Are You Suffering with Social Phobia???

Diagnostic Criteria for Social Phobia

A marked and persistent fear of social or performance situations in which the person is exposed to unfamiliar people or to scrutiny by others. The individual often fears that he will act in a way that will be humiliating or embarrassing.

Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a panic attack.

The person recognizes that the fear is excessive or unreasonable.

The feared situations are avoided or endured with intense distress.

The avoidance, anxious anticipation, or distress in the feared situations interferes with normal functioning or causes marked distress.

The duration of symptoms is at least six months.

The fear is caused by a substance or medical condition, and is not caused by another disorder.

If a medical condition or another mental disorder is present, the fear is unrelated (eg, the fear is not of trembling in a patient with Parkinson’s disease).

Specify if the fear is generalized: The fear is generalized if the patient fears most social situations.

Clinical Features of Social Phobia

Patients often display hypersensitivity to criticism, difficulty being assertive, low self esteem, and inadequate social skills.

Avoidance of speaking in front of groups may lead to work or school difficulties. Most patients fear public speaking, while less than half fear meeting new people.

Less common fears include fear of eating, drinking, or writing in public, or of using a public restroom.

Epidemiology and Etiology of Social Phobia

Lifetime prevalence is 3-13%.

Social phobia is more frequent in first degree relatives of patients with the disorder.

Onset usually occurs in adolescence, with a childhood history of shyness.

Social phobia is often a lifelong problem, but the disorder may remit or improve in adulthood.

Differential Diagnosis of Social Phobia

Substance-Induced Anxiety Disorder: Substances such as caffeine, amphetamines, cocaine, alcohol or benzodiazepines may cause a withdrawal syndrome that can mimic symptoms of social phobia.

Obsessive Compulsive Disorder, Specific Phobia, Hypochondriasis, or Anorexia Nervosa: Anxiety symptoms are common to many psychiatric disorders such as depression and the anxiety disorders. The diagnosis of social phobia should be made only if the anxiety is unrelated to another disorder. For example, social phobia should not be diagnosed in panic disorder if the patient has social restriction and excessive anxiety about having an attack.

Anxiety Disorder Due to a General Medical Condition: Hyperthyroidism and other medical conditions may produce significant anxiety, and should be ruled out. (See page .)

Mood and Psychotic Disorders: Excessive social worry and anxiety can occur in many mood and psychotic disorders. If anxiety occurs only during the course of the mood or psychotic disorder, then social phobia should not be diagnosed.

Treatment of Social Phobia: Social phobia with performance anxiety responds well to beta blockers, such as propranolol. The effective dosage can be very low, such as 10-20 mg qid. It may also be used on a prn basis; 20-40 mg given 30-60 minutes prior to the anxiety provoking event.

Benzodiazepines, such as clonazepam ( Klonopin) 0.5 - 2 mg per day and selective serotonin reuptake inhibitors such as paroxetine ( Paxil) 20 mg per day or sertraline ( Zoloft) 50 mg per day are also effective.

Cognitive/behavioral therapies are effective, and should focus on cognitive retraining, desensitization, and relaxation techniques. Combined pharmacotherapy and cognitive or behavioral therapies is the most effective treatment.

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