Internet Mental Health
 
SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)
 



Social Anxiety = Social Phobia

Prediction: Lasts For Decades

      Occupational-Economic:
  • Academic or occupational impairment (due to fear of public speaking)
      Social:
  • Detachment (if severe and prolonged, develops into avoidant personality disorder)
  • Negative emotion (social anxiety, panic attacks if forced to do public speaking)
      Medical:
  • Under stress has blushing, hand tremor, nausea, or urgency of micturition

SYNOPSIS

Social Phobias F40.1 - ICD10 Description, World Health Organization

Fear of scrutiny by other people leading to avoidance of social situations. More pervasive social phobias are usually associated with low self-esteem and fear of criticism. They may present as a complaint of blushing, hand tremor, nausea, or urgency of micturition, the patient sometimes being convinced that one of these secondary manifestations of their anxiety is the primary problem. Symptoms may progress to panic attacks.
Social Anxiety Disorder (Social Phobia) - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with social anxiety disorder (social phobia) needs to meet all of the following criteria:

  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

  • The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

  • The social situations almost always provoke fear or anxiety. Note: In children, the fear or anxiety may be experienced by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

  • The social situations are avoided or endured with intense fear or anxiety.

  • The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

  • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

  • The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functiioning.

  • The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

  • The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

  • If another medical condition (e.g., Parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clarly unrelated or is excessive.
In this anxiety disorder, the individual has a marked and persistent fear of situations in which the individual is exposed to unfamiliar people or to possible scrutiny by others. The individual fears being humiliated or embarrassed, which leads to avoidance of social situations. The individual recognizes that this fear is excessive or unreasonable. The feared social or performance situations are avoided or else are endured with intense anxiety or distress. Social phobia is usually associated with low self-esteem and fear of criticism. This disorder may present with complaints of blushing, hand tremor, nausea, or urgency of micturition. Symptoms may progress to panic attacks. Social phobia and avoidant personality disorder have similar symptoms, genetics, and treatment response. Thus avoidant personality disorder is merely a more severe form of social phobia. Often individuals with this disorder may develop substance abuse or depression.

Effective Therapies

Cognitive behavioral therapy (CBT), SSRI and SNRI antidepressant medication have all proven to be effective in the treatment of this disorder. Often a combination of CBT plus antidepressant medication is used.

Ineffective Therapies

Vitamins and dietary supplements are ineffective for this disorder.

Typical Fears

  • Social Interactions Scare The Individual:
    • Parties and social events
    • Talking to strangers
    • Talking to people in authority
    • Being criticized
    • Having heart palpitations when around people
  • Is Embarrassed By:
    • Blushing in front of people
    • Sweating in front of people
    • Doing things when people might be watching
    • Trembling or shaking in front of others
  • Fears Performing In Front Of Others:
    • Avoids being the centre of attention
    • Avoids giving speeches
    • Fears being embarrassed or looking stupid

Core Problems

  • Social and/or Occupational Impairment [ 1, 2, 3 ]
  • Phobia (Excessive Fear of Specific Social Situations) [ 4, 5 ]

Complications

Individuals with this disorder may develop hypersensitivity to criticism, negative evaluation, or rejection. They often have difficulty being assertive; and have a low self-esteem or have feelings of inferiority. They often fear indirect evaluation by others, such as taking a test. They may have poor social skills (e.g., poor eye contact) or observable signs of anxiety (e.g., cold clammy hands, tremors, shaky voice). They may underachieve at school due to test anxiety or avoidance of classroom participation. They may underachieve at work because of anxiety during, or avoidance of, speaking in groups, in public, or to authority figures and colleagues. They often have few friends and are less likely to marry. In more severe cases, individuals may drop out of school, be unemployed and not seek work due to difficulty interviewing for jobs, have no friends or cling to unfulfilling relationships, completely refrain from dating, or remain with their family or origin.

Comorbidity

This disorder may be associated with other anxiety disorders, mood disorders, substance use disorders, and bulimia nervosa and usually precedes these disorders. Avoidance personality disorder is frequently present in individuals with this disorder.

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Prevalence

Community-based studies have reported a lifetime prevalence of social phobia ranging from 3% to 13%. Most individuals with this disorder fear public speaking, whereas somewhat less than half fear speaking to strangers or meeting new people. Other performance fears (e.g., eating, drinking, or writing in public, or using a public restroom) appear to be less common. In outpatient clinics, rates of social phobia have ranged between 10% and 20% of individuals with anxiety disorders. Social phobia is rarely the reason for admission to inpatient settings.

Course

This disorder typically has an onset in the mid-teens, sometimes emerging out of a childhood history of social inhibition or shyness. However, some experience an onset in early childhood. Onset may abruptly follow a stressful or humiliating experience, or it may be insidious. This disorder frequently is lifelong, although some improve or totally recover in adulthood. The course may fluctuate with life stressors. For example, this disorder may diminish after a person with fear of dating marries and reemerge after death of a spouse.

Familial Pattern

Social phobia occurs two to six times more frequently among first-degree biological relatives of those with the disorder compared with the general population.

Description

Stories

Free Diagnosis Of This Disorder

Rating Scales

Treatment

Research

Other Web Pages

Internet Mental Health 1995-2011 Phillip W. Long, M.D.