Social Anxiety Disorder: An Integrative Review
Abstract
Social anxiety disorder (SAD) is a persistent and impairing condition characterized by fear of negative evaluation, social avoidance, and distress in situations involving scrutiny. This integrative review examines the diagnostic features, etiology, course, assessment, and treatment of SAD across cognitivebehavioral, neurobiological, developmental, psychoanalytic, and existential erspectives. Current research indicates that attentional and interpretation biases, negative autobiographical memory, self-focused attention, and avoidance interact to reinforce symptoms over time. Neurobiological differences and developmental risk factors further contribute to the onset and persistence of the disorder. Psychoanalytic and existential perspectives expand this understanding by emphasizing internalized criticism, self-consciousness, and the meaning individuals assign to being evaluated by others. Although cognitive behavioral therapy, acceptance-based interventions, medication, and attention-based approaches can reduce symptoms, some individuals continue to experience negative self-perceptions and residual anxiety. These findings support a multilevel understanding of SAD and highlight the need for assessment and treatment approaches that address both observable symptoms and the individual’s subjective experience of the self in social situations