Social phobia

What is Social phobia?

Social phobia, also called social anxiety disorder, is characterized by an excessive fear of humiliation or embarrassment in various social settings, such as public speaking, urinating in a public restroom (also called shy bladder), and speaking to a date. A generalized type of social phobia is often a chronic and disabling condition that is characterized by a phobic avoidance of most social situations. This type of social phobia can be difficult to distinguish from avoidant personality disorder. Like panic disorder, social phobia is a common, frequently severe anxiety disorder that can cause significant work and social impairment.

A phobia is an irrational fear resulting in a conscious avoidance of the feared object, activity, or situation. Either the presence or the anticipation of the phobic entity elicits severe distress in the affected person who recognizes that the reaction is excessive. Nevertheless, the phobic reaction results in a disruption of the person's ability to function in life.

Studies have revealed that phobias are the single most common mental disorders in the US. For social phobia, the onset may be as young as five years of age and as old as 35 years. The peak age of onset is in the teen years. In regard to gender, females are affected more often than males in epidemiological studies, yet, in clinical studies, the reverse is found. A reason for the discrepancy is not known.

How is it diagnosed?

History: The diagnosis of social phobia is accomplished with the psychiatric interview and mental status exam. The DSM-IV excludes the diagnosis of a social phobia if the individual is avoiding social situations due to embarrassment about another psychiatric condition or a medical condition. Some examples of this would be an individual who is severely handicapped or disfigured from trauma, and someone who is morbidly obese.

The DSM-IV diagnostic criteria for social phobia include: a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.

• The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing;
• exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack;
• the person recognizes that the fear is excessive or unreasonable;
• the feared social or performance situations are avoided or else are endured with intense anxiety or distress;
• the avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia;
• in individuals under age 18 years, the duration is at least six months;
• the fear or avoidance is not due to the direct physiological effects of a substance (a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (panic disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, a pervasive developmental disorder, or schizoid personality disorder);
• if a general medical condition or another mental disorder is present, the fear in associated with social phobia is unrelated to it, that is, the fear is not of stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in anorexia nervosa or bulimia nervosa.

Physical exam is generally not helpful in diagnosing social phobia.

Tests include laboratory evaluation to rule out organic causes of anxiety, i. e. thyroid and adrenal gland abnormalities. Psychological testing may be helpful in the evaluation of this disorder and could help differentiate a social phobia from avoidant personality disorder.

How is Social phobia treated?

Treatment in its simplest form is the avoidance of the phobic situation. However, in the case of social phobia, it is often times impossible or not feasible to avoid the situation that causes the anxiety. Psychotherapy involves the use of insight-oriented therapy that enables the individual to seek healthy ways of dealing with the anxiety-provoking stimulus. Hypnosis, supportive (group therapy), and family therapy may be useful in the treatment of phobias in general.

The treatment for social phobia usually incorporates behavioral and cognitive methods. It has been reported that psychotherapy and pharmacotherapy used in combination have the best results compared to using either therapy alone. Pharmacotherapy for social phobia involving performance such as, stage fright and shy bladder involves the use of antiadrenergic and beta-adrenergic.

For the generalized type of social phobia, antianxiety agents may be useful. Various studies have shown serotonin-specific reuptake inhibitors (SSRIs) and benzodiazepine to be helpful.

Medications

Information	Brand	Generic	Label	Rating
	Neurontin	Gabapentin
	Effexor	Venlafaxine
	Paxil	Paroxetine
	Zoloft	Sertraline

Celexa (Citalopram), Prozac (Fluoxetine), BuSpar (Buspirone), Klonopin (Clonazepam), Xanax (Alprazolam), Ativan (Lorazepam)

What might complicate it?

AThe distress associated with social phobia can lead to further psychiatric complications, including other anxiety disorders, major depressive disorder, and substance-related disorders. Individuals may self-medicate with marijuana, alcohol, and other mood altering substances. This complicates the course and prognosis of the disorder. Associated major depression and other anxiety disorders cause complications. Personality disorders are associated with social phobia and are a complicating factor of course, prognosis, and treatment of social phobia. Often, the exposure to or anticipation of the phobic situation leads to panic attacks.

Predicted outcome

Only recently has social phobia been recognized as an important mental disorder. Available studies for the course and outcome of this disorder are limited.

Alternatives

It is important to differentiate social phobia from individuals who are normally shy and who have appropriate fears about certain social situations. The DSM-IV requires these symptoms must impair the individual's ability to function appropriately for a diagnosis of social phobia. Schizophrenics may exhibit social phobia and can be differentiated by the presence or absence of psychotic symptoms (delusions, hallucinations), and thought disorder. Individuals with social phobia will have some insight into their fears, often recognizing their phobia is irrational. Panic disorder with or without agoraphobia involves many of the same physiologic symptoms experienced by individuals with social phobia. These might include sweating, palpitation shortness of breath, and a fast pulse or pounding heart.

Appropriate specialists

Psychologist, psychiatrist, and licensed certified social worker.

Last updated 20 December 2011