Social Phobia
Children and adolescents with Social Phobia live in fear that they are going to do something they perceive as disastrous in a social situation, and that rejection, disgust or derision will follow.
In social settings, kids with Social Phobia feel like they are under a spotlight which illuminates their flaws or incompetence and that others are constantly judging them and finding them deficient, ugly, stupid, or otherwise unacceptable.
Social phobia tends to emerge in late childhood or early adolescence. The avoidant behavior associated with social phobia can limit opportunities for friendships, extracurricular activities, help-seeking in academic settings and employment.
Symptoms
- anxious about being with other people
- fear of social or performance situations
- reticent to talk in social settings (short answers, soft spoken)
- self-conscious and anticipate being embarrassed
- anticipate that others will judge them
- avoid places where there are other people
- feel nauseous or sick to their stomach when with other people
- blush, sweat, or tremble around other people
DSM-5 Criteria
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).
Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.
The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
The social situations almost always provoke fear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
The social situations are avoided or endured with intense fear or anxiety.
The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Specify if: Performance only: if the fear is restricted to speaking or performing in public.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC
Disorder-specific treatment strategies
Evidence-based treatment for Social Phobia includes exposure-based Cognitive Behavioral Therapy (CBT) and treatment with a selective serotonin reuptake inhibitor (SSRI). For many patients, SSRI treatment is essential to bring their fear level down sufficiently to tolerate even the mildest exposures.
