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.
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.
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.
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.
