Social Anxiety Disorder (Social Phobia)
This patient meets diagnostic criteria for Social Anxiety Disorder, characterized by persistent fear of humiliation and negative evaluation in social situations, strong need for acceptance and positive perception by others, feelings of being unvalued when social contact is limited, perfectionistic traits, and documented improvement with cognitive restructuring—all hallmark features of this condition. 1
Core Diagnostic Features Present
The patient's presentation aligns precisely with the defining characteristics of Social Anxiety Disorder:
Marked and persistent fear of social or performance situations where he may be negatively evaluated, specifically fearing humiliation or embarrassment at work and in social contexts 1, 2
Strong need to be perceived as intelligent and competent by others, with anxiety increasing when he believes others judge him negatively—this reflects the core fear of negative evaluation that defines Social Anxiety Disorder 1, 3
Feelings of being "not valued" or believing "people don't want to see me" when social interactions are limited, demonstrating the excessive concern about social acceptance characteristic of this disorder 4, 5
Perfectionistic personality traits, which commonly co-occur with Social Anxiety Disorder and reflect the heightened self-scrutiny and fear of making mistakes in social situations 6
Evidence of Clinical Improvement
The patient demonstrates response to cognitive-behavioral interventions, which is the gold-standard treatment for Social Anxiety Disorder:
Improvement in challenging negative thoughts about social evaluation 2, 3
Increased openness with friends and improved confidence in friend groups, indicating reduced avoidance behaviors 5
Reduced rumination when negative thoughts arise, showing development of adaptive coping strategies 2
These improvements are consistent with successful cognitive-behavioral therapy for Social Anxiety Disorder, which specifically targets maladaptive thought patterns about social evaluation 2, 3, 5
Epidemiology Supporting This Diagnosis
Social Anxiety Disorder affects 7% of primary care patients and has a lifetime prevalence of 10-15%, making it the most common anxiety disorder 1, 3
The disorder typically begins during adolescence and early adulthood, consistent with this patient's presentation 1, 3
It is often chronic and disabling when untreated, but responds well to cognitive-behavioral therapy and SSRIs 2, 3, 4
Differential Considerations (Less Likely)
Generalized Anxiety Disorder would present with chronic, pervasive worry across multiple life domains rather than anxiety specifically focused on social evaluation and judgment by others 1
Avoidant Personality Disorder shares features with Social Anxiety Disorder but involves more pervasive patterns of social inhibition, feelings of inadequacy, and hypersensitivity to criticism across all contexts—not just performance situations 1
Body Dysmorphic Disorder could be considered if the patient had fixed preoccupations about perceived physical defects, but his concerns center on behavioral performance and social judgment rather than appearance 1
Cultural Considerations
The patient's fear of negative evaluation and need for acceptance aligns with both Western presentations of Social Anxiety Disorder and the "allocentric" concerns described in Asian cultures (Taijin Kyofusho), where fear of offending or disappointing others is prominent 1
Approximately 75% of individuals with Social Anxiety Disorder across U.S. and South Korean samples report concerns about offending others, indicating this is a universal feature rather than culturally specific 6
Clinical Validation
The Mini-SPIN screening tool (3-item Social Phobia Inventory) is 89% sensitive and 90% specific for detecting Social Anxiety Disorder in primary care settings, with a cutoff of 6 points or more 1
The patient's documented improvement with cognitive restructuring provides additional diagnostic confirmation, as cognitive-behavioral therapy is specifically efficacious for Social Anxiety Disorder and would not be expected to produce such targeted improvement in other anxiety disorders 2, 3, 5
Treatment Implications
The patient's positive response to cognitive interventions suggests he is already engaged in evidence-based treatment. Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy if symptoms persist or worsen, with combination therapy (medication plus CBT) showing the best outcomes 2, 3, 4, 5
Treatment should continue for at least 3 months to one year to prevent relapse, even with symptom improvement 3