Background: This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues. Method: A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Results/Conclusions: Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a ''predominantly performance'' variety of SAD. A specifier based on ''fear of showing anxiety symptoms'' (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options. Depression and Anxiety 27:168-189, 2010. Key words: DSM-V; social anxiety disorder; social phobia; subtypes; classification; interpersonal; performance; test anxiety; selective mutism; avoidant personality disorder INTRODUCTIONThis review evaluates several issues pertaining to the diagnostic criteria for social phobia or social anxiety disorder (SAD) (Table 1), in light of empirical evidence gathered since DSM-IV. The review was guided by questions posed in the DSM-IV Sourcebook (Vol. 2), chapters titled ''Social phobia'' [1] and ''Social phobia subtypes,''[2] a review conducted as part of the DSM-V Stress Induced and Fear Circuitry Disorders Workgroup Conference, titled ''Social Phobia: Towards DSM V, '' [3] by questions posed by the DSM-V Anxiety, OC Spectrum, Posttraumatic, and Dissociative Disorder Work Group and by issues raised by consulted experts and advisors. The main issues to be addressed are the generalized specifier and its alternatives, the overlap with avoidant personality disorder, and developmental issues including the relationship that SAD shows in childhood with selective mutism (SM) and test anxiety. STATEMENT OF THE ISSUESThis review addresses the following questions, using the validators provided by the DSM-V Task Force: (1) What is the evidence/utility of the DSM-IV generalized specifier? If there is insufficient evidence/utility for a generalized specifier, what is the utility/evidence for alternative sub...

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Forty-two men and 34 women (mean age 27.5 years) who met DSM-III criteria for avoidant personality disorder were randomly assigned to 1 of 3 treatment conditions or to a waiting-list control group. Treatment Ss who participated in a 10-week group treatment program displayed significantly greater improvement on a variety of self-report and behavioral measures than did untreated control subjects. The inclusion of skills-training procedures did not contribute to the effects of graduated exposure procedures alone. The gains made during treatment were maintained over the follow-up period, but few further improvements were made. Clinical significance was evaluated by both the subjective evaluation method and the social comparison method. These procedures indicated that although significant improvements had been made, these avoidant Ss were not functioning at the level of normative comparison samples at treatment termination.

Background: Our objective was to compare personality traits between urologists and other surgeons, as well as between surgeons and non-surgeons. Methods: Eighty-six surgeons (57 faculty, 29 residents) completed the Revised NEO Personality Inventory (NEO PI-R), a validated measure of normal personality traits. Subjects agree or disagree with 240 statements to generate a score in each of the 5 major character traits: extraversion (E), openness (O), conscientiousness (C), agreeableness (A) and neuroticism (N). Each factor is subdivided into 6 component facets. Scores for urology faculty and residents were compared to the other surgical groups and 21 pediatricians. Results: The 3 groups differed significantly on extraversion (p < 0.001). Post-hoc analyses indicated that urologists obtained significantly higher extraversion scores than other surgeons (p < 0.05) and non-surgeons (p < 0.001) Other surgeons also scored significantly higher than non-surgeons on the extraversion factor (p < 0.05). No significant differences emerged on openness, conscientiousness, agreeableness or neuroticism. Of the 6 extraversion facets, urologists obtained significantly higher scores on gregariousness and excitement-seeking (p < 0.05) than non-urologist surgeons, and significantly higher scores on gregariousness (p < 0.05), activity (p < 0.01), excitement seeking (p < 0.001), and positive emotions (p < 0.05) than non-surgeons. Non-urologist surgeons obtained significantly higher scores than non-surgeons on Activity and Excitement-seeking (p < 0.01).There were no significant differences in the facets of warmth or assertiveness. Interpretation: Urologists appear to be more extraverted compared to other surgeons. Both groups of surgeons were more extraverted than non-surgeons. If these findings can be confirmed on a wider basis, the data may be helpful in resident selection, mentoring, evaluation and career counselling.