Diagnostic Features:
Social Phobia is a condition characterized by a marked and persistent fear of social or performance situations in which embarrassment may occur. Exposure to the social or performance situation almost invariably provokes an immediate anxiety response. Although adolescents and adults with this disorder recognize that their fear is excessive or unreasonable, this may not be the case in children. Most often, the social or performance situation is avoided, although it is sometimes endured with dread. In individuals younger than 18, symptoms must have persisted for at least 6 months before is disorder is diagnosed. This diagnosis should not be given if the fear is reasonable given the context of the stimuli (e.g., fear of being called on in class when unprepared). The disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. This disorder is not due to a medical condition, medication, or abused substance. It is not better accounted for by another mental disorder (e.g., Panic Disorder, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).
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-Related Disorders, and Bulimia Nervosa and usually precedes these disorders. Avoidant Personality Disorder is frequently present in individuals with 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 more frequently among first-degree biological relatives of those with the disorder compared with the general population.