 |
Social Phobia
U of U Clinical Trials-- 801-585-7827
(Courtesy: University of Utah Neuropsychiatric Institute)
Essential Features
- Fear of negative evaluation in social or performance situations
- Avoidance of the feared situations
- The person recognizes the fear is excessive or unreasonable
- Significantly interferes with functioning
Common Precipitating Situations
- Speaking or eating in public
- Writing in front of others
- Meeting new people
- Talking to people in authority
- Using public lavatories
Common Symptoms
- Blushing, sweating, trembling, "mind going blank," dizziness
- Fear of vomiting or of urinary incontinence
- Negative, critical, maladaptive self-evaluation
Onset and Course
- Mean age of onset 14-16 years old
- Course is generally chronic
Epidemiology
- Is the most common anxiety disorder
- Lifetime prevalence-- about 10%
- Prevalence in primary care populations-- about 5%
Management in Primary Care
- Is the most common anxiety disorder yet is rarely diagnosed
- Sufferers often don't know they have a disorder
- Presentation is usually for a comorbid condition, such as depression or alcoholism
- Presentation may be for distressing symptoms-- sweating, trembling, blushing, dizziness, etc.
- Patients should be screened for Social Phobia when:
- The presenting problem is depression
- Symptoms involve trembling, blushing, or shaking
- Alcoholism is present
- The patient seems overly inhibited or shy
- This screening question has been shown to have 80% sensitivity and 83% specificity for Generalized Social Phobia: "When you are around other people do you often feel nervous, self-concious, or uncomfortable?"
Treatment
- Comprehensive treatment includes both psychosocial (cognitive/behavioral) and psychopharmacologic approaches
- The drug of choice for treating social phobia are SSRI's.
|
|
