Social Phobia

Social phobia (presently known as social anxiety disorder) is ananxiety disorder characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that could be evaluated negatively by others.

Situations that trigger this distress include fear of saying something that sounds foolish in public, not being able to answer questions in a classroom, looking awkward while eating or drinking in public, and performing badly on stage.

Whenever possible, people with social anxiety disorder avoid these social situations. If they are unable to avoid them, they endure the situation with intense anxiety and emotional distress.

Small children with this disorder may be mute, nervous, and hide behind their parents. Older children and adolescents may be paralyzed by fear of speaking in class or interacting with other children. The worry over saying the wrong thing or being criticized immobilizes them.

Conversely, younger people may act out to compensate for this fear, making an accurate diagnosis more difficult. This anxiety often results in physical complaints to avoid social situations, particularly school.

Fear of public speaking is the most common manifestation of social anxiety disorder. Interestingly, this disorder has afflicted famous singers and actors such as Barbra StreisandOpens in new window and Sir Laurence OlivierOpens in new window, both of whom were terrified that they might forget the words to songs and scripts.

The 12-month prevalence of social anxiety disorder is the same for children, adolescents, and adults – about 7%. As with many of the anxiety disorders, females are more likely to be affected.

Risk factors for social anxiety disorder include childhood mistreatment and adverse childhood events. The trait of shyness is also strongly heritable. Having parents who are shy carries a double risk of genetic transmission and parental modeling.

Chronic social isolation may increase the risk for major depression. Substance use disorders are common and may be related to the social isolation and inhibition of this illness. Bipolar disorder and body dysmorphic disorder are also comorbid. In children, comorbidities include high-functioning autism and selective mutism.

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