & Clark,
2008). Rapee and Heimberg’s (1997) cognitive behavioural model
of social anxiety emphasises the presence of safety behaviours
(i.e., behaviours performed in an attempt to minimise the risk of
anxiety/embarrassment, for example, speaking softly or avoiding
eye contact). These safety behaviours are performed during the
social situation, and contribute to the persistent nature of social
anxiety both within the social situation and outside of it.
Individuals with social anxiety tend to remain self-focused in
the social situation and mistakenly believe that safety behaviours
are helpful in several ways (e.g., reducing the anxiety experienced in a social situation, improving their performance in the
social situation). However, research into this relationship is in line
with cognitive models of social anxiety. McManus et al. (2008)
conducted an experiment to directly investigate the impact of
safety behaviours and self-focus on the persistence of anxiety. The
researchers manipulated the use of safety behaviours and selffocus in short conversations and found that higher levels of anxiety
were reported in individuals who were asked to perform safety
behaviours and maintain self-focus (F(1,36) = 32.60 p >Approximate cost: $8 per page.
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