Social phobia

Patients with social phobia (social anxiety disorder) have a fear of being scrutinized, ridiculed or humiliated by other people.

In generalised social phobia the patient will avoid all contact with people outside the family circle. Other patients have phobia which are more focussed, for example, fears concerning:

• public speaking
• eating in public
• using public toilets

Although worries about some of these situations are common in the general population, people with social anxiety disorder worry excessively about them at the time and before and afterwards

• they fear that they will do or say something that they think will be humiliating or embarrassing (such as blushing, sweating, appearing boring or stupid, shaking, appearing incompetent, looking anxious)
• social anxiety disorder can have a great impact on a person's functioning, disrupting normal life, interfering with social relationships and quality of life and impairing performance at work or school
• people with the disorder may misuse alcohol or drugs to try to reduce their anxiety (and alleviate depression )

Symptoms usually begin in adolescence and may result in underperformance at school and work

• children may show their anxiety in different ways from adults: as well as shrinking from interactions, they may be more likely to cry, freeze or have tantrums
  • may also be less likely to acknowledge that their fears are irrational when they are away from a social situation
  • particular situations that can cause difficulty for socially anxious children and young people include participating in classroom activities, asking for help in class, joining activities with peers (such as attending parties or clubs), and being involved in school performances

Estimates of lifetime prevalence vary but according to a US study, 12% of adults in the US will have social anxiety disorder at some point in their lives, compared with estimates of around 6% for generalised anxiety disorder (GAD), 5% for panic disorder, 7% for post-traumatic stress disorder (PTSD) and 2% for obsessive-compulsive disorder

There is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression (19%), substance-use disorder (17%), GAD (5%), panic disorder (6%), and PTSD (3%).

Social anxiety disorder has an early median age of onset (13 years) and is one of the most persistent anxiety disorders

• only about half of those with the disorder ever seek treatment, and those who do generally only seek treatment after 15-20 years of symptoms
• a significant number of people who develop social anxiety disorder in adolescence may recover before reaching adulthood
• if the disorder has persisted into adulthood, the chance of recovery in the absence of treatment is modest when compared with many other common mental health problems

Reference:

• 1) NICE (May 2013). Social anxiety disorder: recognition, assessment and treatment