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is the fear that in certain social situations, one will be criticized or

judged negatively. The individual feels a great deal of anxiety,

humiliation, embarrassment or even panic in social settings. One can have

either specific or generalized social phobia. The most common specific

social phobia is the fear of speaking in public. Individuals with

generalized social phobia are anxious in almost all interpersonal

situations. If the individual is going to be judged or graded on his

a minor case of the “jitters” before performing in public. For some,

this mild anxiety actually enhances their performance. However, this

anxious reaction is massively exaggerated in the individual with social

phobia. While mild normal anxiety can actually enhance performance,

episode may be associated with some or all of the symptoms of a panic

attack. These might include sweaty palms, palpitations, rapid breathing,

tremulousness and a sense of impending doom. Some individuals,

particularly those with generalized social phobia may have chronic anxiety

symptoms. Individuals with social phobia may turn down accelerated classes

and after school activities because of their fears that these situations

with a specific social phobia feels anxious during the feared social

situation and also when anticipating it. Some individuals may deal with

their fear by arranging their lives so that they do not have to be in the

feared situation. If the individual is successful at this, he or she does

with generalized social phobia are characterized as extremely shy. They

often wish that they could be more socially active, but their anxiety

prevents this. They often have insight into their difficulties. They often

report that they have been shy most of their lives. They are sensitive to

even minor perceived social rejection. Because they become so social

isolated, they have greater academic, work and social impairment. They may

is the third most common psychiatric disorder. (Depression—17.1%

Alcoholism—14.1% Social phobia—13.3%. (Kessler et al 1994.) Onset is

usually in childhood or adolescence. It tends to become chronic. It is

often associated with depression, substance abuse and other anxiety

disorders. The individual usually seeks treatment for one of the other

disorders. Individuals with SP alone are less likely to seek treatment

than people with no psychiatric disorder (Schneier et al 1992) Social

phobia is vastly under-diagnosed. It is not as likely to be noticed in a

classroom setting because these children are often quiet and generally do

not manifest behavior problems. Children with SP often show up with

physical complaints such as headaches and stomach aches. Parents may not

noticed the anxiety if it is specific to situations outside the home.

Additionally, since anxiety disorders often run in families, the parents

may see the behavior as normal because they are the same way themselves.

On the other hand, if the parent has some insight into his of her own

childhood anxieties, he or she may bring the child into treatment so that

the child will not have to experience the pain the parent experienced as a

There is the most evidence for cognitive-behavioral psychotherapy. Since

the child or adolescent is more dependent on his parents than an adult,

and group therapy are useful. The basic premise is that faulty assumptions

contribute to the anxiety. The therapist helps the individual identify

Create a hierarchy of feared situations and start to allow one to

experience them. One starts with situations that only elicit a little

anxiety and then gradually move up to more intense experiences. This must

This can be a powerful modality for individuals with social phobia. A

patient may need to use individual therapy to prepare for group therapy.

In the group patients can encourage each other and can try out new

behaviors within the safety of the group. They can get immediate feedback

that may refute their fears. Patients should not be forced to participate

Treatment: 

have shown that some of the SSRI medications can be helpful in the

treatment of SP. Paroxetine (Paxil) sertraline (Zoloft) have been approved

by the FDA for treatment of SP. Other medications that may be useful

include ß blockers (propranolol, atenolol) Benzodiazepines (lorazepam,

clonazepam) buspirone, and the MAO inhibitors (Parnate, Nardil.) 

MAO Inhibitors are only rarely used in children and adolescents

because one must go on dietary restrictions while taking them. SSRI and

other antidepressant medications are going to now have special

cautionary statements about the potential activation of suicidal

thoughts. However the SSRI medications are still useful if monitored

carefully.  

McGonagle, K.A. Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen,

H.U., and Kendler, K.S.(1994) Lifetime and 12-month prevalence of

DSM-III-R psychiatric disorders in the United States. Results from the

National Comorbidity Survey. Archives of General Psychiatry, 51,

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Stein, M.B., Berglund, P. (1998) Social Phobia Subtypes in the National

Comorbidity Survey. American Journal of Psychiatry, 155:5. 

Chartier, M.J., Hazen, A.L., Kozak, M.V.Tancer, M.E., Lander, S., Furer,

P., Chutbaty, D., Walker, J.R.  A

Direct Interview Family Study of Generalized Social Phobia. American

Journal of Psychiatry, (1998) 155: 1. 

Otto, M.W.Sabatino, S., Majcher, D., Worthington, J.J. McArdle, E.T.,

Rosenbaum, J.F. Relationship of Childhood Anxiety to Adult Panic Disorder:

Correlates and Influence on Course. American Journal of Psychiatry. 153:

3.  

Johnson, J., Hornig, C.., Liebowitz, M.R. and Weissman, M.M. (1992) Social

Phobia: Comorbidity and morbidity in a epidemiologic sample. Archives