Social phobia is an anxiety disorder in which patients have an intense fear of being scrutinized in social or public situations (e.g., giving a speech, speaking in class). The disorder may be generalized or limited to specific situations.

Epidemiology

Social phobias occur equally among men and women and affect 3% to 5% of the population. The typical onset is in adolescence, with most cases occurring before age 25.

Etiology

Phobic disorders, including social phobia, tend to run in families. Behavioral theorists argue that phobias are learned by being paired with traumatic events.

Some theorists posit that hypersensitivity to rejection is a psychological antecedent of social phobia.

Clinical Manifestations

History and Mental Status Examination
Social phobias are characterized by the fear of situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. Exposure to the feared social situation must almost invariably provoke an anxiety reaction. Avoidance of or distress over the feared situation must impair everyday activities or relationships. For those younger than age 18, symptoms must persist for at least 6 months. Social phobia can either be generalized (the patient fears nearly all situations) or limited to specific situations.

Differential Diagnosis
The principal differential diagnosis is another mental disorder (such as avoidance of school in separation anxiety disorder) presenting with anxiety or fearfulness.

Management

Mild cases of social phobia can be treated with CBT, but many cases require medication. MAOls, beta- blockers, SSRls, alprazolam, and gabapentin have proven successful in treating social phobia. CBT uses the exposure therapy techniques of flooding and systematic desensitization to reduce anxiety in feared situations. Supportive individual and group psychotherapy is helpful to restore self-esteem and to encourage venturing into feared situations.