Fast Five Quiz: Holidays and Mental Health

Stephen Soreff, MD

Disclosures

December 14, 2020

Social phobia, also called social anxiety disorder, involves intense distress in response to public situations. Individuals with social phobia typically experience symptoms resembling panic during a social encounter. These situations may include speaking in public, using public restrooms, eating with other people, or engaging in social contact in general.

Persons with this disorder fear being humiliated or embarrassed in social and/or performance situations by their actions and may become intensely anxious, with an increased heart rate, diaphoresis, and other signs of autonomic arousal. These physical symptoms may cause additional anxiety, often leading to a conditioned fear response that reinforces their anxiety in public situations.

Auditory or visual hallucinations are not elements of social phobia, but schizophrenia or acute stress disorder may be comorbid with social phobia. Delusions — persistent false beliefs held in the face of logical proof — are not present, but preoccupation with the scrutiny of others may approach delusional levels. True fixed delusions are not consistent with social phobia and are more suggestive of schizophrenia.

The DSM-5 criteria for social phobia are:

  • Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. In children, the anxiety must occur in peer settings and not just during interactions with adults.

  • Fear of acting in a way or showing anxiety symptoms that will be negatively evaluated.

  • Recognition that one's fear is excessive or unreasonable. This feature may be absent in children.

  • Social situations almost always provoke fear or anxiety. In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

  • Social situations are avoided or endured with intense fear or anxiety.

  • The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

  • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

  • The fear, anxiety, or avoidance causes clinically significant distress or impairment in social interaction, at work, or in other important areas of functioning.

  • The fear, anxiety, or avoidance is not attributable to the physiologic effects of a substance or another medical condition.

  • The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder.

  • If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

A combination of pharmacotherapy and psychotherapy is usually indicated for persons with social phobia. Antidepressants, including SSRIs, are commonly prescribed to treat the symptoms of social phobia and generally result in remission of symptoms after 4 weeks of treatment. SSRIs are quickly becoming the standard first-line medications for social phobia.

Behavioral psychotherapies can be helpful in patients with social phobia. Gradual desensitization involves slowly exposing the patient to simulations of scenarios that typically produce anxiety. If effective, the patient is eventually able to more easily tolerate situations that usually induce anxiety.

Read more about the diagnosis of social phobia.

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