Psychological Disorders: Social Phobia
American
Description
A marked and persistent 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 individual fears that he or she
will act in a way (or show anxiety symptoms) that will be humiliating
or embarrassing. Note: In children, there must be evidence of the
capacity for age-appropriate social relationships with familiar people
and the anxiety must occur in peer settings, not just in interactions
with adults.
Exposure
to the feared social situation almost invariably provokes anxiety,
which may take the form of a situationally bound or situationally
predisposed Panic Attack. Note: In children, the anxiety may be expressed
by crying, tantrums, freezing, or shrinking from social situations
with unfamiliar people.
The
person recognizes that the fear is excessive or unreasonable. Note:
In children, this feature may be absent.
The
feared social or performance situations are avoided or else are endured
with intense anxiety or distress.
The
avoidance, anxious anticipation, or distress in the feared social
or performance situation(s) interferes significantly with the person's
normal routine, occupational (academic) functioning, or social activities
or relationships, or there is marked distress about having the phobia.
In
individuals under age 18 years, the duration is at least 6 months.
The
fear or avoidance is not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication) or a general medical
condition and is not better accounted for by another mental disorder
(e.g., 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,
the fear in Criterion A is unrelated to it, e.g., the fear is not
of Stuttering, trembling in Parkinson's disease, or exhibiting abnormal
eating behavior in Anorexia Nervosa or Bulimia Nervosa.
Specify
if:
Generalized: if the fears include most social situations (also consider
the additional diagnosis of Avoidant Personality Disorder)
European Description
Social phobias often start in adolescence and are centred around a
fear of scrutiny by other people in comparatively small groups (as
opposed to crowds), leading to avoidance of social situations. Unlike
most other phobias, social phobias are equally common in men and women.
They may be discrete (i.e. restricted to eating in public, to public
speaking, or to encounters with the opposite sex) or diffuse, involving
almost all social situations outside the family circle. A fear of
vomiting in public may be important. Direct eye-to-eye confrontation
may be particularly stressful in some cultures. Social phobias are
usually associated with low self-esteem and fear of criticism. They
may present as a complaint of flushing, hand tremor, nausea, or urgency
of micturition, the individual sometimes being convinced that one
of these secondary manifestations of anxiety is the primary problem;
symptoms may progress to panic attacks. Avoidance is often marked,
and in extreme cases may result in almost complete social isolation.
Diagnostic
Guidelines
All of the following criteria should be fulfilled for a definite diagnosis:
(a)
the psychological, behavioural, or autonomic symptoms must be primarily
manifestations of anxiety and not secondary to other symptoms such
as delusions or obsessional thoughts;
(b) the anxiety must be restricted to or predominate in particular
social situations; and
(c) avoidance of the phobic situations must be a prominent feature.
Includes:
* anthropophobia
* social neurosis
Differential
Diagnosis
Agoraphobia and depressive disorders are often prominent, and may
both contribute to sufferers becoming "housebound". If the
distinction between social phobia and agoraphobia is very difficult,
precedence should be given to agoraphobia; a depressive diagnosis
should not be made unless a full depressive syndrome can be identified
clearly.