Social Phobia

Definitions and common symptoms of Social Phobia

According to the Diagnostic and Statistical Manual, 4th edition, of the American Psychiatric Society (DSM-IV), social phobia, or alternatively called social anxiety disorder, is a condition characterized by the following:

  • A significant and relatively enduring fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The person fears being humiliated or embarrassed in such situations due to their behaviour including behavioural signs of their being anxious.
  • Exposure to the feared situation almost always results in anxiety which may manifest as a panic attack.
  • The person realizes that their fear is unreasonable or exaggerated.
  • The phobic situation is either endured with intense anxiety or avoided completely.
  • The anxiety invoked by the phobic situation must interfere significantly with the person’s usual routine e.g. at work, at home or in social interactions
  • In children these symptoms must be present for at least six months.

It must be noted that according to the DSM-IV “Performance anxiety, stage fright, and shyness in social situations that involve unfamiliar people are common and should not be diagnosed as social phobia unless the anxiety or avoidance leads to clinically significant impairment or marked distress.”

Prevalence of Social Phobia

Social phobia is a surprisingly common disorder being the second most common anxiety disorder with a lifetime prevalence of 12.1% outranked only by specific phobia at 12.5% (Kessler et al 2005). Moreover social phobia ranks as the fourth most common psychiatric disorder surpassed only by major depression at 16.6%, alcohol abuse at 13.2%, and specific phobia at 12.5% (Kessler et al 2005).

Treatments for Social Phobia

In their review of research on treatment of social phobia, Hofmann and Bogels (2006) pointed out that without treatment, social phobia follows a “chronic, unremitting course, leading to substantial impairments in vocational and social functioning”.

This same conclusion of a dismal prognosis for untreated social phobia was also made in a 2011 paper by Burnstein et al in a 2011 paper. Hence there is an urgent need for individuals suffering from social phobia to obtain treatment.

Fortunately there are a variety of treatment approaches used including:

  • Cognitive Behavioural Therapy (CBT) (Hofmann and Bogels, 2006; Nelson et al, 2010)
  • Pharmacological (Cottraux, J.,2005)
  • Internet-based treatment (Berger et al 2011).
  • Self-help groups. Like many other psychiatric disorders, social phobia probably exists along a continuum of severity from mild subthreshold cases to more severe diagnosable cases. Of course the latter are unlikely to join a self-help group.

Some people, particularly men may drink alcohol in an attempt to cope with the social phobia and consequently may develop alcohol abuse or dependence. Anecdotal evidence suggests that if such men join Alcoholics Anonymous, he (or sometimes she) may over time, due to acceptance by other group members, gradually find their social phobia disappears completely.

Similarly many shy or mild socially phobic clients may find attendance at meetings of “Toastmasters” to be extremely helpful. Persons with full blown social anxiety disorder may benefit from a combination of psychological counselling and attendance at a self-help group.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (4th ed., text rev.) Washington, DC: Author.

Berger, T., Caspar, F., Richardson, R., Kneubühler, B., Sutter, D., & Andersson, G. (2011).

Internet-based treatment of social phobia: A randomized controlled trial comparing unguided with two types of guided self-help. Behaviour Research and Therapy, 49(3), 158-169.

Burstein, M., He, J., Kattan, G., Albano, A.M., Avenevoli, S., Merikangas, K. R. (2011). Social phobia and subtypes in the National Comorbidity Survey–Adolescent Supplement: Prevalence , correlates, and comorbidity.

Journal of the American Academy of Child & Adolescent Psychiatry, Vol 50(9), 870-880.

Cottraux, J. (2005). Recent developments in research and treatment for social phobia (social anxiety disorder). Current Opinion in Psychiatry, 18(1), 51-54.

Hofmann, S.G. & Bögels, S.M. (2006). Recent advances in the treatment of social phobia : Introduction to the special issue. Journal of Cognitive Psychotherapy, Vol 20(1), 3-5.

Kessler, Ronald C., Berglund, Patricia, Demler, Olga, Jin, Robert, Merikangas, K. R., Walters, Ellen E., (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, Vol. 62(6), 593-602.

Nelson, E. A., Lickel, J. J., Sy, J. T., Dixon, L. J., & Deacon, B. J. (2010). Probability and cost biases in social phobia: Nature, specificity, and relationship to treatment outcome. Journal of Cognitive Psychotherapy, 24(3), 213-228.


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