3- Adolescent Social Anxiety Disorder

Case 3 - Clinical History: (pp. 32-35)

Key Answer: B. Social Anxiety Disorder, with panic attacks

Explanation: Bonnie’s panic attacks occur only in social situations where she fears negative evaluation. This rules out panic disorder (which requires unexpected attacks). Agoraphobia is not appropriate since avoidance is not about escape safety. MDD is present but secondary.

Which of the following best fits Bonnie’s primary DSM-5 diagnosis?

A. Panic Disorder
B. Social Anxiety Disorder, with panic attacks
C. Agoraphobia
D. Major Depressive Disorder, recurrent

Key Answer: B. Triggered by feared social situations and negative evaluation

Explanation: In her case, panic attacks occur only in performance/evaluation situations (e.g., answering phone, eating in public, meeting new people), consistent with SAD with panic attacks.

Bonnie’s panic attacks are best understood as:

A. Random and unexpected episodes typical of panic disorder
B. Triggered by feared social situations and negative evaluation
C. A response to physical illness
D. Symptoms of psychotic disorder

Key Answer: B. The transition to high school and breakup with her boyfriend

Explanation: According to the 4Ps, precipitating factors are recent triggers. For Bonnie, these were entering high school (new environment, demands) and a breakup that intensified withdrawal and depressive symptoms.

Which of the following is a precipitating factor in Bonnie’s increased social anxiety?

A. Her supportive parents
B. The transition to high school and breakup with her boyfriend
C. Her good flute-playing ability
D. Lack of family history of anxiety

Key Answer: B. Single episode, now in partial remission

Explanation: Bonnie had a 2-month depressive period after her breakup but reported improvement by evaluation. Hence, DSM-5: MDD, single episode, in partial remission.

Which is the most accurate description of Bonnie’s depressive episode?

A. Chronic and ongoing with no remission
B. Single episode, now in partial remission
C. Bipolar disorder
D. Major depressive disorder, recurrent severe

Key Answer: A. Strong family support and presence of close friends

Explanation: The 4Ps framework emphasizes protective factors. Bonnie’s supportive parents, her small group of close friends, and intact academic performance are all protective.

Which of the following is a protective factor for Bonnie?

A. Strong family support and presence of close friends
B. School transition stress
C. Panic attacks in social situations
D. Avoidance of school activities

Key Answer: A. Her parents pushing her to socialize, increasing avoidance

Explanation: Perpetuating factors are those that maintain symptoms. In Bonnie’s case, parental pressure worsened avoidance, reinforcing her cycle of social anxiety.

Which of the following represents a perpetuating factor in Bonnie’s difficulties?

A. Her parents pushing her to socialize, increasing avoidance
B. Breakup with her boyfriend
C. Transition to high school
D. Lack of family history of anxiety

Key Answer: C. Fear of negative evaluation

Explanation: DSM-5 emphasizes negative evaluation as the core cognitive feature of SAD.

Bonnie’s fear of being judged, her avoidance of parties, and her refusal to answer the phone are most consistent with which SAD feature?

A. Fear of separation from parents
B. Fear of physical harm
C. Fear of negative evaluation
D. Fear of contamination

• 300.23 Social anxiety disorder, with panic attacks

• 296.25 Major depressive disorder, single episode, in partial remission

DSM-5 Diagnosis

On the basis of the information collected from the interviews with her and her parents, Bonnie was assigned the following DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) diagnosis:

Key Answer: C. Longstanding shyness and tendency to worry about evaluation

Explanation: In the 4Ps model, predisposing factors are long-term vulnerabilities. Bonnie had always been shy and concerned about what others thought, which made her vulnerable to SAD.

Which of the following is a predisposing factor for Bonnie’s social anxiety?

A. Her breakup with her boyfriend
B. Entering high school
C. Longstanding shyness and tendency to worry about evaluation
D. Panic attacks during social situations

Key Answer: B. Her fears extend beyond performance situations to many everyday social interactions

Explanation: “Performance-only” SAD applies only when the fear is restricted to speaking/performing in public. Bonnie fears eating in public, meeting new people, talking to teachers, and answering the phone—so the specifier does not apply.

Why is the DSM-5 specifier “performance-only” not applied in Bonnie’s case?

A. She is not afraid of performing at all
B. Her fears extend beyond performance situations to many everyday social interactions
C. She does not have panic attacks in public
D. She does not meet DSM-5 criteria for SAD

Key Answer: B. Bonnie’s avoidance is driven by fear of negative evaluation, not fear of being unable to escape or get help

Explanation: In SAD, the focus is fear of embarrassment or negative judgment. In Agoraphobia, the focus is fear of being trapped, helpless, or unable to escape. Bonnie clearly fits SAD.

Which of the following best differentiates Social Anxiety Disorder from Agoraphobia in Bonnie’s case?

A. Bonnie avoids public places because she fears physical harm
B. Bonnie’s avoidance is driven by fear of negative evaluation, not fear of being unable to escape or get help
C. Bonnie’s panic attacks occur in all settings, including when she is alone at home
D. Bonnie has a family history of anxiety disorders