Social phobia is defined by DSM-IV-TRas an anxiety disorder characterized by a strong and persistent fear of social or performance situations in which the patient might feel embarrassment or humiliation. Generalized social phobia refers to a fear of most social interactions combined with fear of most performance situations, such as speaking in public or eating in a restaurant. Persons who are afraid of only one type of performance situation or afraid of only a few rather than most social situations may be described as having nongeneralized, circumscribed, or specific social phobia.
Social phobia, which is also known as social anxiety disorder, is a serious mental health problem in the United States. In any given year, social phobia affects 3.7% of the American population between the ages of 18 and 54, or about 5.3 million people. It is the third most common psychiatric condition after depression and alcoholism. Patients diagnosed with social phobia have the highest risk of alcohol abuse of all patients with anxiety disorders; in addition, they suffer from worse impairment than patients with major medical illnesses, including congestive heart failure and diabetes.
Social phobia varies in its development and initial presentation. In some young people, the disorder grows out of a long-term history of shyness or social inhibition. In others, social phobia becomes apparent following a move to a new school or similar developmental challenge. In adults, circumscribed social phobia may be associated with a change of occupation or job promotion, the most common example being the emergence of the disorder with regard to public speaking in a person whose previous jobs did not require them to make presentations or speeches in front of others. The onset of social phobia may be insidious, which means that it gets worse by slow degrees. About half of all patients, however, experience a sudden onset of social phobia following a particularly humiliating or frightening experience. For example, in one British case study the patient's social phobia developed abruptly after her father's sudden death. The patient had had an argument with him one morning and he was killed in an accident later in the day. The onset of social phobia almost always occurs in childhood or the midteens; onset after age 25 is unusual. The disorder is often a lifelong problem, although its severity may diminish in adult life.
Adults and adolescents with social phobia, as well as many children with the disorder, have sufficient insight to recognize that their fears are excessive or unwarranted. This factor often adds to their distress and feelings of inferiority.
Social phobia is of major concern to society as a whole for two reasons. One reason is the disorder's very high rate of comorbidity with such other mental health problems as major depression and substance abuse. In comparison with patients diagnosed with other anxiety disorders, patients with social phobia have higher averages of concurrent anxiety disorders (1.21 versus 0.45); comorbid depression or other disorders (2.05 versus1.19); and lifetime disorders (3.11 versus 2.05). The most common comorbid disorders diagnosed in patients with social phobia are major depression (43%); panic disorder(33%); generalized anxiety disorder(19%); PTSD (36%); alcohol or substance abuse disorder (18%); and attempted suicide(23%).
The second reason is the loss to the larger society of the gifts and talents that these patients possess. Social phobia can have a devastating effect on young people's intellectual life and choice of career, causing them to abandon their educations, stay stuck in dead-end jobs, refuse promotions involving travel or relocation, and make similar self-defeating choices because of their fear of classroom participation, job interviews, and other social interactions in educational and workplace settings. One sample of patients diagnosed with social phobia found that almost half had failed to finish high school; 70% were in the bottom two quartiles of socioeconomic status (SES); and 22% were on welfare. In addition to their academic and employment-related difficulties, people with social phobia have limited or nonexistent social support networks. They are less likely to marry and start families of their own because of their fear of interpersonal relationships. Many continue to live at home with their parents even as adults, or remain in unfulfilling relationships.
Rebecca J. Frey Ph.D., The Gale Group Inc., Gale, Detroit,