| Social phobia is characterized by an excessive fear of humiliation or embarrassment in various social or performance settings such as public speaking, going to parties, urinating in a public restroom (also called shy bladder), and speaking to a date. The individual realizes that his or her fears are excessive and unreasonable. Exposure to the feared social situation may bring on intense anxiety feelings with rapid heartbeat and breathing, sweating, and feelings of impending doom. Like panic disorder, social phobia is a common, frequently severe anxiety disorder that can cause significant work and social impairment. Even anticipation of the situation provoking fear can elicit severe distress in the affected individual. Common associated features are hypersensitivity to criticism, difficulty being assertive, or feelings of inferiority. Risk: For social phobia, the onset may be as young as age 5 and as old as 35. In epidemiological studies, females are more often affected than males but in clinical studies, more males are affected. The reason for this discrepancy is not known. Social phobia is more prevalent among first-degree relatives of those with this diagnosis than in the general population. Incidence and Prevalence: Studies reveal that phobias in general are common mental disorders in the US. Lifetime prevalence has a wide range, approximately 3% to 13%. In clinical studies, individuals with anxiety disorder have a 10% to 20% chance of developing social phobia (DSM-IV-TR 453). Anxiety disorder shares the same prevalence rates as major depressive disorder. A US national comorbidity survey identified social phobia as the third most common psychiatric disorder in the US. Prevalence of social phobia is estimated at 7% and has also been noted that prevalence of social phobia appears to be increasing among white, married, and well-educated individuals; internationally, the lifetime incidence of social phobia is estimated at 7% to 12% (Chang). |
Source: Medical Disability Advisor
| History: A diagnosis of social phobia excludes conditions where the individual avoids social situations due to embarrassment about another psychiatric condition or a medical condition (e.g., individual is severely handicapped or disfigured from trauma or is morbidly obese).
The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision) criteria for social phobia include a marked and persistent fear of one or more social or performance situations where individual is exposed to unfamiliar people or possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that is humiliating or embarrassing but also recognizes that the fear is excessive or unreasonable. Exposure to the feared social situation almost invariably provokes anxiety that may take the form of a panic attack.
The feared social or performance situations are either avoided or endured with intense anxiety or distress. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the individual's normal routine, occupational or academic functioning, or social activities or relationships. Individual may also exhibit marked distress about having the phobia. The fear or avoidance is not due to the direct physiological effects of a substance (drug of abuse or medication) or a general medical condition. It is not better accounted for by another mental disorder such as panic disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, a pervasive developmental disorder, or schizoid personality disorder. If a general medical condition or another mental disorder is present such as stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior as in anorexia nervosa or bulimia nervosa, the fear associated with social phobia is unrelated to it. The symptom duration if the patient is under the age of 18 is over 6 months (DSM-IV-TR 456). Physical exam: An exam is generally not helpful in diagnosing social phobia. The individual may exhibit increased heart rate or blood pressure if he or she is experiencing anxiety or distress during the interview. Tests: Tests include laboratory evaluation to rule out organic causes of anxiety such as thyroid and adrenal gland abnormalities. Psychological testing may be helpful in the evaluation of this disorder and could help differentiate a social phobia from avoidant personality disorder. |
Source: Medical Disability Advisor
| In the case of social phobia, it is often impossible or not feasible to avoid the situation causing the anxiety. The primary treatment for social phobia is cognitive behavior therapy. This type of psychotherapy typically takes the form of repeated exposure to the situation that triggers the phobic response, and the individual is taught techniques specific to the situation to reduce the anxiety. Hypnosis, supportive therapy (group therapy), and family therapy may also be useful.
Cognitive therapy may incorporates a variety of behavioral and cognitive methods, most of which involve gradually exposing the individual to the dreaded situation (in reality, imaginarily, or virtually through computerized simulation). For example, interceptive exposure involves progressively guiding the individual through structured experiences that reproduce the feared physical sensations such as increased heart rate, dizziness, or sweating. Similarly, in vivo exposure gradually confronts individuals with small, manageable components of the feared activity. Relaxation training, progressive muscle relaxation, and respiratory control training may be helpful. Many therapists include homework and specific readings (bibliotherapy) for the individual to do between sessions. Since the individual may only spend a few sessions in one-on-one contact with a therapist, this method allows individuals to continue to work on their own with the aid of a printed manual.
Psychodynamic treatment refers to another "talk therapy" where the therapist and individual work together to uncover underlying emotional conflicts. Although this type of therapy may help relieve the stress that contributes to panic attacks, no scientific evidence exists that show this form by itself is effective in overcoming panic disorder or agoraphobia. However, if a phobic disorder occurs along with another emotional disturbance, psychodynamic therapy may be a helpful addition to the overall treatment plan.
Pharmacotherapy for social phobia involving performance anxiety such as stage fright and shy bladder involves the use of antiadrenergic and beta-adrenergic medications. For the generalized type of social phobia, anti-anxiety agents may be useful. Various studies show that selective serotonin reuptake inhibitors (SSRIs) and a benzodiazepine are helpful. |
Source: Medical Disability Advisor
| Only recently has social phobia been recognized as an important mental disorder. Available studies for the course and outcome of this disorder are limited. Duration may be life-long but symptoms can decrease at times especially with treatment. |
Source: Medical Disability Advisor
| The distress associated with social phobia can lead to further psychological complications including other anxiety disorders, major depressive disorder, and substance-related disorders. Individuals may self-medicate with marijuana, alcohol, and other mood-altering substances. This complicates the course and prognosis of the disorder. Personality disorders are associated with social phobia and are also a complicating factor. Often, the exposure to or anticipation of the phobic situation leads to panic attacks. Avoidance of feared social situations can lead to severe impairment in school, work, and relationships. |
Source: Medical Disability Advisor
| High profile positions with frequent contact on a one-to-one basis will be uncomfortable and may be intolerable for the socially phobic employee. A work environment involving a small group of individuals rather than a large one will be more comfortable for the individual with this disorder. Contact with a large or an unfamiliar group of individuals should be limited. A determination of the phobic situation or object and avoidance of that situation should enable the individual to maintain employment.
Time-limited restrictions and work accommodations should be individually determined based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of the restrictions/accommodations is to help maintain the worker's capacity to remain at the workplace without a work disruption or to promote timely and safe transition back to full work productivity. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Do individual's expressed fears meet the criteria for social phobia?
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Has diagnosis been confirmed?
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Has objective psychological testing been conducted?
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Is normal functioning significantly impaired?
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What is happening in individual's life that may be triggering or compounding the phobia?
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Have other conditions with similar symptoms been ruled out?
Regarding treatment:
- If not already on medication, would drug therapy be beneficial to this treatment plan?
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If individual is not responding effectively to current medication, what other drug treatment options are available?
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Through cognitive-behavioral therapy, is individual learning to recognize the earliest thoughts and feelings in the panic cycle, eliminate thought patterns that contribute to symptoms, and change his or her behavior?
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Is individual being taught to cope effectively with symptoms he or she experiences during a panic attack?
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If individual has been avoiding particular places or situations, would the addition of interceptive or invivo exposure be beneficial?
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Is individual involved in a therapy program that includes relaxation techniques? By learning to relax, is individual able to reduce the anxiety and stress leading to panic attacks?
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Is individual currently involved in a therapy group?
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Would individual also benefit from psychodynamic treatment, in which therapist and individual work together to uncover underlying emotional conflicts?
Regarding prognosis:
- How long has individual been involved in cognitive-behavioral therapy?
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Would individual benefit from extended therapy?
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Has individual been involved in current form of treatment for over 6 weeks without a noticeable effect? Has treatment plan been reassessed? What direction will new treatment plan take?
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Since successful treatment of social phobia requires diagnosis and treatment of coexisting conditions, such as substance abuse (both intoxication and withdrawal states) and depression, are these conditions being appropriately addressed?
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Source: Medical Disability Advisor
| Chang, Kiki D. "Social Phobia." eMedicine. Eds. Mohammed Memon, et al. 15 Aug. 2004. Medscape. 29 Dec. 2004 <http://emedicine.com/med/topic3121.htm>.Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000. |
Source: Medical Disability Advisor
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