|SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)||
Social Phobias F40.1 - ICD10 Description, World Health Organization
Social Anxiety Disorder (Social Phobia) - Diagnostic Criteria, American Psychiatric AssociationIn 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 TherapiesCognitive 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 TherapiesVitamins and dietary supplements are ineffective for this disorder.
ComplicationsIndividuals 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.
ComorbidityThis 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 FindingsNo laboratory test has been found to be diagnostic of this disorder.
PrevalenceCommunity-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.
CourseThis 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 PatternSocial phobia occurs two to six times more frequently among first-degree biological relatives of those with the disorder compared with the general population.
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