II. Epidemiology
-
Prevalence: very common
- Lifetime Prevalence: 13.3%
- Annual Prevalence rate: 7.9%
- Onset
- Peaks between ages 11 and 19 years old
- Rarely has onset after age 25 years
III. Symptoms: Common Social Phobia Fears
- Attending social gatherings
- Public speaking or performance
- "Small Talk"
- Small group discussion
- Asking questions in groups
- Being introduced
- Meeting or talking with strangers
- Interacting with "important" people
- Being assertive
- Performing activities in public
- Being observed performing an activity
- Indirect evaluation (Test anxiety)
- Using the telephone
- Using public restrooms
IV. Diagnostic Criteria (DSM IV)
- Marked and persistent fear of social situations
- Exposure to unfamiliar people
- Exposure to scrutiny by others
- Performance before others
- Person fears humiliation or embarrassment
- Fear unrelated to underlying medical condition
- Trembling in Parkinson's Disease
- Abnormal eating in Eating Disorder
- No other psychiatric condition explains symptoms
- See Differential Diagnosis below
- Exposure to feared social situation results in anxiety
- Panic Attack may occur
- Person has insight into fear as unreasonable, excessive
- Person avoids feared social or performance situations
- Impaired function or distress related to Social Phobia
- Interferes with normal daily routine
- Interferes with occupational or academic functioning
- Interferes with social activities or relationships
- Special criteria modifications in children
- Anxiety related to peer setting
- Anxiety expressed by crying, tantrums, or withdrawal
- Child may not have insight into unreasonable fear
- Duration persists >6 months in age under 18 years
V. Differential Diagnosis
- Avoidant Personality Disorder
- Schizoid Personality Disorder
- Panic Disorder
- Separation Anxiety Disorder
- Body Dysmorphic Disorder
- Developmental Disorder
- Substance Abuse
VI. Management: Cognitive-Behavioral Therapy
- Background
- Offered as 16 to 24 weekly sessions
- Group therapy preferred over individual counseling
- Total Cost: $750 to $2000 (Insurance covers 50-80%)
-
Anxiety Management skills
- See Relaxation Training (e.g. Progressive Relaxation)
- Relaxation and calming techniques
- Social skills training
- Initiating and maintaining conversation
- Making appropriate eye contact
- Appropriate self-assertion
- Cognitive restructuring
- Change fearful thinking about social situations
- Gradual exposure to feared situations
- Gradual challenges into feared social situations
VII. Management: Medications
- SSRI (50-75% efficacy)
- MAO inhibitors (66% efficacy)
-
Benzodiazepine (40-80% efficacy)
- Clonazepam (Klonopin) 0.25 to 0.5 mg PO bid
-
Beta Blocker (for Performance Anxiety, 45 min before)
- Propranolol (Inderal) 20-40 mg PO prn performance
- Atenolol (Tenormin) 50 to 100 mg PO prn performance
VIII. References
- APA (1994) DSM IV, APA, p. 416-7
- Bruce (1999) Am Fam Physician 60(8): 2311-2320 [PubMed]
- Weiller (1996) Br J Psychiatry 168: 169-74 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (PSY) | Apprehension or fear of social interaction or social situations in general. Compare SOCIAL PHOBIA. |
| Concepts | Mental or Behavioral Dysfunction (T048) |
| SnomedCT | 247832004 |
| Italian | Paura sociale |
| Japanese | 社会的恐怖, ｼｬｶｲﾃｷｷｮｳﾌ |
| Czech | Strach ze sociálních kontaktů |
| English | social anxiety, anxiety social, Social fear, Social fear (finding), Social Anxiety |
| Hungarian | Szociális félelem |
| Spanish | miedo social (hallazgo), miedo social, Miedo social |
| Portuguese | Medo do relacionamento social |
| Dutch | sociale angst |
| French | Crainte sociale |
| German | soziale Angst |
