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Social Phobia

• Fear or avoidance of social situations that may lead to scrutiny, criticism or embarrassment
  • eating
  • drinking
  • speaking
  • acting
• onset usually gradual from puberty (17-30)

Diagnosis

• ICD-10
  • one from
    • fear of blushing/shaking
    • fear of vomiting
    • urgency/fear of micturition or defecation
  • plus two anxiety symptoms
  •  in feared situation

Epidemiology

• 6-month prevalence 1-2%
• males = females
• less likely to be married, higher educational and social class

Association with

• Generalised Anxiety Disorder
• Depression
• alcohol abuse

Differential / Overlap

•  social dysfunction
  • social skills deficit
  • avoidant personality disorder
  • social phobia limited to specific situations, whereas in social dysfunction there is a more general social skills deficit

Variants

• dysmorphophobic 
  • avoids social situation / dysfunction because of belief of defect of appearance or smell

Treatment

• Tricyclics (imipramine) build dose slowly to typically 150mg/d
• MAOIs (Phenelzine 45mg/d)
• Benzodiazepines not recommended in UK, (alprazolam licensed in US)