A persistent irrational fear of situations in which the person may be closely watched and judged by others, as in public speaking, eating, or using public facilities.
- The patient strongly, repeatedly fears at least one social or performance situation that involves facing strangers or being watched by others. The patient specifically fears showing anxiety symptoms or behaving in some other way that will be embarrassing or humiliating.
- The phobic stimulus almost always causes anxiety, which may be a cued or situationally predisposed panic attack.
- The patient realizes that this fear is unreasonable or out of proportion.
- The patient either avoids the situation or endures it with severe distress or anxiety.
- Either there is marked distress about having the phobia or it markedly interferes with the patient’s usual routines or social, job or personal functioning.
- Under the age of 18, and have the symptoms for 6 months or longer.
- The symptoms are not better explained by a different mental disorder, including Anxiety Disorders, Dysmorphic Disorder, Pervasive Developmental Disorder or Schizoid Personality Disorder.
- The symptoms are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
- If the patient has another mental disorder or a general medical condition, the phobia is not related to it.
Specify whether Generalized. The patient fears most social situations.
Associated Features:
- Depressed Mood.
- Somatic/Sexual Dysfunction.
- Addiction.
- Anxious/Fearful/Dependent Personality.
Differential Diagnosis:
Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.
- Panic Disorder With Agoraphobia;
- Agoraphobia Without History of Panic Disorder;
- Separation Anxiety Disorder;
- Generalized Anxiety Disorder;
- Specific Phobia;
- Pervasive Developmental Disorder;
- Schizoid Personality Disorder;
- Avoidant Personality Disorder;
- Anxiety Disorder Not Otherwise Specified;
- Performance Anxiety, Stage Fright, and Shyness.
Cause:
Social phobias are characterized by fear and avoidance of situations in which a person may be subject to the scrutiny of others. The fear may be complicated by a lack of social skills due to lack of practice or to a high level of anxiety. Everyday activities may generate anxiety, and the fears may be specific, such as using lifts, public restrooms or eating in public. The onset may occur in adolescence and be associated with parental over protectiveness or limited social opportunity. Males and females are affected equally with this disorder.
Treatment:
The goal of treatment is to help the person function effectively. The success of the treatment usually depends upon the severity of the phobia.
Counseling and Psychotherapy [ See Therapy Section ]:
Systematic desensitization is the preferred behavioral technique used to treat phobias. It based upon having the person relax, then imagine the components of the phobia, working from the least fearful to the most fearful. Gradual exposure to real life phobias has also been used with success to help people overcome their fears.
Social skills training may involve social contact in a group therapy situation to practice social skills. Role playing and modeling are techniques used to help the person gain comfort in relating to others in a social situation.
Pharmacotherapy [ See Psychopharmacology Section ] :
Antianxiety and antidepressive medications are sometimes used to help relieve the symptoms associated with phobias. Dependency on the medication is a possible side effect of this treatment.
