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Sociophobia: Fear of People / Psychotherapy

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      Sociophobia is most commonly known as social anxiety or social phobia. Lifetime prevalence ranges from 2.8 to 13% in epidemiological studies. It is the third most common psychiatric disorder in the United States. The prevalence of social phobia appears to be increasing among white, married, and well-educated individuals.

      Individuals with social phobia typically experience symptoms resembling panic during a social encounter. These situations may include speaking in public, using public restrooms, eating with other people, or social contact in general. Patients fear being humiliated or embarrassed by their actions and may become intensely anxious, with increased heart rate, diaphoresis, and other signs of autonomic arousal. These physical symptoms may cause additional anxiety, often leading to a conditioned fear response that reinforces the anxiety of public situations.

      Social phobia is considered a disorder if it is severe enough to adversely affect social or occupational functioning. That is, individuals with true social phobia go to great lengths to avoid social situations, usually to their own detriment. The fear of embarrassment is ego dystonic, and patients with social phobia are distressed by their symptoms.

      Social phobia typically manifests in early adolescence (i.e., aged 11-12 years) but may appear in younger children or older adults. There are two peaks of incidence: 11-15 and 18-25 years. Untreated childhood social phobia typically continues into adulthood.

Social phobia is an anxiety disorder involving intense distress in response to public situations.

      According the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for social phobia are as follows:

• The person has a marked and persistent fear of one or more social or performance situations in which he or she is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Children must show evidence of the capacity for age-appropriate social relationships with familiar people, and the anxiety must occur in peer settings, not just in interactions with adults.

• Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack. In children, the anxiety may be expressed as crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

• The person recognizes that the fear is excessive or unreasonable. In children, this feature may be absent.

• The feared social or performance situations are avoided or are endured with intense anxiety or distress.

• The avoidance, anxious anticipation, or distress in the feared social or performance situation interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships; alternatively, the patient has marked distress about having the phobia.

• In individuals younger than 18 years, the duration is at least 6 months.

• The fear or avoidance is not due to the direct physiological effects of a substance (eg, drug of abuse, medication) or a general medical condition and is not better accounted for by another mental disorder (eg, panic disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, pervasive developmental disorder, schizoid personality disorder).

• If a general medical condition or another mental disorder is present, the fear in one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others is unrelated to it; for example, the fear is not of stuttering, trembling in persons with Parkinson disease, or exhibiting abnormal eating behavior in persons with anorexia nervosa or bulimia nervosa.

• The phobia is specified as generalized if the fears include most social situations; also consider the additional diagnosis of avoidant personality disorder.

• Associated features include depressed mood; somatic/sexual dysfunction; addiction; and anxious, fearful, or dependent personality.

Julia Kulesh MD, psychiatrist
Dnipropetrovsk Municipal Hospital No14 
05 сентября 2010
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